Instances of trouble in aphasia and dementia: an analysis of trouble domain and interactional consequences

Abstract

ABSTRACT Background Language problems in dementia resemble the symptoms of aphasia in many respects. Persons with aphasia (PWA) and persons with dementia (PWD) present rather similar results on standardised language tests and cognitive screening tools. There is limited research that compares PWA’s and PWD’s language abilities, and a particularly small number of studies have an interactional focus. Aims In this study, we will contribute to the emergent discussion about interaction in aphasia and dementia. The aim was to investigate instances of trouble in conversations involving PWD, PWA and speech and language pathologists (SLPs), with a particular focus on trouble domain and interactional consequences. Methods & Procedures Ten PWD and 10 PWA were video-recorded during informal conversations with SLPs. Ten minutes of each conversation were transcribed thoroughly according to Conversation Analytical principles and instances of trouble were identified and calculated throughout the data. Thereafter, the instances of trouble were categorised by trouble domain: as connected to either primarily linguistic or cognitive issues. Outcomes & results At first glance, the conversations between the PWD and PWA seemed rather similar when looking at the number of turns and the number of instances of trouble. The analyses, however, reveal that significantly more turns were spent on trouble solving in the conversations involving the PWA. The vast majority of the troubles involving the PWA were categorised as being connected primarily to linguistic issues, whereas trouble among the PWD were more evenly distributed between the trouble domains. The SLPs took a more active role in supporting the conversations of the PWA than for the PWD. Conclusions The results indicate that many conversational troubles involving PWD are connected to primarily linguistic issues. However, PWD seem to have less severe linguistic problems compared to PWA. The analyses also reveal that many of the language problems described in PWD might be a direct consequence of cognitive issues, and that SLPs may take a more passive role in trouble solving in conversations involving PWD. The lack of personal common ground and preconceived notions about the medical conditions are discussed as potential motives for the SLPs’ behaviour. The analysis of instances of trouble in informal conversations might contribute to both research and clinical assessment of language abilities in PWA and PWD.