Formulaic language in Alzheimer's disease

Abstract

Background Studies of productive language in Alzheimer’s disease (AD) have focused on formal testing of syntax and semantics but have directed less attention to naturalistic discourse and formulaic language. Clinical observations suggest that individuals with AD retain the ability to produce formulaic language long after other cognitive abilities have deteriorated. Aims This study quantifies production of formulaic expressions in the spontaneous speech of individuals with AD. Persons with early- and late-onset forms of the disease were compared. Methods & Procedures Conversational language samples of individuals with early- (n = 5) and late-onset (n = 6) AD and healthy controls (n = 5) were analyzed to determine whether formulaic language, as measured by the number of words in formulaic expressions, differs between groups. Outcomes & Results Results indicate that individuals with AD, regardless of age of onset, used significantly more formulaic expressions than healthy controls. The early- and late-onset AD groups did not differ on formulaic language measures. Conclusions These findings contribute to a dual process model of cerebral function, which proposes differing processing principles for formulaic and novel expressions. In this model, subcortical areas, which remain intact into late in the progression of Alzheimer’s disease, play an important role in the production of formulaic language. Applications to clinical practice include identifying preserved formulaic language and providing informed counseling to patient and family.

The role of subcortical structures in recited speech: Studies in Parkinson's disease

“…As subcortical structures have been shown to be involved in procedural memory for syntax production (Ullman, 2008; Zanini et al, 2004), recitation speech as a task may also be procedural, driven by subcortical neural substrates controlling automatic, overlearned motor sequences. Similar to findings of formulaic language (see Bridges & Van Lancker Sidtis, 2013; Rogers et al, 2009 for discussion of formulaic language in Alzheimer's disease and Parkinson's disease), successful recitation speech is also associated with an intact subcortex, as deficits are observed with severe subcortical dysfunction (in the participants with DBS turned OFF). Overall, these findings provide support for the dual process model of language production involving a subcortical-right-hemisphere circuit in addition to the left-hemisphere (Van Lancker Sidtis, 2004, 2006, 2012; Wray & Perkins, 2000).…”

“…Similarly, Sidtis et al (2009) found reduced incidence of formulaic language in the spontaneous speech of individuals who have had subcortical strokes when compared to healthy adults. Findings from studies of the speech of individuals with Alzheimer's disease show relative preservation of formulaic language even when novel language production deteriorates due to cortical degeneration (Bridges & Van Lancker Sidtis, 2013), providing evidence that intact subcortical structures may be involved in the production of this language form.…”

“…They found that individuals with basal ganglia stroke had significantly fewer formulaic expressions in their spontaneous speech than individuals with left-hemisphere damage and healthy adults, implicating the basal ganglia (and right-hemisphere) in formulaic language production. Clinical observations of aphasia (language impairment due to left-hemisphere cortical damage) and research on the language of people with Alzheimer's disease (Bridges & Van Lancker Sidtis, 2013) also support the importance of intact subcortical structures in the production of fixed and formulaic expressions, as these are frequently preserved when novel language is impaired. Illes, Metter, Hanson and Iritani (1988) studied the spontaneous speech of healthy adults and those with Parkinson's disease and found that individuals with Parkinson's disease had fewer modals and interjections (e.g., “Ah,” “Well”), which are types of formulaic expressions (see Sidtis et al, 2009).…”

Lexical Substitution and Paraphasia in Advanced Dementia of the Alzheimer Type

“…Producing more empty phrases and conjunctions (Nicholas, Obler, Albert, & Helm-Estabrooks, 1985). Indefinite pronouns and general names occur as substitutions for the target word in everyday conversations, according to the well-known peculiarity of the AD patients' speech (Bridges & Van Lancker Sidtis, 2013). Our patient used indefinite pronouns in spontaneous speech, sometimes pretending to generate a figure of speech, making an attempt to mask her word recollecting failures.…”

“…The influence of poor semantic processing and weak executive functioning on the verbal communication in general. Individuals with AD overuse cliché (Bridges & Van Lancker Sidtis, 2013) because a cliché penetrates into the speech program automatically as a filler of a syntactic position. The increase of the associations in naming tests and spontaneous speech reflects the poor semantics, insofar as associations replace semantic relations and accuracy of the lexical selection.…”