Facilitating Conversation in Elderly Persons with Alzheimer's Disease

Deterioration of verbal abilities is among the most debilitating consequences of Alzheimer's disease (AD). Recent research suggests that the common responses of conversational partners may contribute to excess verbal deficits in persons with AD in that they function to punish verbal behavior. The purpose of this study was to systematically evaluate two types of listener repair responses, indirect and direct repairs, on the conversational speech of older adults with AD. In an indirect repair, the listener paraphrases the speech of the person with AD. In a direct repair response, the listener interjects with corrective feedback. Three men diagnosed with AD participated in this study. A female confederate was trained in indirect and direct repair responses. An ABAC single subject design was used to evaluate the effects of listener repair responses on the amount, duration, and fluency of the speech of the participants during videotaped conversations with the confederate. The results indicate that the confederate's responses significantly impacted the conversational speech of older adults with AD. Indirect repair responses by the confederate were associated with higher levels of coherent speech for all participants compared to the direct repair and baseline conditions. The results indicate that indirect repair responses may decrease the risk of excess verbal deficits in persons with AD by functioning to reinforce (i.e., increase) speech. The findings have implications for the training of care-givers of persons with AD. Training caregivers in responses that reinforce rather than punish verbal behavior may prevent or reduce excess disability thereby improving the quality of life for persons with AD and their care-givers.