Authors: Arkin S, Mahendra N
Title: Discourse analysis of Alzheimer’s patients before and after intervention: Methodology and outcomes
Source: Aphasiology 2001 5(6): 533-569
Year: 2001
Research Design: Non Randomised Controlled Trial
Rating Score: 04/10
This rating is confirmed
Eligibility specified - Y
Random allocation - N
Concealed allocation - N
Baseline comparability - Y
Blind subjects - N
Blind therapists - N
Blind assessors - N
Adequate follow-up - Y
Intention-to-treat analysis - N
Between-group comparisons - Y
Point estimates and variability - Y

This articles describes a content-focused easy-to use method of analyzing the discourse of Alzheimer's patients. It also reports results of the method's application to the to the discourse of seven Alzheimer's patients before and after two semsters of participation in different version of a multi-modality intervention program. Eight discourse prompts, representing five different discourse types were used. Rules for demarcating respondents' transcripts into utterances are presented. Three classes of codes - positive, neutral, and negative- are described. Discourse-based outcome measures used were ratio of topic comments to total utterances (TC/U), ratio of different nouns to total nouns (DN/TN), and ratio of vague nouns to total nouns (VN/TN). Other outcome measures were information units (IUs) produced on a picture description task and scores on a mental status test (MMSE) and a standardized language test battery (ABCD). All participants received physical fitness training and, during the second semester, a weekly session of supervised volunteer work. Experimental participants received, in addition, a prescribed set of memory- and language-stimulation exercises during their fitness workout; control participants experienced unstructured conversation during that time. Experimentals outperformed controls on the MMSE and the DN/TN ratio. Neither group declined significantly on the ABCD, TC/U ratio, and VN/TN ratio. Both declined by three IUs on the picture description task, but only the control group's decline was significant. Between-group difference was significant only on the DN/TN ratio. Two experimental participants increased and two had the same MMSE score; three declined. All four controls declined. Discourse assessment is an ecologically valid method of monitoring change in Alzheimer's disease.

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