Executive dysfunction as an explanatory basis for conversation symptoms of aphasia: A pilot study

Abstract

Background: Lack of communicative success for people with aphasia is no longer seen as purely a linguistic deficit. Instead, the integrity of the executive functions (EF) is thought to be at least partly responsible for successful communication, particularly during conversation. In order to inform clinicians regarding both conversation and EF, a merging of two paradigms-conversational and neuropsychological approaches-is proposed. Aims: First, we explore the relevance of both neuropsychological and conversational approaches to the assessment of aphasia. Second, we present the executive battery that was designed and administered to a single participant (MS) to assess various aspects of EF. The results of a Conversation Analysis (CA) undertaken on an excerpt of MS's conversation are given. Results of the EF analysis are presented with the CA in order to highlight proposed relationships that may impact on conversational strengths and difficulties. Methods and Procedures: The executive battery was designed to assess the following constructs: attention, verbal and nonverbal working memory, memory, planning, generation, and concept formation. The participant was video-recorded in conversation with a familiar interlocutor. Transcriptions were derived and subjected to Conversation Analysis. A discussion of conversational features is presented in conjunction with results from the executive battery. Outcomes and Results: Several areas including simple sustained attention, interference control, memory, and planning appeared to be preserved. This profile occurred together with the ability to maintain concentration and track meaning during interactions with one interlocutor. Memory for previously stated information was preserved as well as the ability to think and plan ahead. These strengths also co-occurred with intact turn taking and topic management. However MS's performance also indicated difficulty with shifting attention, verbal and nonverbal working memory, generation, and concept formation. The latter two especially appeared to be mediated by the effects of perseveration, which resulted from a reduced ability to shift focus. In terms of conversation, MS reported difficulty in multi-party settings. In addition, conversational repair was affected by poor generation and selection of strategies as well as an inability to shift away from current ineffectual forms of expression to more effective, flexible, and potentially successful forms of communication.Conclusions: The notion of merging two distinct and historically separate paradigms presents unique and valuable opportunities for creative and effective treatment of individuals with aphasia who have reached plateaus or who, as in this case, present with relatively intact linguistic skills on formal testing but experience daily frustration during conversation.

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