An analysis of trouble and repair in the natural conversations of people with dementia of the Alzheimer's type

Conversational Analysis (CA) is increasingly being used to examine the conversations of people with neurogenic language disorders because it allows for the description of how trouble in a conversation is signalled, how it is repaired and to what extent these conversational repairs are successful. The present study has used CA to investigate the frequency and nature of trouble and repair in conversations between persons with Senile Dementia of the Alzheimer's Type (SDAT) and their communication partners. The study recorded spontaneous conversations between 10 subjects with SDAT and 10 control subjects tall unfamiliar to the SDAT subject). The conversations were audiotaped and later transcribed and analysed according to type of Trouble Indicating Behaviour (12), pattern of Repair Trajectory (6), specific Repair Types (7), and whether or not the repair was successful. The results of the study revealed that the normal partners used a high proportion of interactive trouble indicating behaviours to signal a breakdown in the conversation. Whereas indicating trouble in a conversation was more an interactive enterprise between the two conversational partners, the normal partner assumed a greater burden when negotiating the repair sequence. Paraphrasing was an effective repair strategy used by the normal partners. The subjects with SDAT, however, used more non-interactive trouble indicating behaviours reflecting topic maintenance and elaboration difficulty that contributed to conversational dysfluency and discontinuity. There were more instances of inappropriate repair by the SDAT subjects that were sometimes accepted by the normal partner in an attempt to preserve the self esteem of the subject with SDAT and/or to maintain the flow of conversation. The study's findings highlighted the potential usefulness of CA in recommending communication strategies to the partners of individuals with SDAT that are effective in signalling and repairing conversational breakdown.