This article reports on linguistic features and patterns of coherence in two levels (mild and advanced) of discourse produced by Alzheimer's patients. It argues and demonstrates that as the disease progresses, the discourse of Alzheimer's patients becomes pregrammatical in that it is vocabulary driven and reliant on meaning-based features of discourse rather than grammatically based features. Theories of pregrammatical and grammatical modes of processing and comprehension are discussed and used as an explanatory framework for understanding 4 fundamental coherence requirements. These are grounding, temporal coherence, spatial coherence, and thematic coherence. Data collected from Alzheimer's patients are used to illustrate how these types of coherence vary from earlier to later stages of the disease.
Get full access to this article
View all access options for this article.
References
1.
American Psychiatric Association
. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.
2.
Bayles, K. A.
, & Kaszniak, A. (1987). Communication and cognition in normal aging and dementia. Boston: Little, Brown.
3.
Berko Gleason, G.
, Goodglass, H., Obler, L., Green, E., Hyde, M., & Weintraub, S. (1980). Narrative strategies of aphasic and normal speaking subjects. Journal of Speech and Hearing Research, 23, 370-382.
4.
Bloom, R. L.
, Obler, L. K., DeSanti, S., & Ehrlich, J. S. (Eds.). (1994). Discourse analysis and applications: Studies in adult clinical populations. Hillsdale, NJ: Lawrence Erlbaum.
5.
Bové, P. A.
(1995). Discourse. In F. Lentricchia & T. McLaughlin (Eds.), Critical terms for literary study (pp. 50-65). Chicago: University of Chicago Press.
6.
Cheney, G.
, & Tompkins, P. K. (1988). On the facts of the text as the basis of human communication research. In J. Anderson (Ed.), Communication yearbook 11 (pp. 455-481). Newbury Park, CA: Sage.
7.
De Santi, S.
, Koenig, L., Obler, L. K., & Goldberger, J. (1994). Cohesive devices and conversational discourse in Alzheimer's disease. In R. L. Bloom, L. K. Obler, S. De Santi, & J. S. Ehrlich (Eds.), Discourse analysis and applications: Studies in adult clinical populations (pp. 201-215). Hillsdale, NJ: Lawrence Erlbaum.
8.
Dore, J.
(1985). Children's conversations. In T. A. van Dijk (Ed.), Handbook of discourse analysis (pp. 47-65). London: Academic Press.
9.
Doty, P.
, Liu, K., & Wiener, J. (1985). An overview of long-term care. Health Care Financing Review, 6, 69-78.
10.
Ehrlich, J. S.
(1994). Studies of discourse production in adults with Alzheimer's disease. In R. L. Bloom, L. K. Obler, S. De Santi, & J. S. Ehrlich (Eds.), Discourse analysis and applications: Studies in adult clinical populations (pp. 149-160). Hillsdale, NJ: Lawrence Erlbaum.
11.
Ellis, D. G.
(1992). From language to communication. Hillsdale, NJ: Lawrence Erlbaum.
12.
Ellis, D. G.
(1994). Codes and pragmatic comprehension. In S. Deetz (Ed.), Communication yearbook 17 (pp. 333-343). Thousand Oaks, CA: Sage.
13.
Ellis, D. G.
(1995). Fixing communicative meaning: A coherentist theory. Communication Research, 22, 515-544.
14.
Folstein, M.
, Folstein, S., & McHugh, P. R. (1975). Mini-Mental State: A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189-198.
15.
Foucault, M.
(1972). The archeology of knowledge and the discourse on language (A. M. Sheridan Smith, Trans.). New York: Harper & Row.
16.
Garcia, L. J.
, & Joanette, Y. (1994). Conversational topic-shifting analysis in dementia. In R. L. Bloom, L. K. Obler, S. De Santi, & J. S. Ehrlich (Eds.), Discourse analysis and applications: Studies in adult clinical populations (pp. 161-183). Hillsdale, NJ: Lawrence Erlbaum.
17.
Givón, T.
(1989). Mind, code, and context. Hillsdale, NJ: Lawrence Erlbaum.
18.
Givón, T.
(1995). Coherence in text vs. coherence in mind. In M. A. Gernsbacher & T. Givón (Eds.), Coherence in spontaneous text (pp. 59-115). Amsterdam: John Benjamins.
19.
Goffman, E.
(1967). On face-work. In E. Goffman (Ed.), Interaction ritual (pp. 5-45). Garden City, NY: Doubleday.
20.
Goodrich, P.
(1987). Legal discourse. New York: St. Martin's.
21.
Halliday, M.A.K.
, & Hasan, R. (1976). Cohesion in English. London: Longman.
22.
Halliday, M.A.K.
, & Hasan, R. (1989). Language, context, and text: Aspects of language in a social-semiotic perspective. Oxford: Oxford University Press.
23.
Hamilton, H. E.
(1991). Accommodation and mental disability. In H. Giles et al. (Eds.), Contexts of accommodation (pp. 157-186). Cambridge: Cambridge University Press.
24.
Hamilton, H. E.
(1994a). Conversations with an Alzheimer's patient. Cambridge: Cambridge University Press.
25.
Hamilton, H. E.
(1994b). Requests for clarification as evidence of pragmatic comprehension difficulty: The case of Alzheimer's disease. In R. L. Bloom, L. K. Obler, S. De Santi, & J. S. Ehrlich (Eds.), Discourse analysis and applications: Studies in adult clinical populations (pp. 185-199). Hillsdale, NJ: Lawrence Erlbaum.
26.
Hankamer, J.
, & Sag, I. (1976). Deep and surface anaphora. Linguistic Inquiry, 7, 391-426.
27.
Henderson, A. S.
(1990). Epidemiology of dementia disorders. In R. J. Wurtman, S. Corkin, J. H. Growdon, & E. Ritter-Walker (Eds.), Advances in neurology volume 51: Alzheimer's disease (pp. 15-25). New York: Raven.
28.
Joanette, Y.
, & Brownell, H. (1990). Discourse ability and brain damage: Theoretical and empirical perspectives. New York: Springer-Verlag.
29.
Jorm, A. F.
(1990). Some pitfalls in data analysis. In R. J. Wurtman, S. Corkin, J. H. Growdon, & E. Ritter-Walker (Eds.), Advances in neurology volume 51: Alzheimer's disease (pp. 35-39). New York: Raven.
30.
Jorm, A. F.
, Korten, A. E., & Henderson, A. S. (1987). The prevalence of dementia: A quantitative integration of the literature. Acta Psychiatria Scandinavia, 76, 465-479.
31.
Kempler, D.
(1991). Language changes in dementia of the Alzheimer's type. In R. Lubinski (Ed.), Dementia and communication: Research and clinical implications (pp. 98-114). Philadelphia, PA: Decker.
32.
Kintsch, W.
(1995). How readers construct situation models for stories: The role of syntactic cues and causal inferences. In M. A. Gernsbacher & T. Givón (Eds.), Coherence in spontaneous text (pp. 139-160). Amsterdam: John Benjamins.
33.
Light, E.
, & Lebowitz, B. D. (Eds). (1990). Alzheimer's disease treatment and family stress. New York: Hemisphere Publishing.
34.
Mishler, E.
(1984). The discourse of medicine: Dialectics of medical interviews. Norwood, NJ: Ablex.
35.
Nicholas, M.
, Obler, L. K., Albert, M. L., & Helm-Estabrooks, N. (1985). Empty speech in Alzheimer's disease and fluent aphasia. Journal of Speech and Hearing Research, 28, 405-410.
36.
Obler, L. K.
, Au, R., Kugler, J., Melvold, J., Tocco, M., & Albert, M. L. (1994). Intersubject variability in adult normal discourse. In R. L. Bloom, L. K. Obler, S. De Santi, & J. S. Ehrlich (Eds.), Discourse analysis and applications: Studies in adult clinical populations (pp. 15-27). Hillsdale, NJ: Lawrence Erlbaum.
37.
Perry, R.
, Irving, D., Blessed, G., Perry, E. K., Smith, C. S., & Fairbairn, A. F. (1990). Dementia in old age: Identification of a clinically and pathologically distinct disease category. In R. J. Wurtman, S. Corkin, J. H. Growdon, & E. R. Walker (Eds.), Advances in neurology volume 51: Alzheimer's disease (pp. 41-46). New York: Raven.
38.
Ramanathan, V.
(1994). Interactional differences in Alzheimer's discourse: An examination of AD speech across two audiences. Language in Society, 23, 31-58.
39.
Ramanathan, V.
(1995). Schematic understanding: Evidence from Alzheimer's discourse. Communication Theory, 5, 224-247.
40.
Ribeiro, B. T.
(1994). Coherence in psychotic discourse. New York: Oxford University Press.
41.
Ripich, D.
, & Terrell, B. (1988). Patterns of discourse cohesion and coherence in Alzheimer's disease. Journal of Speech and Hearing Disorders, 53, 8-15.
42.
Ripich, D.
, Vertes, D., Whitehouse, P., Fulton, S., & Ekelman, B. (1991). Turn-taking and speech act patterns in the discourse of senile dementia of the Alzheimer's type patients. Brain and Language, 40, 333-343.
43.
Rochester, S.
, & Martin, J. R. (1979). Crazy talk: A study of the discourse of schizophrenic speakers. New York: Plenum.
44.
Schegloff, E.
, Jefferson, G., & Sacks, H. (1977). The preference for self-correction in the organization of repair in conversation. Language, 53, 361-382.
45.
Ulatowska, H. K.
, & Chapman, S. B. (1994). Discourse macrostructure in aphasia. In R. L. Bloom, L. K. Obler, S. De Santi, & J. S. Ehrlich. (Eds.), Discourse analysis and applications: Studies in adult clinical populations (pp. 29-46). Hillsdale, NJ: Lawrence Erlbaum.
46.
Ulatowska, H. K.
, North, A. J., & Macaluso-Haynes, S. (1981). Production of narrative and procedural discourse in aphasia. Brain and Language, 13, 345-371.
47.
van Dijk, T. A.
(1980). Macrostructures: An interdisciplinary study of global structures in discourse, interaction and cognition. Hillsdale, NJ: Lawrence Erlbaum.
48.
van Dijk, T. A.
(1985). Semantic discourse analysis. In T. A. van Dijk (Ed.), Handbook of discourse analysis (Vol. 2, pp. 103-136). London: Academic Press.
49.
Villaume, W. A.
, Jackson, J., & Schouten, T. G. (1989). Issue-event extensions and interaction involvement: Text-based and meaning-based discourse strategies. Human Communication Research, 15, 407-427.
