گفتمان سالمندان مبتلا به زوال عقل نوع آلزایمر: پیوستگی محاوره ای (مقاله علمی وزارت علوم)
درجه علمی: نشریه علمی (وزارت علوم)
آرشیو
چکیده
پیوستگی یکی از ویژگی های ساخت گفتمان است که فقدان آن در گفتمان سالمندان مبتلابه زوال عقل نوع آلزایمر سبب درک نشدن گفتمان این بیماران می شود. پژوهش حاضر با هدف بررسی پیوستگی در گفتمان سالمندان کُردزبان مبتلابه زوال عقل نوع آلزایمر انجام گرفته است. ماهیت روش شناختی این پژوهشِ کمّی و علّی مقایسه ای بوده که در یکی از خانه های سالمندان کرمانشاه در سال 1398 انجام گرفته است. جامعه آماری شامل 20 نفر (10 نفر بیمار زوال عقل نوع آلزایمر و 10 نفر سالمند سالم) بود که بر اساس سن (63 تا 75 ساله)، جنسیت (زن و مرد)، بی سواد بودن و گویشور زبان کُردی بودن (گویش کلهری) همتا شده اند. آزمون تعیین سطح کارکرد حافظه برای تعیین میزان زوال عقل برگزار و افراد با نمرات میان 5/0 و 2 انتخاب شدند. سپس، آزمودنی ها به مدت 10 دقیقه به پرسش های مربوط به خانواده، زندگی و فعالیت های روزمره و نیز، چگونگی برگزاری مراسم عید نوروز پاسخ دادند. بررسی پیوستگی در پژوهش حاضر بر اساس دیدگاه لین و همکاران انجام گرفته و نتایج آماری با استفاده از نرم افزار SPSS نسخه 16 و آزمون تی مستقل به دست آمد. یافته ها حاکی از آن است که تفاوت معناداری در استفاده از پیوستگی فراگیر و پیوستگی موضعی در گفتمان دو گروه سالمندان کُردزبان مبتلابه زوال عقل نوع آلزایمر و سالمندان طبیعی وجود دارد. همچنین، نتایج نشان داد که میزان استفاده از هر دو نوع پیوستگی فراگیر و پیوستگی موضعی در گفتمان سالمندان کُردزبان مبتلابه زوال عقل نوع آلزایمر از فراوانی کمتری برخوردار است، اگرچه نبود پیوستگی فراگیر مشهودتر است.The Discourse of Elderly People with Alzheimer ’s-Type Dementia: Conversational Coherence
Coherence is one of the discourse-building features whose absence in the discourse of the elderly people with senile dementia of the Alzheimer’s type causes their discourse to become misunderstood. So, the present study aims to investigate coherence in the discourse of Kurdish Alzheimer’s type dementia. The methodological nature of this quantitative study is ex post facto type and the statistical population of this study includes 20 subjects (10 senile dementia of the Alzheimer’s type subjects and 10 normal elderly subjects) who were matched by age (63-75), gender (male/female), illiteracy, and native Kurdish (Kalhori dialect) speaking. To determine the severity of dementia, the Clinical Dementia Rating Scale was administered and subjects with the scores between 0.5 and 2 were selected. Then subjects answered questions about their daily routines, families, and celebrating Eid-e Nowrouz. The data were analyzed based on Laine et al.’s view and SPSS 16.0, and an independent T-test was used to obtain the statistic results. The findings indicate that there is a significant difference between the discourse of senile dementia of the Alzheimer’s type and normal elderly subjects in the use of global coherence with P=0.004 and local coherence with P=0.003. The results showed that the use of global and local coherence has less frequency in the discourse of senile dementia of the Alzheimer’s type subjects; however, the absence of global coherence is more obvious. In other words, local coherence occurs more frequently than global coherence. Introduction Aging, an inevitable biological process, often coincides with various neurological disorders that accelerate cognitive decline. Among these, Alzheimer’s disease (AD) is a prevalent form of dementia characterized by progressive memory loss, cognitive impairments, and communicative breakdown. As language is deeply intertwined with cognition, linguistic deterioration is a salient marker of Alzheimer’s disease often observed in both micro- and macro-linguistic dimensions of discourse. One of the key dimensions affected in Alzheimer's-type dementia is the disruption of discourse coherence—a foundational feature enabling the logical and meaningful flow of conversation. While numerous studies have explored lexico-semantic and syntactic impairments in AD patients, relatively less attention has been paid to discourse-level deficits, especially in understudied languages and dialects. The study addresses this gap by focusing on coherence structures in the spontaneous speech of elderly Kurdish speakers (Kalhori dialect) diagnosed with Alzheimer's-type dementia. This research is significant for two reasons. First, it investigates an underrepresented linguistic population. Second, it contributes to the understanding of discourse-level impairments in Alzheimer’s disease by specifically analyzing local and global coherence, two critical constructs in discourse organization. This study explores whether patients with AD exhibit significantly different patterns of coherence in their speech compared to cognitively healthy elderly speakers. Literature Review Discourse coherence encompasses the logical, thematic, and referential connectivity between utterances. It is often divided into local coherence (relationships between adjacent sentences or utterances) and global coherence (thematic consistency across the entire discourse). Van Dijk (1980), Glosser and Deser (1990), and Laine et al. (1998) have provided theoretical frameworks for understanding these coherence types in neurodegenerative contexts. Prior studies (e.g., Ripich & Terrell, 1988; Dijkstra et al., 2002; Kim et al., 2019) have consistently found that AD patients exhibit marked reductions in both coherence types, particularly in global coherence. These impairments are attributed to disruptions in working memory, semantic memory, and executive functioning. In Persian-speaking populations, Golbaz (2007) and Farivar et al. (2019) reported similar coherence deficits in AD patients using narrative and conversational tasks. Furthermore, Lai & Lin (2014) and De Lira et al. (2019) emphasized that coherence impairments, especially in global organization, occur early in the disease course. These impairments often precede more overt syntactic or lexical deficits, highlighting the diagnostic utility of discourse analysis. The current study draws from this body of work while addressing a distinct linguistic and cultural context: elderly, illiterate Kurdish speakers with Alzheimer’s in western Iran—a group previously neglected in psycholinguistic research.The review goes under these subheadings. Methodology This was a quantitative, ex post facto (causal-comparative) study designed to compare discourse coherence in two groups of elderly individuals: those diagnosed with Alzheimer’s-type dementia (n = 10) and the cognitively healthy members of the control group (n = 10). All participants were monolingual speakers of Kurdish (Kalhori dialect), aged between 63 and 75, illiterate, and balanced by sex (5 males and 5 females per group). Participants were selected from a nursing home in Kermanshah, Iran, during the winter of 2019. The Clinical Dementia Rating (CDR) scale was used for cognitive screening, and only those with scores between 0.5 and 2 (indicating mild to moderate dementia) were included in the Alzheimer’s group. The control group had CDR scores of 0. Participants engaged in 10-minute semi-structured interviews conducted in Kurdish, addressing topics such as family life, daily routines, and Nowruz celebrations. Responses were audio-recorded, transcribed, and phonetically transcribed. Prolonged pauses (> 20 seconds) were used as cues for question progression. The data were segmented into propositional units (utterances or speech turns). Using Laine et al.'s (1998) framework, each utterance was coded for the presence or absence of local and global coherence. Statistical analyses were conducted in SPSS 16 using an independent t-test to assess differences between the two groups. Results The Alzheimer’s group produced significantly fewer non-repeated words (M = 172.4; SD = 36.5) than the control group (M = 425.4; SD = 123.1). The number of utterances was also lower in the Alzheimer’s group (M = 7.72; SD = 2.01) compared to the control group (M = 23.21; SD = 6.23). Local Coherence: The AD group exhibited a mean score of 59.85 (SD = 11.18), significantly lower than the control group (M = 98.85; SD = 0.86), p = 0.003. Global Coherence: The mean score for the AD group was 40.91 (SD = 10.93), compared to 97.84 (SD = 1.25) in the control group, p = 0.004. Examples of disrupted coherence included irrelevant or off-topic responses, as well as fragmentary or semantically unrelated utterances. While some responses preserved local coherence (e.g., direct answers to questions), they failed to maintain the overall topic, indicating global coherence breakdown. For instance, in response to "Where were you born?" a control participant said, “I was born in Qasr-e Shirin,” maintaining both local and global coherence. In contrast, an AD participant responded, “I had some problems,” showing a loss of global relevance. Global coherence was more impaired than local coherence. Patients with AD relied heavily on immediate lexical cues (suggesting preserved local associations), while struggling with maintaining thematic progression or returning to the topic after digressions. Gender differences were minimal, though a slight trend showed female participants using less global coherence, aligning with prior literature. Conclusion This study underscores the debilitating effects of Alzheimer’s-type dementia on discourse coherence among elderly Kurdish-speaking individuals. The findings demonstrate that both local and global coherence decline significantly in affected individuals, with global coherence being more severely compromised. These results confirm the crucial role of working memory and semantic integration in sustaining coherent discourse. The disruption of global coherence indicates that patients with AD are unable to maintain a mental representation of the ongoing discourse topic, leading to communication breakdowns. The study's implications extend to clinical linguistics, dementia diagnostics, and caregiving strategies. Discourse analysis may serve as a non-invasive, language-based tool for early detection of cognitive decline. Moreover, the study highlights the need for culturally and linguistically tailored assessment tools for minority language speakers.
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