When Language Breaks Down: Analysing Discourse in Clinical Contexts

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You will be asked to input your password on the next screen. Remove this title from your notification list? In this study, experts participated in phases 1 and 2 were 4 professionals, and phase 3 was performed by 2 professionals. The professionals were divided into pairs for the annotation of a sample of each group. The Kappa index was calculated to verify the concordance between the judges, and the data were adjusted. Both texts with the manual segmentation performed by the evaluators were analyzed by Coh-Metrix-Dementia for the extraction of metrics. The original story was taken into account, and the main ideas were then selected.

The 28 propositions were also grouped according to four major components of the narrative structure:. Using features provided by the tool and by manual marking, the macrostructural characteristics were extracted. The analyses of the macrostructural characteristics were carried out as follows: The groups were matched for age, education, and, although not controlled, gender was balanced among groups.

Coh-Metrix-Dementia was used to capture discourse features. Statistical analyses were performed to verify the features and metrics capable of differentiating the groups. Regarding the number of propositions reported in the discourse, mAD individuals presented lower numbers in relation to aMCI and HC, indicating less informative discourses. The number of propositions in each item was superior to mAD.


Demographical and global cognitive results and analysis of the amount of proposition and narrative structure. In the average features between adjacent sentences and mean of similarity between all sentence pairs in the text, a difference was found only between aMCI and mAD. The aMCI presented the lowest values in these measurements.

The mAD individuals presented the highest values in the metric standard deviation among sentences, among all sentence pairs. In the other features of the latent semantic analysis category, no differences were found between the groups.

The total idea density of the text showed that mAD individuals presented a lower total number of propositions. Empty emissions analysis, total idea density analysis, latent semantic analysis, and number of modalizations. The purpose of this study was to verify the differences between mAD, aMCI, and HC in the task of producing narratives, exploring an innovative method of computational discourse analysis that could identify performance markers in macrostructural aspects and help differentiate individuals in each stage.

We did not differentiate multiple or single domain in our sample, as most language studies in the literature [39] , [40] , [41]. In relation to macrostructural aspects, informativity, global coherence, and modalization were analyzed.

When Language Breaks Down: Analysing Discourse in Clinical Contexts

The informativity refers to the target propositions expected for the narrative. Twenty-eight propositions were defined in Cinderella's story. The results showed that the mAD individuals presented less propositions than the aMCI and HC individuals, indicating less informative discourses with less reference to what was expected for the narrative. These findings corroborate the literature that indicates alteration in the content of individuals with AD [14] , [19]. We minimize memory impact in discourse production since the Cinderella scenes were available for consultation during the task.

Fleming and Harris [43] found differences between individuals with MCI and healthy subjects regarding discourse length and quality, impaired in the former by the absence of central elements. The performance compromised in semantic activities may occur due to shortcomings in executive skills related to semantic processing, which is responsible for retrieving, maintaining, monitoring, and manipulating semantic representations.

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The study by Lira [19] reported that the AD group presented half of the propositions in comparison to the total of the control group in a narrative task and linked this difficulty to a loss in content processing. In the present study, the expected number of propositions was high, which may have contributed to the results found. The fact that no subject has produced a discourse with all the selected propositions should be emphasized.

This was also found in Toledo [44] with normal individuals and corroborates the results of Alves and Souza [45] , who evaluated the differences of priorities between examiner and subject in the construction of narratives. Individuals with AD presented discourses with lower relevant content than those of MCI and healthy subjects, who presented similar performance, as found in the present study. Another hypothesis that explains the amount of information produced by the individuals would be the context of the evaluation.

In this hypothesis, the individuals produced less information because they assumed that the evaluator already knew the figure. In the present study, the structure of the narrative by the division in orientation, problem, development, and outcome was analyzed. For the analysis of the global coherence, the empty emissions, the total idea density feature, and the latent semantic analysis feature were verified. Greater difficulty was found in the discourse of the mAD individuals.

They also presented higher numbers of empty emissions without reference to the narrative, indicating greater difficulty to maintain the theme. The mAD presented lower values in the total idea density feature when compared with the other groups. This feature takes into account the ideas transmitted by the subject and how each transmitted information cell is related to the target propositions.

The features that analyze the similarity between sentences and their contribution to global coherence are highlighted. In the metric standard deviation between sentences, higher values in mAD among all pairs of sentences were found, indicating greater difficulty in keeping the theme throughout the discourse. The average metric between adjacent sentences and average similarity between all sentence pairs differentiated the aMCI from the mAD, which presented the highest values and shows more repetitive discourse without introducing new information.

It was not possible to discriminate each group based on these features. This study demonstrates an innovative method for the analysis of global coherence, using automatically extracted metrics and empty emission marking. The authors state that these difficulties are associated with the semantic-pragmatic and lexical components of language.

The good performance of the MCI group can be explained by the lesser recruitment of episodic memory and the preservation of working memory [49] , which could support the good performance of the aMCI group in the present study. It is hypothesized that the executive functions are faulty or that the executive control of the work memory does not activate properly the relevant clues that would allow the retrieval of ideas related to the topic [48]. The MCI and AD groups presented similar performance, differing from the control group, in disagreement with our results.

The difficulties of global coherence were related to the executive and semantic-pragmatic components of language. Individuals present difficulties to create a macroplane, which contemplates the macrostructure of the text [17]. In this study, the mAD individuals found difficulty in the planning and organization of the ideas related to the topic, demonstrating compromise of the textual macroplane. According to Nespoulous [50] , the presence of modalizations indicates a disruption of the discursive macrostructure because the subject includes opinions and comments about his performance during the discourse.

It was decided to maintain the analysis of the modalization at the macrostructural level because it can be characterized as a discursive incoherence. In contrast, Lira [19] did not find higher frequency of modalization for the AD group. The presence of the modalizations indicates the difficulty of maintaining the central theme of the discourse, but it may indicate an effort of the subject to provide pragmatic aspects of interaction with the evaluator. Individuals with AD often inserted excerpts from personal narrative, associating something presented in the figure with an autobiographical personal experience.

The introduction of irrelevant content and off-topic elements can occur because of the presence of problems in the semantic-pragmatic component of the language [15]. The use of computational mechanisms reduces the time and excessive work demanded from clinicians in relation to traditional manual analyses. It can be an ally in the discourse analysis of individuals with cognitive decline, contributing to diagnosis, longitudinal evaluations, and verification of intervention effects.

The use of Coh-Metrix-Dementia provides a large number of automatically extracted metrics quickly, which can aid in clinical practice. This study explored a computerized tool to verify differences in the discourses of individuals from the three groups. Individuals from the mAD presented discourses with greater macrostructural impairment, that being a less informative discourse, poorer global coherence, and more modalizations.

These differences were not found between the aMCI and HC groups for the proposed task when considering isolated metrics. A larger number of subjects are recommended to replicate this sort of study, considering the training needs of the computational system and also because the discourse is considered a complex activity with great sociolinguistic variation that may interfere in the answers.

Another factor that could be emphasized would be the capture of discourses in a suitable environment, minimizing noise level for optimal acoustic analyzes, and to accurately measure nonlinguistic factors such as duration and location of pauses and disfluencies. Finally, the study evaluated MCI as a whole, given the small number of amnestic single domain. The linguistic analysis of each subgroup could provide, however, valuable insights for the establishment of a possible continuum among these patients with single domains, multiple domains, and dementia. The authors would like to thank Michael James Stablein of the University of Illinois Urbana-Champaign for his translation services and review of this work.

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This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. National Center for Biotechnology Information , U. Journal List Alzheimers Dement Amst v. Published online Sep Abstract Introduction The depiction of features in discourse production promotes accurate diagnosis and helps to establish the therapeutic intervention in cognitive impairment and dementia. Results mAD showed worse overall performance compared to the other groups: Discussion Our results are in line with the literature, verifying a pathological change in the macrostructure of discourse in mAD.

Mild cognitive impairment, Alzheimer disease, Aging, Narration, Language disorders, Communication, Diagnosis, Automatic data processing. Background The progressive growth of the elderly is a well-established phenomenon in most populations, with a special burden in the demographic structure of developing countries such as Brazil.

Open in a separate window. The manual comprises 3 phases: Phase 1—Removal of a set of words, called nonwords: Phase 2—Segmentation of the text in sentences: Segmentation took into account syntactic and semantic characteristics. Phase 3—Annotation of the narrative propositions from the sentences: The definition of the 28 propositions was made from the base story, selecting the main ideas that could tell the story.

Cinderella's mother dies 2. Cinderella's father marries again 3. Envy Stepmother and Daughters 6. Debauchery and wickedness 8. Invitation to the ball dance 9. They do not let Cinderella go to the dance Animals help make the dress Cinderella is happy with the dress Stepmother's daughters tear Cinderella dress Fairy godmother appears Fairy godmother measuring Cinderella for new dress Fairy Godmother warns Cinderella to return before midnight Went to the dance Prince meets Cinderella Prince dances with Cinderella Prince picks up shoe and looks for Cinderella Stepmother holds Cinderella in the attic The stepmother's daughter tries the shoe and does not fit Animals free Cinderella Cinderella tries the shoe and it fits Average givenness of each sentence of the text from the second sentence onward.

If the text has only one sentence, the metric is set to 0. Givenness of a sentence is defined as the LSA similarity between the sentence and all the text that precedes it. Standard deviation of sentences givenness Standard deviation of the similarity between each sentence and all the text that precedes it. Standard deviation of the givenness of each sentence of the text from the second sentence onward. The givenness of a sentence is defined as the LSA similarity between the sentence and all the text that precedes it.

Mean span of sentences Mean span of each sentence of the text from the second onward. The span of a sentence, as well as givenness, is a way of measuring the closeness between a sentence and the context that precedes it. The difference, in simple terms, is that span seeks to capture similarity not only with the explicit content presented earlier in the text but also with everything that can be inferred from that content.

Standard deviation of sentence span The standard deviation of the span of each sentence of the text, from the second onward.