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Despite playing a major role in laying the theoretical foundations for many of the humanities and social sciences, interest in linguistics has waned over the last 20 years. The decline of structuralism, coupled with the rise of both cognitive sciences and communications theory, means that the subject is increasingly limited to strictly academic circles; even in this restricted context, it can be hard to convince funding bodies of the utility – that allimportant, overriding criterion – of linguistics projects. It would be wise to note the significant role played by linguistics in the fields of natural language processing (e.g. in search engine development, automatic translation, etc.) and in foreign language teaching, where it plays a supporting, but no less essential, role. In this book, we have chosen to focus on a field of application in which linguistics plays a supporting role, providing theoretical insights into a domain of expertise. The application of linguistics to the field of medicine is
relatively novel, and not without its risks; success is not guaranteed.
Jakobson highlighted this issue in his 1963 conference presentation on aphasia (1969, p. 133):
“I make no claim to expertise in pure linguistics, psychology or medicine; as such, my comments will be limited to linguistic observations of linguistic facts, and no more”. Similarly, in this book, we have chosen to focus on two aspects: 1) The detection of Alzheimer-type dementia (and, consequently, of certain related conditions) using cognitive testing. We will not go into any detail concerning other methods of investigation, whether of the phenomenological type (perception through oral questioning or questionnaires) or of the strictly experimental type. Instead of the head-on approach used by neuropsychologists, speech therapists and geriatric specialists, we have chosen to view the problem from a different angle, focusing on providing support for diagnosis. We shall concentrate on one simple question, asking whether or not language-based cognitive tests are well-designed in linguistic terms, and whether they provide sufficient information. We ask whether these tests are supported by findings from the field of linguistics, particularly with regard to textual semantics. Evidently, even if this is not the case, it is not our intention to pass judgment on the practices of healthcare professionals.
2) An investigation of the linguistic characteristics of speech in patients suffering from Alzheimer’s disease. This more “conventional” study aims to provide a thorough inventory of traces of amnesic troubles in patient speech, and of the strategies used by sufferers to work around these problems. This book follows a relatively predictable plan, beginning with a review of the limited number of existing studies which consider various pathologies from a linguistic perspective. Next, we shall give an overview of the linguistic symptoms of Alzheimer’s disease, touching briefly on other related conditions. Chapter 3, which forms the basis for the rest of our work, consists of a detailed examination of diagnostic tests, beginning with general tests before moving onto those which focus more specifically on speech in the context of memory-related pathologies. The majority of our critical remarks, along with suggestions for improvements, are found in this section. We highlight a number of promising new pathways, while giving further consideration to certain ideas which have only briefly been touched upon in the literature and which, in our view, merit further investigation.
For instance, the textual dimension of information encoding produces a large volume of recall cues, but is systematically excluded from test procedures in favor of a less “ecological”, more symptomatic and more “evocative” approach. Similarly, cultural differences are generally ignored and left open to interpretation by the practitioner. Our intention is to carry out a more in-depth investigation of these possible pathways, although we make no pretense to verify these hypotheses in practice or produce new tests as a function of our findings. Chapter 4 of this book concerns recent developments in the domain of patient speech, touching on the notions of corpus linguistics and on the studies of interviews carried out with Alzheimer’s patients in a clinical context. This chapter includes several extracts from interviews which we carried out: in these transcripts, we attempt to identify characteristic features of patient speech, relating to syntax, semantics or other areas. Due to our own professional background, we focus on this latter consideration, particularly in terms of confabulation analysis.
This book contains the critical reflections of a linguist concerning a field of application which, at first glance, lies far outside his area of expertise. In presenting these observations, we aim to stimulate reflection and debate on the subject, with the aim of improving the lot of patients. Our experience of working alongside neuropsychologists and speech therapists has led us to believe that such progress is eminently possible. Evidently, the ultimate goal of our work is to contribute to the improvement of diagnostic tests, using findings from linguistics to fine-tune practical approaches. Furthermore, we hope that our speech analyses will help caregivers to better support and better understand patients, improving communication. This work may be of interest to non-specialist readers who have encountered cognitive testing procedures in the past (e.g. friends and relatives of dementia patients) or who simply wish to know more about specific characteristics of the speech of Alzheimer’s sufferers; to this end, we have chosen to write in a very direct style with as little jargon as possible. As we shall see, this book makes no claim to exhaustivity, and our analyses may lay the foundation for future work, finally responding to the decades-old call issued by Hatfield (1972): “Looking for help from linguistics”.