When nouns and verbs degrade: Facilitating communication in semantic dementia

Abstract

Background: Little is known about how to maintain communicative effectiveness in semantic dementia as the disease progresses from impairment in word retrieval to a loss of conceptual knowledge.

Aim: The purpose of this study is twofold. The first objective is to characterise communicative effectiveness using a modified framework derived from Chapman and Ulatowska (1997) that integrates two components: codification of ideas (falling on a continuum from verbal to nonverbal and generative to automatic forms) and functions of communication (imaginative, heuristic, informative, personal, interactional, regulatory, and instrumental). The second objective is to outline principles of a discourse intervention that focuses on communicative effectiveness.

Method & Procedures: The participant was Mr Bobby V, a man with semantic dementia. His communication abilities were characterised at diagnosis and 24 months later using the framework of communicative effectiveness, based on discourse samples, clinical observation, and caregiver report. From the time of diagnosis, Bobby V received discourse intervention, which focused on maintaining his communication abilities using all available communication resources. We outline principles of discourse intervention in semantic dementia based on our experience of delivering individual and group intervention to Bobby V.

Outcomes and Results: The communicative effectiveness framework described here could be used to characterise communication skills, set therapy goals, and monitor progress in semantic dementia. Discourse intervention likely facilitated Bobby V's continued success in maintaining communication despite progressive loss of nouns and verbs.

Conclusions: Targeting conversational effectiveness in terms of communicative functions offers a promising and ecologically valuable intervention for people with semantic dementia, as it allows individuals with this form of dementia to connect meaningfully with people in their immediate surroundings well into the later stages of the disease.

We deeply appreciate support from the Frank Garrott Fund, Temple Stark Fund, and other private donors to the Center for BrainHealth, as well as professional support from Anne M. Lipton, Katy Milton, and Garen Sparks. We are profoundly grateful for Bobby V and his wife, who have taught us much about optimism and adaptation in the face of difficulty.

Keywords:

• Semantic dementia
• Discourse
• Communicative effectiveness
• Function
• Intervention

Notes

We deeply appreciate support from the Frank Garrott Fund, Temple Stark Fund, and other private donors to the Center for BrainHealth, as well as professional support from Anne M. Lipton, Katy Milton, and Garen Sparks. We are profoundly grateful for Bobby V and his wife, who have taught us much about optimism and adaptation in the face of difficulty.