Interaction and Language Assessment in Aphasia and Dementia : A Comparative Perspective

Abstract

Language problems in dementia resemble the symptoms of aphasia in many respects. A growing body of research discusses the cognitive deficits associated with aphasia. Despite common denominators, very little is written with a comparative perspective on the two clinical groups. Although speech and language pathologists (SLPs) play a central role in aphasia care, they are not routinely involved in healthcare services for dementia. By tradition, language assessments tend to be test-oriented, even though there is an awareness of the advantages with informal assessment approaches. The overall aim of this thesis was to examine interaction in persons with aphasia (PWA) and persons with dementia (PWD) in test conversation and more informal conversations. The thesis has an interactional focus with a comparative perspective on the two clinical groups, on conversational contexts, and on test results with reference to SLP services.Study I, involving ten PWA, and study II, involving ten PWD, had similar approaches, investigating the organization of interaction between the participants and SLPs in test conversations and in more informal conversations. Furthermore, the participants' interactional abilities were related to their actual test results on expressive tasks on an aphasia test battery. Study III involved detailed analyses of the Mini-Mental State Examination (MMSE) test interaction for both PWA and PWD. Additionally, the study set out to explore the relationship between linguistic and cognitive difficulties, in relation to assessments. Study IV investigated instances of trouble in conversations involving PWA/PWD and SLPs, with a particular focus on "trouble domain" and interactional consequences.The results of study I and II demonstrated substantial differences between the organization of interaction in test conversations and informal conversations, regardless of whom they involved. The informal conversations provided opportunities for the PWA/PWD to talk more and to initiate own topics and multimodal resources were used by the PWA. This was seen to a far lesser degree among the PWD. With a few distinct exceptions, the PWD came across as rather communicatively competent. This was not necessarily reflected by the aphasia test results, since several participants struggled with a couple of test assignments. In PWA, the demonstration of aspects of communication that could be related to being a competent speaker did not fully correlate with aphasia test scores. The analyses showed that instances of trouble occurred 2015). Dementia and languageDementia affects each individual in a different way, but memory problems is the most salient feature of the condition. The deterioration of cognitive function also affects problem-solving, orientation, comprehension, calculation,