How to construct a case of Alzheimer's disease in three languages: case-based reasoning in narrative gerontology

Abstract

ABSTRACTThis paper explores how people reason about Alzheimer's disease by telling stories about others who have the disease. More specifically, the paper is a cross-linguistic investigation of the narrative and linguistic devices used by African Americans in English, Mexican Americans in Spanish, and refugees/immigrants from the former Soviet Union (to the United States of America) in Russian in their oral productions of such stories. We examine the narratives as instances of case-based reasoning in which lay people (non-medical professionals) distinguish, represent and ‘perform’ symptomatic behaviours and construct a ‘case’ of the disease as a way of probing the difference between the normal and the pathological in conversational contexts. In particular, we examine situations in which stories are accepted and confirmed and situations in which stories are contested and negotiated. Common narrative and discursive devices across the three languages include concatenation, intertextuality, conjunction and conjunctive adverbs, lexical opposition, past progressive tenses, temporal adverbials, reported speech and prosodic cues. The fine-grained analysis of these narrative and discursive devices lays bare the inner-workings of case-based reasoning as a conversational task and suggests specific linguistic tools for intervening in lay narrative reasoning in clinical settings and in public health messaging about Alzheimer's disease.