Narrative Language Abilities in Adults with Parkinson disease

1
Narrative Language Abilities in Adults with
Parkinson disease Biji A. Philip, Amrita Nambiar,
Lynne E. Hewitt, Alexander Goberman Department of
Communication Disorders Bowling Green State
University
Abstract Narrative language requires
sophisticated discourse planning. This may be
compromised in adults with Parkinsons disease
(PD) secondary to deficits in abstract cognitive
and higher level linguistic abilities. In this
pilot study, we collected narrative language
samples from 12 adults with PD (63 to 89 years),
using a wordless picture book. Formal test
results indicated difficulty in identifying and
explaining ambiguities, and making inferences.
Narratives were characteristic of embedded
episodes and involved detailed descriptions of
episodes. However, the narratives lacked
contiguity appropriate prosodic inflections
failure to use a child-directed register
referential inadequacy, and difficulty in making
appropriate inferences about story ending.
Preliminary results support feasibility of
protocol.

• Results (Microstructure Narrative Analyses)
• Use of ambiguous or incorrect referents (4
  participants had 15 or greater incomplete ties).
• High percentage of pauses and reformulations.
• Lack of appropriate cohesive markers to indicate
  transitions from one episode to another.
• Persistent use of the simple conjunctive
  cohesive marker and.
• Lack of semantically rich conjunctions.
• P0017 used a variety of conjunctions which
  rendered a higher quality to the narrative.

Table 1 Demographic characteristics of
participants with PD
Comparative Case Study

• Introduction
• Research findings indicate that abstract
  cognitive and higher level language abilities are
  compromised in individuals with Parkinsons
  disease (PD).
• Investigations have revealed that subtle
  language deficits may exist even in non-demented
  individuals with PD (Berg et al., 2003 Grossman
  et al., 2002 Gurd, 2000 Kemmerer, 1999 Lewis
  et al., 1998 Hough, 2004)
• Most studies focus on semantic and grammatical
  deficits.
• Semantic deficits
• Generative naming deficits (Hough, 2004).
• Verbal fluency deficits (Gurd, 2000).
• Morpho-syntactic deficits
• Difficulty understanding ambiguous sentences
  (Lewis et al., 1998) and passive sentences
  (Grossmann et al., 2002 Kemmerer, 1999).
• High-level language deficits (Berg et al., 2003
  Lewis et al., 1998)
• Making inferences.
• Understanding metaphors.
• Only one study up to date that focuses on
  conversational pragmatics (McNamara Durso,
  2003).
• Results indicated that participants with PD had
  difficulties in conversational appropriateness,
  stylistics, speech acts, gestures, prosodic
  inflections, and facial expressions.

Figure 1 Narrative abilities of PD participant
compared to age, gender, and education-matched
control

Table 2 Results of formal language and cognitive
testing
Table 2 Results of Formal Language and Cognitive
Testing

• Rationale
• Limited research on pragmatic language abilities
  in adults with PD.
• Narrative language requires sophisticated
  discourse planning.
• May be compromised in adults with PD, secondary
  to deficits in abstract cognitive and higher
  level language abilities.
• Conversations and personal narratives are
  inherent to everyday life.
• Results may provide useful insights for
  intervention.
• Potential impact on quality of life for
  individuals with PD.

• Macrostructure Narrative Analyses
• Both provided a title and named the three main
  characters in the story.
• Fewer references to the internal responses of
  the characters in the narrative of the
  participant with PD.
• Participant with PD did not use child-directed
  register used complex vocabulary.
• The control participant asked several questions
  directed to the child also defined certain
  complex words.
• Participant with PD did not provide an adequate
  resolution to the problem in the story.
• Lack of prosodic inflections or humor in the
  narrative of the participant with PD when
  compared to control.
• Microstructure Narrative Analyses
• Ambiguous referents and lexical errors present
  in the narrative of the PD participant.
• Higher percentage of pauses and reformulations
  in PD participants narrative.

• Research Questions
• What are the narrative language abilities of
  adults with PD?
• Are there differences between the narrative
  abilities of adults with PD and age, gender, and
  education-matched controls?

• Discussion
• Formal language test results
• Deficits in identifying resolving ambiguities
  making appropriate inferences.
• Better performance on pragmatic sub-test on
  CASL.
• Possibly attributable to ease of task leading to
  ceiling effects.
• Results of cognitive testing
• 7 participants scored in below average to
  average range. Individual differences seen
  higher performance on narrative task formal
  language testing not always seen in the more
  able individuals.
• Suggests that language deficits may exist in
  some non-demented individuals with PD.
• Narrative language samples indicate deficits in
  - orienting the speaker to the story providing
  unambiguous information referencing the internal
  responses of the characters and in making
  appropriate inferences.
• Deficits may be secondary to abstract cognitive
  and higher language ability deficits.
• Higher percentage of pauses and reformulations,
  and lack of prosodic inflections attributable to
  motoric deficits.
• Pragmatic effects of speech deficits include
  communicative breakdowns leading to deficits in
  functional communicative competence of speakers
  with PD.
• Future directions
• Pilot work supports further investigation of
  narrative and other pragmatic language abilities
  in adults with PD.
• Recruitment of age, gender and education-matched
  controls needed.
• Expanding analysis from narrative to other
  contexts, including conversations.
• Development of language assessment protocol for
  assessing adults with PD may assist in
  identifying pragmatic deficits that affect
  quality of life.

Table 3 Percentage of pauses, mazes, and
narrative cohesion

• Method
• Participants
• 12 adults with PD, aged 63-89 years, 4 females
  and 8 males.
• 10 lived in the community 2 lived in a nursing
  home.
• Duration of disease ranged from 3-12 years.
• Number of years of education ranged from 13-22
  years.
• Procedure
• Participants were initially administered the
  following cognitive and language tests.
• Dementia Rating Scale, 2nd Ed. (DRS-2 Jurica,
  Leitten, Mattis, 2001).
• Peabody Picture Vocabulary Test (PPVT-III B
  Dunn Dunn, 1997).
• Three sub-tests assessing pragmatic language
  abilities from the Comprehensive Assessment of
  Spoken Language (CASL Carrow-Woolfolk, 1999).
• Participants were then asked to familiarize
  themselves with the story from a wordless picture
  book Frog, where are you? (Mayer, 1969). They
  were then instructed to narrate the story as if
  they were telling it to a child.
• The narrative samples were audio and video
  recorded.
• Data analysis
• The narratives were transcribed using the
  Systematic Analysis of Language Transcripts
  (SALT Miller Chapman, 2000).
• The first author then analyzed the narrative
  samples based on the existing coding systems in
  the literature.

• Results (Macrostructure Narrative Analyses)
• 50 of narratives were characteristic of
  embedded episodes.
• Detailed descriptions of the events in the
  story. However, lack of contiguity between
  episodes.
• 3 participants provided a title.
• 4 participants named the characters in the
  story.
• Limited references to the internal responses of
  the characters.
• 5 participants made the appropriate inference of
  the story ending.
• 3 participants did not provide an adequate
  resolution to the problem. One participant did
  not even identify the problem.
• Only 3 participants used a child-directed
  register.
• Lack of prosodic inflections to indicate novel
  events or absurdities.

• References
• Berg, E., Bjornram, C., Hartelius, L., Laakso,
  K., Johnels, B., (2003). High level language
  difficulties in Parkinsons disease. Clinical
  linguistics phonetics,17, 63-80.
• Carrow-Woolfolk, E. (1999). Comprehensive
  Assessment of Spoken Language. Circle Pines, MN
  American Guidance Service.
• Dunn, T., Dunn, L. (1997). Peabody Picture
  Vocabulary Test-III. Circle Pines, MN American
  Guidance Service.
• Grossman, M., Lee, C., Morris, J., Stern, M. B.,
  Hurtig, H. I. (2002). Assessing Resource
  Demands during Sentence Processing in Parkinsons
  Disease. Brain and Language, 80, 603-616.
• Gurd, J. M. (2000). Verbal fluency deficits in
  Parkinsons disease individual differences in
  underlying cognitive mechanisms. Journal of
  Neurolinguistics, 13, 47-55.
• Hough, M. S. (2004). Generative word fluency
  skills in adults with Parkinsons disease.
  Aphasiology, 18, 581-588.
• Hughes, D., McGillivray, L., Schmidek, M.
  (1997). Guide to narrative language. Eau Claire,
  WI Thinking Publications.
• Jurica, P. J., Leitten, C. L., Mattis, S.
  (2001). Dementia Rating Scale-2. Lutz, FL
  Psychological Assessment Resources.
• Kemmerer, D. (1999). Impaired comprehension of
  raising-to-subject constructions in Parkinsons
  disease. Brain and Language, 66, 311-328.
• Lewis, F. M., Lapointe, L. L., Murdoch,, B. E.,
  Chenery, H. J. (1997). Language impairment in
  Parkinsons disease. Aphasiology, 12, 193-206.
• Liles, B., Coelho, C., Duffy, R., and Zalagens,
  M. Effects of elicitation procedures on the
  narratives of normal and closed head-injured
  adults. Journal of Speech and Hearing Disorders,
  54, 356-365.
• Mayer, M. (1969). Frog, where are you? New York
  Puffin Books.
• McNamara, P. Durso, R. (2003). Pragmatic
  communication skills in patients with Parkinsons
  disease. Brain and Language, 84, 414-423.
• Miller, J. Chapman, R. (2000). Systematic
  Analysis of Language Transcripts. Madison, WI
  University of Wisconsin Language Analysis Lab.