2. Alzheimer’s disease as linguistic disturbance
3. Research methodology
4. Data analysis and discussion
Abstract: this study intends to investigate language performance and impairment elicited in the speech sample of some Iraqi patients diagnosed with Alzheimer’s. The aim of this study is to see whether Alzheimer’s disease affects patients’ language, and if so, what areas of language it affects. In addition, it inspects and explains both language performance and impairment of Alzheimer’s patients during the disease. It is hypothesized that Alzheimer’s patients suffer from sound substitution and omission on the phonological level, that the patients’ language is affected on both the denotative and connotative sides, that the patients break the rules of turn taking when they engage in conversations, and that Alzheimer’s patients then suffer from language impairment in these areas. The prominent outcome of this study is that Alzheimer’s patients suffer from language impairment in the phonological, semantic, and pragmatic areas of language.
Keywords: Alzheimer’s disease, language impairment.
Alzheimer’s disease is sometimes referred to as the forgetting disease (Brill, 2005: 10). It is called so because one of the main symptoms of the disease is the loss of the patient’s memory as well as the loss of the ability to recognize or understand where, when and who the patient is. Alzheimer’s mainly attacks the human brain which is the control center of the human body that takes care of the five senses, speech, vision, breathing, learning ability, memory and movement. The patients then lose their ability to function due to the disease attack on the human brain (Ibid: 11). Alzheimer’s gradually destroys all of the parts of the human brain (Lu, 2011: 3). It is regarded as a case of dementia in which the patient brain slowly shrinks and dies (Kelly, 2008: 8).
In the early stage of the disease, the memory center starts to be impaired then later, as the disease progresses, all areas of the brain which control language, vision, thinking, and reasoning become impaired as well (Lu, 2011: 3). The patients of Alzheimer’s patients also undergo changes in their behavior and personality (Kar, 2009: 81). They suddenly become so angry, aggressive or even delusional (Ibid).
Alzheimer’s is a degenerative disorder that happens in the brain which leads to memory and language loss. The progressive decline in the cognitive functions is regarded to be the main characteristic of the disease, which is mainly increased among human beings whose age is 65 years old or even more or less, as mentioned before (Duthey, 2013: 8). The decline progresses as the disease progresses. Later, it affects memory, thinking, language and learning capacity (Ibid). Alzheimer’s patients tend to ask questions repeatedly due to their inability to recognize and remember that they have just asked the same question (Soukup, 1996: 11). They also tend to be angry, aggressive, suspicious and paranoid especially when they misplace significant items (Ibid).
2. Alzheimer’s disease as linguistic disturbance
When Alzheimer’s disease attacks, it first attacks the human memory, both short and medium term memories are attacked (Ronald et al. 2016: 21). In the mild phase of Alzheimer’s disease, speech seems to be fluent and the patients’ language is unaffected, but the patients may have difficulties finding the right word. The first sign of language deficit observed in the mild phase is anomia, the difficulty of finding the right word either in structured tasks or in spontaneous conversations. The patients begin to use semantically empty words such as things and stuff instead of content words (Kempler, 1995: 98). Concerning language comprehension in the mild phase, Alzheimer’s patients often show full comprehension of simple, structured, and concrete language, which depends on the meaning of single words (Silverman, 2011: 14). However, their comprehension of abstract language, which requires inference, appears to be poor (O’Brien et al. 2005: 209). In writing, Alzheimer’s patients tend to show difficulty generating continuous language through writing though the mechanisms of writing seem to be not affected at all. It should be mentioned here that the patients are aware of these deficits in their language but their awareness decreases by the end of this phase (Kempler, 1995: 99).
In the moderate phase, patients start to suffer from difficulties with both production and comprehension of language (Faust, 2011: 357). Concerning language production, anomia becomes worse and the patients suffer a growing difficulty in finding the right word to say (Kempler, 1995: 99).
Alzheimer’s patients at this phase start also to suffer from pragmatic deficits, discourse deficits, poor topic maintenance, poor use of pronouns, and breaking turn-taking rules (Bayles et al. 1985: 102). Concerning language comprehension, one aspect is impaired that is the auditory-spoken language (Lezak, 1995: 212). Reading and writing mechanisms in the moderate phase are unaffected by the disease at all. This means that Alzheimer’s patients can comprehend the written language but not the spoken one (Cutler et al. 1985: 299). Alzheimer’s patients at this phase produce incoherent utterances and their conversations become so hard to follow (Cummings, 2013: 292). They also retreat from social situations that require conversational engagement. It should be mentioned here that at this phase, the patients’ awareness of their language deficits is completely decreased (Kempler, 1995: 99).
In the severe phase of Alzheimer’s disease, the first three signs of language deficit that can be observed concerning language production in this phase are paraphasias (substituting words and sounds), breaking turn taking rules, and the lack of coherence (Fernades and Paul, 2017: 26). As the disease progresses during this phase, speech intelligibility appears to be totally impaired by dysarthria, echolalia (repeating others), palilalia (repeating self), and muteness (Kempler, 1995: 100). Language comprehension, on the other hand, appears to be totally impaired not only in the spoken language but also in the written one even for single words. The patients at this point cannot start or engage successfully in conversations and social situations (Ibid).
3. Research methodology
This includes model of the study, selection of informants and data collection techniques.
3.1 Model of the study
The model chosen for the data analysis for this study is an eclectic model that focuses on the areas of language in which Alzheimer’s patients have difficulties which are phonology, semantics and pragmatics. Therefore, the eclectic model must focus on these three areas.
In order to find the phonemic difficulties that Alzheimer’s patients suffer from such as, sound omission and substitution, phonemic transcription is adopted. The data is phonemically transcribed The symbols used in the phonemic transcriptions represent the phonemes of Nassiriyia Iraqi Arabic taken from Betti (2015: 223-4). According to Crystal (2008: 362), phonemic transcription is a transcription of a particular language in which the phonemes are given written symbols that are enclosed by oblique brackets, for example the phoneme /p/ /k/ /d/…etc. Sound omission is defined as the absence of a speech sound that should be present in a word (Fogle, 2017: 96). It is the process of deleting a particular speech sound in a particular word (Blake, 1981: 151). It is considered the omission of a standard speech sound that normally occurs at any point in a word (Cooper, 1964: 2). According to Sadock et al. (2009: 57), sound omission is regarded to be a speech disorder if it happens unintentionally because of a disease.
This disorder is caused by many mental diseases, such as Alzheimer’s, aphasia, dysarthria, and dyspraxia. It results in errors in whole words creating either a word of a different meaning such as, clap and lap or a string of sounds that has no meaning at all. Another in certain contexts (Crystal, 2009: 442), on the other hand, regards sound substitution, to be the shift of one speech sound. It is the replacement of one phoneme by another in a word such as thoup for soup (Fogle, 2017: 96). Substitution is regarded as a speech error in which the individual cannot produce the right sound for the word, thus, creating either a word of different meaning or a string of sound that has no meaning at all.
For semantic difficulties, Bower (1979: 336) refers to connotation and denotation analyses. These analyses provide a great analytical tool for the components of the words spoken by Alzheimer’s patients. Connotation and denotation are the main two methods in semantics. Connotation is all about the associations that people associate to some words, while denotation is all about the precise, literal meaning of a word that is mainly found in a dictionary. Connotation is regarded to be either cultural or emotional associations carried by words. These associations can be positive or negative concerning their emotional connections (White, 1993: 315). According to Crystal (2008: 102), connotation is referred to as a classification of the types of meaning in semantics. It is applied with reference to the emotional associations of the lexical item, for example, the connotation of the word needle refers to ‘pain’ and ‘sickness.’
Connotative meaning is divided into two main types, affective, and emotive. Affective meaning refers to the attitudinal notion in the meaning of a lexical item (Ibid, 15). It displays the speaker’s feelings, attitude, and opinions about a piece of information. It should be mentioned here that affective meaning is found in both sentence structure and a person’s sign choice (Valli, and Lucas, 2000: 151). Affective meaning is all about the emotions expressed by an individual when he experiences something. It includes the whole range of emotions of the human being (Kramer et al. 2003: 103). Emotive meaning on the other hand, is regarded to be the tendency in which a lexical item can generate affective responses in people (Stevenson, 1937: 23). This tendency is associated with the dynamic usage of the lexical item, that is, the use of a term which does not communicate beliefs, but rather encourages the individual’s feelings, and to incite him to action. Emotive meaning is seen as a disposition of a sign that is regarded to be an expression of attitudes and feelings. It is a kind of meaning that contains a range of emotions as stimuli and responses (Rahmanian, 1989: 68). Denotative meaning is seen as the most basic commonly accepted dictionary meaning of a word. It represents a habitual correlation between an object and a word (Sitaram and Cogdell, 1976: 99). Denotative meaning is totally associated with semantic conventions. For example, the denotative meaning of the word window is a kind of aperture in a wall or in a roof.
For pragmatic difficulties, turn-taking analysis is of importance in this regard. Turn taking is seen as the exchange of turns among individuals who are engaged in a conversation (Lewis, 2013: 314). It is a skill that is acquired side by side with language. Many studies, such as Lewis (2013) and Kaye (1977) find that turn-taking is acquired by infants in the first few weeks of their life. Turn-taking is considered to be a general trait of social interaction. It is seen as granting chances to individuals to participate in social situations (Holler et al, 2015: 255). According to Sacks et al. (1975: 706), turn taking is rulegoverned. The rules postulated can be said as: (1) an individual speaks at a time (2) a speaker change repeats (3) no conversational gap or overlap. The data analysis will focus on these three rules as the rules that govern turn taking.
3.2 The Selection of informants
The informants are three old people (X, Y and Z) who suffer from Alzheimer’s disease. They are diagnosed with Alzheimer’s disease according to their doctors’ reports, and have progressive brain damage according to their doctors’ reports. All of them are native speakers of Nassiriya Iraqi Arabic, and they live in the suburbs around Nassiriya: 2 informants are from Shatra, 44 Km North of Nassiriya, and 1 informant is from Al-Nasr, 59 Km North of Nassiriya.
The informant (X) is a sixty-seven year old male living in Shatra. He suffers from Alzheimer’s disease in the moderate phase according to his doctors’ reports. He is taken care of by his family who grant the researcher the permission to study the informant and to have an interview with. The patient suffers from difficulties in language production. He was diagnosed with Alzheimer’s 3 years ago and took some medicine in order to slow down the effects of the disease.
The informant (Y) is a sixty-nine year old female from Al-Nasr suffering from Alzheimer’s disease in the severe phase. She is unable to speak appropriately and is afraid of the researcher as well as of her family. She suffers severe difficulties in both language production and perception.
The informant (Z) is a seventy-one year old male living in Al-Nasr. He suffers from Alzheimer’s disease in the moderate phase. The patient suffers difficulties in language production. He was diagnosed with Alzheimer’s about five years ago and was given medical care several times. It should be mentioned here that the caregivers and the families of the patients permit all of the interviews and the questions of the interview are related to life activities and events of the patients.
3.3 Data collection techniques
There are two techniques for data collection which are indirect structured interview and naming test.
1. Indirect structured interviews The data is gathered from Alzheimer’s patients by using indirect structured interviews (See Fig. 1). Every informant gets 3 sessions of 60 minutes to answer the researcher’s questions. Their conversations are recorded and the recordings are filtered from noises, and unclear outputs. The recordings then are transcribed to find any phonological, semantic, and pragmatic mistakes. The figure shows the questions of the interview translated:
Abbildung in dieser Leseprobe nicht enthalten
Figure 1. Indirect Structured Interview
These questions are chosen in order to give the informants the freedom to think and speak without any restrictions and to produce real life utterances. It should be mentioned here that these questions are asked with the Arabic language and are repeated multiple times for the informants to understand what they are required to do.
2. Naming test
The data is gathered also by using a naming test, which is designed for individuals to name the objects. The test consists of 14 pictures of objects in the real life and the patients are required to name the objects in order to see whether they remember and say the words that describe the objects in the test or not.
4. Data analysis and discussion
4.1 Phonological Difficulties
Phonemic transcription provides an excellent tool for the analysis of data because it reveals the phonological mistakes that the informants commit while responding to the interview questions and to the naming test. In this study, it is adopted and applied to the data gathered from Alzheimer’s patients to see how well the words uttered by the informants follow the phonological rules, and whether or not they avoid them and follow some other processes like sound substitution. In addition, by such an analysis, it helps to investigate whether Alzheimer’s patients suffer from phonological difficulties or not. The symbols used in the phonemic transcriptions represent the phonemes of Nassiriyia Iraqi Arabic taken from Betti (2015: 223-4).
4.1.1 Sound substitution
The phonemic transcription and the analysis of the data reveal that Alzheimer’s patients suffer from sound substitution especially in the moderate and the severe phases of Alzheimer’s disease. Table 1 displays the sound substitution of Alzheimer’s patients during the interview with the researcher.
Table 1. Sound Substitution of Alzheimer’s Patients
Abbildung in dieser Leseprobe nicht enthalten
As shown by Table 1, Alzheimer’s patients suffer from sound substitution. In the first utterance, the voiceless dental stop /t/ in /truuH/ you go is replaced by the voiced alveolar nasal /n/ as in /nruuH/ we go. In the second utterance, the voiced bilabial nasal /m/ as in /Dalmakaan/ the place is replaced by the voiced bilabial stop /b/ as in /Dalbakaan/. In the third utterance, the short half-close front with lip spreading /i/ as in /?inta/ you (singular) is replaced by both the short half-open central neutral /a/ and the voiced bilabial nasal /m/ as in /?antam/ you (plural). In the fourth utterance, the short half-close front with lip spreading /i/ as in /?inTaani/ he gave me is replaced by both the short half-open central neutral /a/ and the voiced bilabial nasal /m/ as in /?inTaakam/ he give you. In the fifth utterance, both the short half-open central neutral /a/ as in /?inta/ you (masculine) is replaced by the long close front with lip spreading /ii/ as in /?intii/ you (feminine). In the sixth utterance, the high front unrounded consonant /y/ as in /yamta/ when is replaced by the voiced alveolar lateral /l/ as in /lamta/. In the seventh utterance, the voiceless interdental fricative /θ/ as in / θalaθat/ three is replaced by voiceless velar stop /k/ as in /kalaθ/.