Discourse abilities in patients with dementia of the Alzheimer type-with reference to communication problems in their everyday life

本研究的目的是发展措施，以评估阿尔茨海默氏病（AD）的人的话语，并调查其在日常情况下的沟通。为此，我们通过对9例阿尔茨海默病患者的语篇进行定性分析，设计了一套新的语篇评定量表，并对轻度AD患者、轻度失语症患者和健康对照者的语篇表现进行了评定和比较。结果显示了AD患者的一些话语特征，这些特征在失语症患者和健康对照者的话语中是没有的。我们还试图探讨AD患者在不同疾病阶段的话语变化，并提出了话语测量结果与疾病严重程度之间的一些关系。然而，由于严重受损患者的数据稀缺，结论应予以保留。至于日常情况下的沟通困难，我们采访了照顾AD患者的家庭关键人物。虽然许多AD患者的家庭成员报告说，他们发现重复相同的谈话和问题，健忘，理解能力下降，无法科普问题等，少数家庭成员发现语言问题，并探讨家庭成员观察到的语言问题与语篇测量结果之间的关系。一些话语特征，如语言障碍，是常见的，但也有不一致的特征。为了了解AD患者的沟通问题，我们需要来自家庭成员的信息以及临床环境中的话语评估。

The aims of this study were to develop measures to assess discourse of people with Alzheimer's disease (AD) and to investigate its relation to communication in everyday situations. For these purposes, we newly invented a set of discourse rating scales through our qualitative analysis of discourse of 9 patients with Alzheimer' s disease.With these scales, the discourse performance of people with mild AD, people with mild aphasia and healthy controls was assessed and compared. The results revealed a number of the discourse characteristics of people with AD, which were not found in discourse of people with aphasia nor healthy controls.We also tried to investigate the discourse change in AD at different stages of disease, and some relation between the results of the discourse measures and severity of the disease was suggested. However, the conclusion should be reserved because of the scarcity of severely impaired patients' data.As for the difficulties of communication in everyday situations, we interviewed family key persons who were taking care of AD patients. While many of the family members of AD patients reported that they found repetition of the same talks and questions, forgetfulness, reduced ability of comprehension, inability to cope with problems, etc., few family members found problems of language.We also investigated the relation between these problems observed by family members and the results of the discourse measures. Some of the discourse characteristics, such as language impairments, were common, but there were also characteristics that disagreed. In order to understand the communication problems of people with AD, we need information from family members as well as assessment of discourse in clinical settings.