Book Review: Alzheimer Talk, Text and Context: Enhancing Communication

Abstract

Alzheimer Talk, Text and Context constitutes a diverse collection of contributions by authors from a wide range of disciplinary and experiential backgrounds. As such, practitioners, researchers, and the lay public alike should all find something to advance their thinking and practices on a variety of issues related to the contexts and challenges of communication between persons with Alzheimer’s disease (AD) and their conversational partners, as well as strategies for intervening to improve communication. This volume is unique in that the majority of reported investigations were based on data collected as part of a longitudinal digital corpus of spontaneous conversation entitled the “Charlotte Narrative and Conversation Collection.” Data in the corpus have been collected since 1999 at intervals of once or twice a month, and are now available to researchers on the World Wide Web (http://newsouthvoices.uncc.edu/index.php). While this corpus includes conversational data from noncognitively impaired individuals in addition to persons with AD, the contributors to this volume drew primarily from the data of four residents with AD who resided in a not-for-profit retirement living community that included an Alzheimer’s wing. The conversations involving these residents with AD, although spontaneous, were guided for the most part by “experienced communicators” or educated interviewers. The majority of authors used qualitative descriptive and/or discourse analytic methods for the purposes of describing and interpreting the use and consequences of different aspects of language in particular sociocultural contexts. The book is divided into two parts: I. Talk and Text, and II. Text and Context. The contributed chapters, however, vary in the extent to which they relate to each part. Within each part, there is no apparent logic to the sequencing of the chapters, other than the Introduction (Davis) and Epilogue (Hamilton). Part I emphasizes the “social-relational” (e.g., identities) as opposed to the informational dimension of communication. The emphasis in part II is less clear, although it begins with a chapter on communication challenges and interventions (Byrne and Orange, Ch. 9) and is followed by several chapters advocating ways in which written text (Ryan, Spykerman, and Anas, Ch. 10; Russell-Pinson and Moore, Ch. 12) and/or information technology (Green, Ch. 11) can be used to promote effective communication with and for persons with AD. The quality of writing across chapters is generally quite good, and there are few editorial oversights. Content-wise, there are several complementary threads woven into the fabric of this collection: 1) social interactionist and constructivist approaches to understanding the complexities and outcomes of interpersonal communication; 2) promoting positive meaningful communication through affirming and supporting identity and personhood in AD; 3) the identification of strategies, activities, and contexts that may serve to enhance communication with persons who have AD; and 4) interand intraindividual variability in the communication behaviors of individuals with AD. The strengths of this volume include the multifaceted approaches that authors took in addressing both declines and abilities of persons with AD. On the one hand, a number of specific linguistic or discourse structures were identified that could be potential targets in developing compensatory intervention strategies. On the other hand, the effectiveness of compensatory strategies are presumably mediated by the relational context in which conversation takes place, in particular, the ways in which interlocutors position the person with AD. In this regard, the appeal of “lifecourse” (Shenk, Ch. 1) and “personhood” (Ryan et al., Ch. 2) approaches to communication is that they draw out and affirm individuals’ self-worth, strengths, desires, stories, and their past and ongoing contribution to the world around them. Such perspectives counteract the prevailing deficit-oriented social and biomedical construction of AD and replace these with meaningful reciprocity. In addition, as mentioned by Ryan and colleagues (Ch. 2), identity and personhood issues are relevant to any and every communication context, whereas the effectiveness of specific compensatory strategies (e.g., the form of a question) may change depending on contextual variables. Thus, interventions designed to facilitate communication would do well to