CROSS LANGUAGE VARIATIONS IN LINGUISTIC DEFICITS IN DAT INDIVIDUALS

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CROSS LANGUAGE VARIATIONS IN LINGUISTIC DEFICITS
IN DAT INDIVIDUALS

• Mr. SUNIL KUMAR. RAVI, 2nd M. Sc (Speech
  Language Pathology).
• Prof. SHYAMALA. K. C., Dept. of SLP.

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INTRODUCTION
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DEMENTIA

• Dementia is a common clinical syndrome
  characterized by a decline in the cognitive
  function and memory from previously attained
  intellectual levels, which is sustained over a
  period of months or years.
• The deterioration is of such severity that it
  impairs the affected individuals ability to work
  and to perform activities of daily living,
  including communication

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• Cummings and Benson (1992) state that at least
  three of the following five areas of mental
  activity must be involved
• Language
• Memory
• Visuospatial skills
• Emotion or personality and
• Cognition (ex abstraction, calculation, and
  judgment).

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• The DSM IV APA, 1994 states that the
  essential feature in dementia is impairment in
  short term and long term memory.
• This deficit in memory may also be associated
  with one or more features like, aphasia, apraxia,
  agnosia, impairment in abstract thinking,
  impaired judgment, and personality changes.

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INCIDENCE PREVALENCE

• In India, approximately 3 to 4 million people had
  been affected by dementia (ARDSI).
• About 4 of the population over 65 years is
  afflicted with dementia
• It is expected that around 10 million people will
  be afflicted with Alzheimers disease by 2010.
• It is expected to be 36 million by 2020 (WHO,
  2001).

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• Shaji (2005) reported that
• Prevalence of dementia in Kerala was 33.6 per
  1000 (95 CI 27.3-40.7).
• Alzheimer's disease (54)
• Vascular dementia (39), and
• Other causes such as infection, tumor and trauma
  (7)

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• The language disturbances in dementia long have
  been reported.
• Interest in the dementias has increased in the
  past decade
• Resulted in more systematic description of the
  effects of dementia on communication
• Since dementing illnesses are associated with the
  elderly, we can expect that the prevalence of
  dementia will increase.

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• Dementia can be caused by a variety of
  conditions diseases, infections, or infarcts.
• Alzheimers disease (AD) accounting for 50 to 60
  of all the patients with dementia,
• Vascular dementias are seen in 20 of the
  dementia patients.
• Other causes account for 20 .

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DEMENTIA OF ALZHEIMERS TYPE (DAT)
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• A type of dementia which is associated or caused
  due to Alzheimers disease.
• AD is a degenerative disease that attacks the
  brain, begins gradually, and progresses at a
  variable rate.
• AD results in impaired memory, thinking, and
  behavior and can last from 3 to 20 years from the
  time of onset of symptoms.

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• Warning signs of AD are
• Memory loss that affects job/home skills,
• Difficulty performing familiar tasks,
• Problems finding the right words,
• Disorientation to time and place,
• Poor or decreased judgment,
• Difficulty with learning and abstract thinking,
• Placing things in inappropriate places,
• Changes in mood and personality, and
• Marked loss of initiative.

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• With the help of standardized diagnostic
  criteria, physicians can now diagnose AD with an
  accuracy of 85-90 once symptoms occur.
• However, a definitive diagnosis of Alzheimers
  disease is possible only through the examination
  of brain tissue at autopsy.
• AD is a debilitating progressive disease which
  gradually affects all aspects of cognition and
  behavior, including aspects of semantic memory
  and semantic knowledge.

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• Most patients with confirmed Alzheimers disease
  appear to have fluent speech with poor semantic
  content and comprehension.
• Selective loss of the appropriate use and recall
  of word meanings and object naming and
  recognition occurs particularly in discourse.
• Phonology and syntax are usually well preserved
  until later stages of the disease.
• Affected individuals progress from mild memory
  loss and the capacity to live independently to
  intellectual devastation and total dependency.

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Communication deficits in DAT
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Stages of AD
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DAT IN BILINGUALS
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• Using one or two languages depending on the
  context and interlocutor is skill healthy
  bilingual speakers manage with ease.
• They are able to select the appropriate language
  to speak for a particular occasion depends on a
  complex interaction of topic, setting,
  participants and so forth.
• Random switching between languages and mixing
  them together is a common occurrence

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• However, despite this apparent randomness, the
  types and degree of mixing and switching
  tolerated are highly structured.
• When needed, speakers can maintain strict
  separation between their languages for example
  when speaking to a monolingual speaker.
• Studies have suggested that bilingual speakers
  with AD, even in the early stages of
  deterioration, can have problems selecting the
  appropriate language, and maintaining
  conversations in that language once appropriately
  chosen

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• Two mechanisms underlying inappropriate language
  use in bilingual AD speakers
• Language choice problem
• Language separation problem
• Few studies on bilingual AD have investigated
  discourse management along these lines

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• Researchers set out to answer questions such as
  whether a given speaker has either a choice or a
  separation problem
• Whether every bilingual speaker with AD evidences
  these difficulties?
• How the incidence and prevalence of a choice or
  separation problem relates to severity of
  dementia?
• Whether the direction of mis-selection or
  intrusion of one language into another is
  bidirectional and unpredictable, or whether, for
  instance, is it always one language (e.g. the
  most proficient/ the first learned/ the most
  recently used) that takes precedence over the
  other and so forth?

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• Conclusions indicate that not every bilingual
  individual with AD demonstrates inappropriate
  language use.
• There is large variability in the extent of
  appropriate/ inappropriate language use, with
  some individuals showing more language mixing
  than others.

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• The ability to maintain fluency in more than one
  language decreases with advancing age.
• Older people may have a tendency to retreat to a
  single language, even those with a lifetime of
  bilingualism.
• Bilingual dementia patients tended to have
  asymmetrical language impairment with
  preferential preservation and use of the first
  acquired language.

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Need for the Study

• India being a multilingual country and with rapid
  increase in geriatric population, the incidence
  prevalence of DAT is increasing.
• This bilingualism and multilingualism becomes an
  important issue during assessment and management
  of individuals with DAT.
• Question arises in terms of the language in
  which, speech and language therapy should be
  given and on what basis we should select that
  language, etc

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• Therefore, there is a great need to study the
  cross language variations in bilingual dementias
  to explore the nature of language deficits in
  each language.
• And this will in turn help in both assessment and
  management of these individuals.

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AIM OF THE STUDY
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• The aims of the present study were
• To explore the nature of the linguistic deficits
  in both the languages of bilingual DAT
  individuals and also
• To study the differences in performance between
  bilingual DAT individuals and normal population.

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Subjects

• 20 individuals who were diagnosed as DAT by a
  neurologist or psychiatrist in the age range of
  45 to 65 years were taken for the study.
• Inclusion criteria for selection of DAT subjects
• Subjects who are diagnosed as having DAT by a
  neurologist or psychiatrist,
• Subjects who have Kannada as their native
  language (L1) and English as their second
  language (L2),
• A relatively stable clinical and metabolic state,
  and
• Fair knowledge of reading and writing in Kannada
  and English languages.

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• 20 age and gender matched normal subjects without
  any past neurological or psychiatric disorders
  were taken as control group.

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Test material

• Dementia Assessment Battery (DAB) in English and
  Kannada

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Memory Linguistic Expression Linguistic Comprehension Visuospatial skills
1 Episodic Memory Object Naming Comparative Questions Generative Drawing
2 Working Memory Generative Naming Following Commands Figure Copying
3 Semantic Memory Confrontation Naming Reading Comprehension of Sentences
4 Delayed Story Telling Responsive Speech Reading Commands
5 Spontaneous Speech
6 Repetition
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Data Collection

• Data collection was done at Department of Speech
  Language Pathology at All India Institute of
  Speech and Hearing, Mysore, India with the
  subjects hailing from Mysore and Bangalore cities

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RESULTS AND DISCUSSION
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• The results of various tasks like memory,
  language expression and language comprehension
  were compared between DAT individuals in Kannada
  and English languages and the results were also
  compared with that of results of normal adults
• Majorly, four comparisons were made in this study
  to study the cross language variations in DAT
  individuals

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Comparison of performance of normal adults in
Kannada and English Languages

• Independent samples t test to find out the
  significant difference between two groups across
  the parameters.
• No significant difference between two groups on
  memory (pgt0.005, f 0.10) and language
  expression (pgt0.005, f 0.08) tasks and
• Significant difference was found on language
  comprehension tasks (plt0.005, f 0.01).

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Mean and S.D of normal individuals in Kannada and
English on different tasks
Tasks Group N Mean Std. Deviation
Memory Nl Kan 20 86.5500 2.4810
Nl eng 20 81.3500 4.9553
Expression Nl Kan 20 234.1500 5.0604
Nl eng 20 223.6500 9.7618
Comprehension Nl Kan 20 143.0000 4.4129
Nl eng 20 118.0000 11.4202
TOTAL Nl Kan 20 463.7000 6.4571
Nl eng 20 423.0000 18.2064
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Comparison of performance of individuals with DAT
in Kannada and English Languages

• Results showed that there is a significant
  difference between the performances of DAT
  individuals in English and Kannada on all the
  three tasks (plt0.005, f 0.01).

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Mean and S.D of individuals with DAT in Kannada
and English on different tasks
Tasks Group N Mean Std. Deviation
Memory Dem Kan 20 42.6500 5.5562
Dem eng 20 60.6000 5.1031
Expression Dem Kan 20 118.0000 11.4202
Dem eng 20 95.7000 12.2651
Comprehension Dem Kan 20 98.0500 11.5005
Dem eng 20 81.3500 4.9553
TOTAL Dem Kan 20 258.7000 15.3695
Dem eng 20 237.6500 17.1595
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Individuals with DAT Vs normal individuals in
Kannada Language

• Results showed that there is a significant
  difference between the two groups on language
  expression (plt0.005, f 0.04) and language
  comprehension (plt0.005, f 0.01) tasks.
• No significant difference was found between two
  groups in memory tasks (pgt0.005, f 0.06).

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Mean and S.D of individuals with DAT and normal
individuals in Kannada on different tasks.
Tasks Group N Mean Std. Deviation
Memory Normal Kannada 20 86.5500 2.4810
Dementia Kannada 20 42.6500 5.5562
Expression Normal Kannada 20 234.1500 5.0604
Dementia Kannada 20 118.0000 11.4202
Comprehension Normal Kannada 20 143.0000 4.4129
Dementia Kannada 20 98.0500 11.5005
TOTAL Normal Kannada 20 463.7000 6.4571
Dementia Kannada 20 258.7000 15.3695
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Individuals with DAT Vs normal individuals in
English Language

• Results showed that there is a significant
  difference between the two groups in
• memory (plt0.005, f 0.04),
• language expression (plt0.005, f 0.02) and
• language comprehension (plt0.005, f 0.02) tasks

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Mean and S.D of individuals with DAT and normal
individuals in English on different tasks.
Tasks Group N Mean Std. Deviation
Memory Normal Kannada 20 81.3500 4.9553
Dementia Kannada 20 60.6000 5.1031
Expression Normal Kannada 20 223.6500 9.7618
Dementia Kannada 20 95.7000 12.2651
Comprehension Normal Kannada 20 118.0000 11.4202
Dementia Kannada 20 81.3500 4.9553
TOTAL Normal Kannada 20 423.0000 18.2064
Dementia Kannada 20 237.6500 17.1595
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Differences in performances in all the tasks
between groups
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Differences between groups on memory task

• Comparison of the performance of different groups
  is represented in graph 1.

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Differences between groups on language expression
task

• Comparison of the performance of different groups
  is represented in graph 2.

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Differences between groups on language
comprehension task

• Comparison of the performance of different groups
  is represented in graph 3.

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• Graph 4 consists of results of the all the
  groups on three tasks and total of the three
  tasks.

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DISCUSSION
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• The above results indicated significant
  differences in the performance of language and
  memory skills between normal and DAT individuals
  in both languages.
• The differences in performance between Kannada
  and English languages can be attributed to the
  factors like
• age of acquisition of English,
• amount of exposure,
• language use in daily life, etc and these
  factors can influence the performance of the both
  groups.

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• Bilingual dementia patients tended towards
  asymmetrical language impairment with
  preferential preservation and use of the first
  acquired language.
• Studies in aphasic patients from strokes and
  other brain lesions show that recovering language
  patterns are most commonly synergistic recovery
  in one language is accompanied by recovery in
  another.

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• Many bilingual aphasic patients, however, recover
  differentially in one language.
• In these circumstances, the language most
  recovered may be the earliest acquired language,
  or the language of greater use, or the language
  spoken in the patients environment.
• In dementia, due to deficits in memory, the
  earliest language is preserved than the new
  language

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• In dementia, a retreat to the original language
  could result from an exacerbation of the
  cross-language difficulties that typically
  increase with age.
• Cross language interference refers to
  deviations from the language being spoken due to
  the involuntary influence of the deactivated
  language.
• Dementia patients tend to mix languages, and they
  have special problems with language separation.

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• These results are in agreement with studies by
  Cummings et al., 1985 Bayles et al., 1993
  Luderus 1995 in that, the deficits found in this
  study were similar to the findings of the above
  studies.
• The cross language variations were more similar
  to those seen in bilingual aphasics with English
  Yiddish and German Dutch background as
  reviewed by Paradis, 1997.

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CONCLUSIONS
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• This study has revealed that the individuals with
  DAT have language deficits in both comprehension
  and expression and also in memory tasks.
• Significant differences were found between the
  performances of DAT individuals in Kannada and
  English.
• This becomes an important issue in the selection
  of language used in speech and language
  management of bilingual DAT individuals

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• Individuals with DAT have better preserved
  language skills compared to English and thereby,
  suggesting continuing the speech and language
  therapy in the native language than in the second
  language.
• The deficits in language skills in both languages
  were similar to that of bilingual aphasics, but,
• the recovery processes may not be same in both
  the disorders due to variations in the site of
  lesion and also due to changes in
  histopathological changes in the central nervous
  system (CNS).

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• For speech language pathologists, it becomes an
  important issue during selection of management
  programs for individuals with DAT.
• Several studies have been conducted on normal
  bilinguals and on bilingual aphasics to find out
  the language organization in them.
• Future studies are expected to determine the
  language organization in CNS in DAT individuals
  and their effect on first and second languages

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• More studies in this area in different languages
  can give information on differences in
  performances between languages.
• These results can be applied and are useful in
  both assessment and management of the individuals
  with DAT.

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• Dr. Vijayalakshmi Basavaraj, Director, AIISH,
  Mysore.
• Organizers of SCONLI 3.