Pragmatic deficits in patients with schizophrenia and right hemisphere damage: A pilot study

Abstract

Background While pragmatic deficits are well documented in patients with schizophrenia (SCZ) and right hemisphere damage (RHD), there is a paucity of research comparing the pragmatic deficits of these two groups. Do they experience similar cognitive dysfunction or is there a dissociation between the two patient groups? Aims To investigate the nature of pragmatic deficits in these two groups and to gain an understanding of the underlying cognitive mechanisms that might be associated with these deficits to further future investigations. Methods & Procedures A total of 60 participants (15 patients with SCZ; 15 with RHD; 30 (15 + 15) healthy controls (HC) were administered the Bengali Audio‐Visual Test‐Battery for Assessment of Pragmatic Skills. Outcomes & Results Both SCZ and RHD patients were found to have significant pragmatic deficits compared with their matched controls. SCZ patients were found to score significantly better than the RHD group in six out of the 10 pragmatic skills when controlled for age and education. Discriminant function analysis was performed and 86.7% of the cases (HC = 100%, SCZ = 73.3% and RHD = 86.7%) were correctly reclassified into their original categories using the test scores. Conclusions & Implications The study suggests that there is heterogeneity in the nature of the pragmatic breakdown within and across patient groups. Therefore, individualized restorative measures targeting the disrupted cognitive mechanism(s) might help elevate pragmatic competence and enhance the social functioning of patients with pragmatic deficits. What this paper adds What is already known on the subject Pragmatic deficits are common in adults with cognitive impairments of different etiologies. However, few studies have explored pragmatic deficits across clinical populations. Consequently, very little is known about the nature of pragmatic deficits in patients with schizophrenia and right hemisphere damage. What this paper adds to existing knowledge This work offers preliminary data on pragmatic difficulties in patients with schizophrenia and right hemisphere damage. This study overrides the boundaries of traditional classifications and evaluates pragmatic difficulties in these two clinical populations with reference to the underlying cognitive mechanisms, which might be disrupted. What are the potential or actual clinical implications of this work? The study adds a transdiagnostic perspective suggesting that there might be heterogeneity in pragmatic deficits, both within and across patient groups, and stresses the need for individualized therapy.

Exploring Pragmatic Deficits in Relation to Theory of Mind and Executive Functions: Evidence from Individuals with Right Hemisphere Stroke

“…Our results showed that RBD patients performed lower as a group in pragmatic tests compared to the control group. Therefore, the results confirm previous studies, which have shown that RBD patients exhibit communicational deficits [22,48]. A further case-bycase investigation revealed that not all patients demonstrate pragmatic impairments, a finding that verifies the heterogeneity of the patients in terms of communication deficits, a result that has been previously suggested [20,30].…”

“…Furthermore, subjects 1 and 11 should be studied separately due to their low similarity with the other two clusters. The second cluster consists of ten patients (2,6,20,19,4,10,22,14,21,12). In this cluster, the patients exhibit mainly ToM deficits, specifically in the affective facet of the non-verbal test, besides patient 10 who exhibits deficits in three subcomponents from the two ToM tests, with some also presenting impairment in executive functions, specifically in the processing speed.…”

“…First, the intrinsic heterogeneity of the pragmatic aspect of language, especially when observed and measured in RBD patients of various pathologies [21]. The pattern of pragmatic deficits seems to differ among disorders [22]. To deal with this issue, scholars have coined the term "apragmatism" as an umbrella term which may include the various deficits within the pragmatic spectrum [23].…”

The scope of using pragmatic language tests for early detection of dementia: A systematic review of investigations using figurative language

“…132 Preliminary data suggest that the test battery holds promise for a transdiagnostic approach toward pragmatic deficits across clinical populations. 134 Adaptation of such test batteries might help create a relatively homogenous data set for researchers to better understand the nature of language breakdown in different types of clinical populations, in general, and dementia, in particular, as well as its cultural and language-specific variations. Deeper insights may lead us to a more precise and effective diagnostic tool.…”

“…Ten different subtests cover different aspects of pragmatic skills: (a) conversational pragmatics; (b) comprehension of abstract words in sentence context; (c) comprehension of ambiguous words in sentence context; (d) comprehension of figurative speech; (e) narrative and interpretive skill, (f) discourse comprehension, (g) comprehension of inferred meaning; (h) comprehension of emotional expressions; (i) gesture comprehension; and (j) humor comprehension. Moreover, “open‐ended questions and a naturalistic method of elicitation (verbal explanation) make the battery an ideal tool to explore the diverse minds of a diverse population.” 132 Preliminary data suggest that the test battery holds promise for a transdiagnostic approach toward pragmatic deficits across clinical populations 134 . Adaptation of such test batteries might help create a relatively homogenous data set for researchers to better understand the nature of language breakdown in different types of clinical populations, in general, and dementia, in particular, as well as its cultural and language‐specific variations.…”