Table of contents

Table of  contents  1

List  of figures  2

1  Introduction  1

1.1  Procedure of the Work  1

2  The study of Neurolinguistics  2

2.1  The brain  2

2.2  Language and the human brain  4

3  Dementia  7

3.1  Dementia of the Alzheimer’s type  7

3.1.1  Historical background.  7

3.1.2  Causes of Alzheimer’s  8

3.1.3  Diagnosis  8

3.1.4  Therapy  8

3.1.5  The Alzheimer’s brain  8

3.1.6  Speech disorders in Alzheimer’s patients  10

3.1.6.1  Functional language abilities: reading, writing, understanding  10

3.1.6.2  Word finding/lexicon/semantic lexicon  11

3.1.6.3  Syntax  13

3.1.6.4  Discourse  13

3.1.6.5  Spared language abilities  15

3.1.6.6  Alzheimer’s in bilinguals  16

4  Analysis of linguistic Alzheimer’s symptoms in the film Iris’  17

4.1  The film  17

4.2  Depicted speech problems  17

5  Conclusion  22

5.1  Open problems and outlook  23

Appendix   25

Bibliography   28

Literature   28

Internet  Sources  29

Films   29

List of figures

Figure 1: The human brain (Alzheimer’s Disease and Education and Referral Center

2008:11) .................................................................................................................... 3 Figure 2: Language areas of the left brain hemisphere (Obler and Gjerlow 1999: 6) ...... 5 Figure 3: The surface of the cerebral hemispheres from the side, showing some specific functional areas (Jaques and Jackson 2000: 9) ....................................................... 25 Figure 4: PET-Scans of a normal brain and a brain with Alzheimer’s. Red areas show

high activity. (www.alzheimers.org) ...................................................................... 25 Figure 5: Alzheimer’s disease spreads through the brain (Alzheimer’s Disease and

Education and Referral Center 2008: 32) ............................................................... 26 Figure 6: Schrinkage of the brain in Alzheimer’s

(http://www.ahaf.org/alzdis/about/Brain_Neurons_AD_Normal.htm) .................. 26 Figure 7: Plaques and tangles in an Alzheimer’s patient’s brain

(http://www.ahaf.org/alzdis/about/AmyloidPlaques.htm) ...................................... 27 Figure 8: Writing example of an Alzheimer’s patient. Months counted after her first examination. (Mielke and Kessler 1994:18)........................................................... 27

1 Introduction

Iris has got more than one world going on inside her head - a secret world. [...] I’m the only friend that knows of her secret world. [...] It’s like in a fairy story: I’m the young man in love with a beautiful maiden. Who disappears into an unknown and mysterious world every now and again, who always comes back. (John about Iris in the Film ‘Iris’ 2001)

John said this about his novelist girlfriend when they both were young. Unfortunatley in Iris lasts years, when she suffered from Alzheimer’s she also lived in her own world but would never come back again.

Having experienced our neighbour gradually losing his memory when I was about twelve years old Alzheimer’s disease to me has always been a topic I could relate to. Of course when we were kids we often found it funny that our neighbour, who had interesting stories to tell us, would talk about the same events over and over again. The older we got the more we became aware of the tragic behind this disease not necessarily for the patients but definetly for the ones who take care of them. Often the patients don’t realize that they tell stories more than once, but the caretakers who also often have to search for their consigned when they once again forgot the way home or can’t articulate themselves properly anymore have a very hard and often ennnerving task.

This paper is focusing on the impacts of Alzheimer’s disease on language production, since we won’t be able to explain this complex desease in medical detail. For introductory reasons a short insight into language and the brain in general will be given. From a neurolinguistic point of view we will then eleborate on the various brain areas affected by Alzheimer’s and on the various speech deficiencies that can occur within an Alzheimer’s patient. As an example of how big the impact of Alzheimer’s disease on language is, the main character in the film ‘Iris’, a dementic woman, will be examined with a focus on language problems.

1.1 Procedure of the Work

Chapter two gives a brief overview on the study of neurolinguistics and the recent discussions on where language is produced in the brain. Dementia and especially dementia of the Alzheimer’s type are in the focus of chapter three. In this chapter also

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special language problems of Alzheimer’s patients are being explained. In chapter four the film ‘Iris’ that depicts the life of a woman suffering from Alzheimer’s is analyzed in terms of her speech deficiencies that are depicted in the film. A conclusion is drawn in the last chapter also giving an outlook for further studies.

2 The study of Neurolinguistics

It was in the nineteenth century that neurolinguistics emerged from phrenology (the study of linking human characteristics with the relative size of skull areas) and psychiatry (the study of mental illness) (see Obler and Gjerlow 1999: 3). According to Obler and Gjerlow the study of neurolinguistics is the study of “how the brain (‘neuro’) permits us to have language (‘linguistics’).” (1999: 1) Center of the study are the brain and nerve systems and language and how damage to the brain and nerve systems affects linguistic behavior and therefore the question is to be answered where language lies (see ibid.). Main actors in the field of neurolinguistics are neurologists, linguists and often also psychologists, speech-language pathologists and cognitive scientists all qualified in the field of neurolinguistics (see Obler and Gjerlow 1999: 2).

The field of linguistics in neurolinguistics is concerened with phonology, morphology, syntax, discourse, semantics, pragmatics and lexis (see Obler and Gjerlow 1999: 8). The relevant entities of language that are examined are oral, written and visual-gestural language use (see ibid.). The objects to be examined in neurology are the various areas of the brain. The broadest devision being between the cortex (external surface) and the internal space, called the subcortical areas (see ibid.).

2.1 The brain

Humans have two nervous systems one being the central nervous system (brain and spinal cord) and the other being the peripheral nervous system (system that regulates body functions such as breathing) (see Obler and Gjerlow 1999: 13f.). With neurolinguistics the focus is put on the first system described.

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Figure 1: The human brain (Alzheimer’s Disease and Education and Referral Center 2008:11)

In the following the main areas of the brain are described according to Obler and Gjerlow (1999: 18f.) :

The cerebrum and the cerebellum are divided into a left and a right hemisphere that are connected through fiber bundles. The most important fiber bundle out of these is the corpus callosum. The surface of the cerebrum is called cortex and consists mostly of nerve cell bodies and since it appears grey when dissected is also refered to as ‘grey matter’. It is distinguished by its convolutions. They are called gyri and sulci. The gyri and sulci form four important lobes: the frontal lobe, the parietal lobe, the occipital lobe and the temporal lobe. Fissures are between the various lobes: the Rolandic fissure separates the frontal and the parietal lobes and the Sylvian fissure separates the frontal and parietal lobes from the temporal lobe and runs through the language area. The anterior region of the brain is the frontal lobe, the parietal and the occipital lobe belong to the posterior region of the brain.

Underneath the cortex lie the subcortical regions refered to as ‘white matter’. They consist of nerve cell fibres. Since the cortex surrounds the subcortical regions, grey matter can also be found more inside the brain, the thalamus and the hypothalamus are considered ‘grey matter’ as well (see Obler and Gjerlow 1999: 21). The internal capsule is considered as ‘white matter’ but is “implicated in aphasia.” (ibid.) “Also the temporal isthmus along with the arcuate fasciculus connects anterior and posterior cortical areas involved in language.” (ibid.) Most crucial for language production is the cortex, but also the subcortical areas do play a role in language production (see Obler and Gjerlow 1999: 18).

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2.2 Language and the human brain

How do scientists examine where language is situated in the brain if so at all? Most of the research is done on patients that suffered brain damage and are now having problems in speech production of any kind. It is because of this that this paper focuses on Alzheimer’s disease to explain some language disorders. But there are also other methods to examine the brain: cortical stimulation allows us today to directly stimulate the brain by opening up the skull (see Obler and Gjerlow 1999: 9). An easier and less dangerous way is the positron emission tomography (PET-scans) that shows brain activity on a computer scan (see ibid.).

As Obler and Gjerlow describe: “Neurolinguistics has yet to develop a single large-scale unified theory acceptable to all [...] neurolinguists.” (1999: 3) This paper therefore presents some of the sometimes controversial theories on language and the brain. There are two major schools in the study of neurolinguistics. Localizationalists claim that of the two brain hemispheres the left one is mainly responsible for language, especially the central parts of the outer surface and areas within the left-hemisphere cortical language area (see Obler and Gjerlow 1999: 9). The latter ones being devided in areas for producing language and areas for understanding language (see ibid.). Famous supporter of this theory are Broca, Goodglass, Kaplan and Geschwind (see ibid.). Holists instead focus on how the different areas of the brain interconnect (Obler and Gjerlow 1999: 10). “Holists focus more on the ways language is dependent on cognitive abilities such as memory, abstract thinking, etc.” (ibid.) Famous supporter of this school were Goldstein and Jackson (see ibid.). Holists don’t link language to special areas of the brain (see ibid.).

Main areas of interest in neurolinguistics are Broca’s area and Wernicke’s area. Broca found out in 1861 that “the area of the frontal lobe just in front of the Sylvian fissure” (Obler and Gjerlow 1999: 33) has to do with language function. Wernicke pointed in 1874 at an area in the back of the Sylvian fissure and situated behind Heschl’s gyrus that when damaged caused linguistic deficits (see ibid.). As can be seen in the picture below, Broca’s area is said to be responsible for speech planning and output, maybe even for syntax whereas Wernicke’s area is responsible for speech comprehension (see Obler and Gjerlow 1999: 6).

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Figure 2: Language areas of the left brain hemisphere (Obler and Gjerlow 1999: 6)

So far these two centers of language production have been discovered however language is not uniquely produced in these two areas since “language impairment sometimes occurs after brain damage outside the classical language areas.” (Dabrowska 2004: 41) “Aphasic like symptoms may occur after damage to subcortical areas like the basal ganglia and the thalamus.” (ibid.) Today therefore the view is that various regions in the brain and not only these two classical language areas are involved in language processing also because a damage of one of these regions does not always lead to language impairment (see ibid.).

A tertiary association area is the parietal lobule being situated behind Wernicke’s area and consisting of the supramarginal and the angular gyrus (see Obler and Gjerlow 1999: 26). This area connects the secondary association areas namely the temporo, parieto and occipital lobe (see ibid.).

An important fact for the search of the language area is that “stimulation of a cortical area in one hemisphere usually makes the muscles on the opposite side of the body move. This is because most of the nerve fibres cross over to the opposite or contralateral side.” (Obler and Gjerlow 1999: 23)

The area of the brain called motor cortex is where nerve impulses that control the musculature originate (see Obler and Gjerlow 1999: 23). The location of this area is illustrated in figure 3 in the appendix. This area is important to produce language (see ibid.). Heschl’s gyrus, situated in the temporal lobe, makes it possible for us to recieve auditory stimuli (see Obler and Gjerlow 1999: 24). Between the temporal and the parietal lobe lies the planum temporale, a part of the cortex (see Obler and Gjerlow

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