Narrative Language Abilities

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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 Parkinson’s 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. 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? 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. 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 2: Results of formal language and cognitive testing Introduction Research findings indicate that abstract cognitive and higher level language abilities are compromised in individuals with Parkinson’s 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. 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. 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. Macrostructure: Story grammar analysis and story structure levels. (Hughes et al., 1997) Microstructure: Reference and conjunctive markers analyzed based on Hughes et al.’s adaptation of Halliday & Hassan’s coding system. Other types of connective markers not analyzed, as fewer of these occur in oral narratives (Liles et al., 1989). The third author served as the external audit during the coding process. Procedural checks & clarifications were discussed on a regular basis. Inter-rater reliability is ongoing. Table 1: Demographic characteristics of participants with PD Table 3: Percentage of pauses, mazes, and narrative cohesion 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. Comparative Case Study References Berg, E., Bjornram, C., Hartelius, L., Laakso, K., & Johnels, B., (2003). High level language difficulties in Parkinson’s 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 Parkinson’s Disease. Brain and Language, 80, 603-616. Gurd, J. M. (2000). Verbal fluency deficits in Parkinson’s disease: individual differences in underlying cognitive mechanisms. Journal of Neurolinguistics, 13, 47-55. Hough, M. S. (2004). Generative word fluency skills in adults with Parkinson’s 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 Parkinson’s disease. Brain and Language, 66, 311-328. Lewis, F. M., Lapointe, L. L., Murdoch,, B. E., & Chenery, H. J. (1997). Language impairment in Parkinson’s 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 Parkinson’s 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. Figure 1: Narrative abilities of PD participant compared to age, gender, and education-matched control 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 participant’s narrative. Table 2: Results of Formal Language and Cognitive Testing