AAC to Support Conversation in Persons with Moderate Alzheimer’s Disease

Abstract

Even though we know that external memory aids support communication in Alzheimer’s disease, the components of the communication aids for individuals with Alzheimer’s disease have not been studied systematically. The goal of these two pilot experiments was to examine differences in conversational performance of adults with Alzheimer’s disease related to the presence and absence of an aid, the type of symbol embedded in the aid, and the presence or absence of voice output. In Experiment 1, 30 adults with moderate-to-severe Alzheimer’s disease participated in 10-min conversations with and without personalized AAC boards. There was no effect of AAC, regardless of symbol type, and a deleterious effect of voice output. In Experiment 2, modified spaced-retrieval training preceded conversations, standardized prompts were presented, and semantically-based dependent variables were examined. For the 11 participants in the second experiment, there was a significant effect of AAC, showing that the presence of AAC was associated with greater use of targeted words during personal conversations. We discuss new information about the contribution of AAC for persons with Alzheimer’s disease, and demonstrate how the applied research process evolves over the course of a long-term commitment to a scientific investigation.

Keywords::

• AAC
• Alzheimer’s disease
• Dementia
• Aided conversation

Acknowledgements

We acknowledge support from the U.S. Department of Health and Human Services, National Institutes of Health grant R21 HD47754 and P30 AG008017; the U.S. Department of Education,, National Institute on Disability and Rehabilitation Research grant H133G040176; and the 2004 Oregon Tax Check-Off Alzheimer’s Research Grant. We thank the participants and their caregivers for inviting us into their homes and permitting us to document their conversations.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.

Appendix

Examples of 10 Initial Questions and Structured Probes used for every Conversation with Participant GS. Topic: Pets

1. Which family dog played soccer? (Brandy)

Which dog did the neighborhood children ask to play with?

This dog knew where the soccer lines were, what dog was it?

2. Who cooked food for Brandy? (Hannah)

This person never had a dog before so she just cooked its meals?

The breeder was astonished at the dog, who was it that fed the dog?

3. Where did you live when you had Brandy? (Germany)

What country did you live in while you had Brandy?

You worked at a school in this country?

4. What cat would take walks with Brandy? (Sheba)

You had a cat that would walk with the dog?

What cat was it that loved Brandy?

5. Which daughter gave you Sheba? (Kathy)

This daughter had to fly back to US to get the Sheba?

This daughter was in college so she gave you Sheba, who was it?

6. What dog was left abandoned? (Jeeves)

You really didn’t care for this dog at first, which dog was it?

Which dog had some behavior problems?

7. What was Jeeves favorite dog toy? (Stuffed Animals)

He took very good care of this special toy, what was it?

Other dogs would tear this apart but not Jeeves, what was it?

8.You had this breed of dog when you were growing up, what was it? (Scottish Terrier)

This dog is known for being feisty and very loyal?

This dog breed came from a European Island?

9. What is the name of the dog that lives with you now? (Flash)

This dog likes to sleep with you in your bed, which dog is it?

This dog is very friendly?

10. Which daughter does Flash belong to? (Janey)

This daughter lives here with you what’s her name?

She is your youngest daughter?

Notes

1.The Flexiboard software was manufactured by Handitek AB of Sweden, and distributed by ZYGO-USA at www.zygo-usa.com of Fremont, California, USA.

2.The Flexiloader software was manufactured by Handitek AB of Sweden, and distributed by ZYGO-USA at www.zygo-usa.com of Fremont, California, USA.

3.The Microsoft Office Sound Recorder is a product of Microsoft Corporation, Redmond, WA USA.

4.The Intel Integrated Audio is a product of the Intel Corporation Santa Clara, CA USA.

5.Observer 5.0 software developed by NOLDUS (2003) is a product of Noldus Information Technology, Wageningen, Netherlands.