Adapting to conversation with semantic dementia: using enactment as a compensatory strategy in everyday social interaction

Abstract

Background Studies to date in semantic dementia have examined communication in clinical or experimental settings. There is a paucity of research describing the everyday interactional skills and difficulties seen in this condition. Aims To examine the everyday conversation, at home, of an individual with semantic dementia. Methods & Procedures A 71-year-old man with semantic dementia and his wife were given a video camera and asked to record natural conversation in the home situation with no researcher present. Recordings were also made in the home environment, with the individual with semantic dementia in conversation with a member of the research team. Conversation analysis was used to transcribe and analyse the data. Recurring features were noted to identify conversational patterns. Outcomes & Results Analysis demonstrated a repeated practice by the speaker with semantic dementia of acting out a diversity of scenes (enactment). As such, the speaker regularly used direct reported speech along with paralinguistic features (such as pitch and loudness) and non-vocal communication (such as body posture, pointing and facial expression) as an adaptive strategy to communicate with others in conversation. Conclusions & Implications This case shows that while severe difficulties may be present on neuropsychological assessment, relatively effective communicative strategies may be evident in conversation. A repeated practice of enactment in conversation allowed this individual to act out, or perform what he wanted to say, allowing him to generate a greater level of meaningful communication than his limited vocabulary alone could achieve through describing the events concerned. Such spontaneously acquired adaptive strategies require further attention in both research and clinical settings in semantic dementia and analysis of interaction in this condition, using conversation analysis, may be helpful.

Trouble and repair during conversations of people with primary progressive aphasia

“…In their single case study of a man with svPPA, Kindell, Sage, Keady, and Wilkinson (2013) acknowledge that little is known about the communication difficulties and strengths in conversation of people with PPA nor how these strengths and weaknesses impact interaction with the person's family members. This study examined the everyday conversation of the participant and concluded that although neuropsychological assessment revealed severe language impairment, he had developed an adaptive strategy of enactment (acting out/performing meaning) that was relatively effective in conversation.…”

Everyday conversation in dementia: a review of the literature to inform research and practice

“…Whilst there has been interest in whether such in‐depth study of conversation could be developed into interventions (Chatwin , Kindell et al . , Perkins et al . , Taylor et al .…”

Collaboration, trouble and repair in multiparty interactions involving couples with dementia or aphasia

“…Dementia, by contrast, is generally considered a result of widespread multifocal pathology, and it involves dissolution of cognitivel function in which language forms an essential feature (Mathews, Obler & Albert, 1994). There are also dementia diagnoses that share many features with aphasia, such as semantic dementia/semantic primary progressive aphasia (Neary et al, 1998;Kindell et al, 2013). Pursuing research with separate diagnostic groups has made it possible for researchers to study for example correlations between focal brain damages and specific language symptoms.…”