Conversational Practices of a Frontotemporal Dementia Patient and His Interlocutors

Abstract

Frontotemporal dementia (FTD) is a dementia difficult to diagnose because, in the early stages, it leaves patients with intact cognitive functioning and a range of social deficits. For example, FTD causes changes in tactfulness and manners, violations of interpersonal space, and emotional appropriateness (Jagust, Reed, Seab, Kramer, & Budinger, 1989). Until recently (for exceptions see Mates, Mikesell, & Smith, in press) these characterizations have come from (a) brief clinical interviews and observations from neuropsychological testing and (b) caregivers' secondhand reports. Given the social nature of FTD, research is needed to examine the ordinary interactions of FTD patients, ones not colored by caregivers' memories or constrained by the structure of a clinic. Using conversation analysis, this article explores two common conversational practices of one patient, SD. This research shows that while SD's practices may appear appropriate in single, isolated turns, they are often inappropriate in more extended sequences. SD can respond locally to individual turns, that is, he can display local understanding, but he often misunderstands the aims of the sequence, often failing to demonstrate understanding. SD, for instance, shows difficulty understanding the interlocutor's goal of open-ended first pair-parts (FPPs) (eg., wh-questions). As such, SD's interlocutors design their talk to adapt to his incompetencies by constraining their FPPs. These constraints are in an attempt to elicit a more appropriate response from SD and enable him to produce a more appropriate response incrementally, turn-by-turn.

Notes

I would like to extend my sincerest thanks to Dr. Mario Mendez, M.D., Dr. Alan P. Fiske, and my colleagues in the Social Relations in Frontotemporal Dementia Research Group, particularly Sam Torrisi, the ethnographer who collected the data from which this research is drawn. I would also like to thank Charles Antaki and three anonymous reviewers, whose feedback was particularly helpful in the revising process. This research would not have been possible without the financial support of the Faculty Research Grant from the Council on Research of the Academic Senate of UCLA and the American Association of University Women (AAUW).

¹This is not the first time this incident happened during this activity. Just before this extract, Extract 21 takes place.

²CT is a nonnative speaker of English.

³SD's wife confirmed that Chicago was indeed where their daughter lived.

⁴As this is an impractical approach for doctors and clinicians who have a responsibility to many patients, social science researchers, particularly those that study interaction and sociality, are needed to better understand the social deficits and behaviors of FTD.