A Functional Approach To The Discourse Of The Alzheimer's Patients

The present study has two purposes. The first purpose is to theoretically address the Systemic functional linguistic (SFL) motive and approach of clinical discourse analysis. The second purpose is to practically conduct a discourse analysis of the Alzheimer's patients within the framework of SFL and to provide linguistics evidence for the assessment and intervention of the Alzheimer's disease.Studies of language disorder are both theoretically and practically significant in our times. So far as the theoretical significance is concerned, the findings of clinical linguistic studies are valuable supplements to the mainstream linguistics. In the meantime, disordered language is a touchstone which serves to the test, remediation and development of the mainstream linguistic theories. In terms of the practical value of language disorder studies, a linguistics-based study of the disordered language would make a clear and accurate assessment of the language functions of the clinical population. A linguistics-based assessment of the language function is essential for the medical diagnosis and intervention of language disorders. Furthermore, it serves as the evidence for making feasible plans and approachable goals for language function remediation. Clinical linguistic studies abroad have reached to all the disordered syndromes and made great achievements in the past few years. In comparison to the prosperity of clinical linguistic studies abroad, we are falling far behind in the scope of certain disordered areas, the research staff, the bank of material, academic journals and references. Currently, Chinese clinical linguistic studies are focused on aphasia and sign language, for other language disorders, such as stuttering, cleft palate, autism and other brain damage induced or disease induced disorders like Specific Brain Impairment and the dementia of Alzheimer's type are not yet given due recognition. Meanwhile, Chinese clinical linguistic studies are pragmaticism guided which pay more attention to remediation rather than theory construction.Conventional clinical linguistic studies were mainly conducted under the guidelines of structural linguistics and generative grammar which focused on phonology, lexicon and syntax and discarded the social context of authentic language use and meaning making. The tendency of clinical linguistic studies is to analyze the disordered language users' discourse and synthesize the social and cultural contexts in the analysis. Meanwhile, cross language performance of the disordered language users is now becoming an emergent area in clinical linguistic studies. In taking the authentic language use and context into consideration, clinical linguistic studies are called to be conducted on discourse level rather than sentence level. The analytic framework of this thesis is the systemic functional linguistics (SFL) for its unique advantages in discourse analysis. The aims of the study were a multi-dimensional investigation of the mild Alzheimer's narrative description of the Cookie Theft Picture. The analyses of the Alzheimer's disease were carried out in accordance with SFL's metafunctions, i.e. ideational, interpersonal and texture with detailed tagging of the discourse in the quantitative and qualitative analyses. The metafunctional analyses of the discourse of the Alzheimer's patients have made it possible to deal with the discourse from clause to text which yielded a comprehensive assessment of the language function of the Alzheimer's patients.Firstly, the textural metafunction of the discourse was analyzed in the markedness of themes, the patterns of theme progression and multiple themes. Secondly, the analyses of the interpersonal meanings of the discourse were carried out in mood, modality and appraisal system. Thirdly, the ideational meanings of the discourse were analyzed in transitivity system with special attention given to the construction of participant and circumstance of the clause. Fourthly, the thesis gave a detailed analysis of the cohesion and coherence of the Alzheimer's patients'discourse in three aspects, i.e. discourse building, cohesion and discourse impairment. SFL provides a unitary framework for discourse analysis, but the three metafuntional analyses of the discourse needed different tagging of the samples. In order to meet the goals of the study, the discourse samples were finely tagged.In terms of theme analyses, the results showed that both the Alzheimer's subject and their counterpart used less marked themes as the departure of the clauses which indicated that both groups tended to use unmarked themes. In theme progression, both groups tended to use linear and iterative patterns and there was no significant difference in linear progression. The mildly demented group used more iterative theme progression which indicated that they might have difficulty in vocabulary retrieval. In multiple theme analyses, the study found no multiple themes which were constructed with textural, interpersonal and ideational elements and most of the multiple themes consisted of interpersonal and topical elements which indicated a simplified multiple theme construction of both groups.Interpersonal meaning analyses were conducted in three aspects. Mood analysis investigated the construction of subjects and complements of the clause. The results showed that in constructing subjects and complements, both groups tended to use simple nominal groups and the difference was that the mildly demented group's nominal groups were less specific and informative. The demented group frequently used superordinate and deictic terms to denote target nouns. The most frequently used superordinate term was thing, the deictic terms were that and this. The findings in the way the demented group constructing their subjects indicated a less efficient retrieval of the noun. The modality analyses investigated the use of auxiliary modal verbs in both groups'discourse. The results showed that in representing the speakers'modal meanings, the mildly demented group used more modal auxiliary verbs and most of the verbs were median and low value ones which meant that the mildly demented subject were less certain about their discourse and they took a negotiating stance in their speaking while their counterpart were more confident in their speaking. The appraisal analyses investigated the subject's semantic resources used to express their attitudes. The results indicated that the mildly demented group did not use appraisal resources in their discourse while the control group made frequent use of this semantic resource. The findings of appraisal analyses reflected a poor semantic resource of the demented subject in expressing their attitudes because of semantic impairment.In transitivity analyses, the study first made an analysis of the processes of the clauses in both groups'discourse. The results showed that both groups were capable of producing all the process types with material, relational and mental processes as the major ones. Secondly, the study investigated the construction of participant and circumstance of the major process types which found that in representing participants and circumstances, the complexity of these two categories of the mildly demented group was much lower than that of the control group. The mildly demented group used more simple nominal groups in representing participants and circumstances. In the complex nominal groups the mildly demented groups used, a lack of modifier, classifier or qualifier of the head nouns could be found which indicated that the discourse of the demented was not as specific and informative as that of the control group.In cohesion and coherence analyses, the study aimed to find out the correlations between discourse and the semantic and working memory of the mildly demented Alzheimer's patients. The analyses were conducted in three aspects, i.e. discourse building, cohesion and discourse impairment. The results showed that in discourse building and cohesion, the mildly demented group used less linguistic resources to build their discourse. The mildly demented group's topic maintenance and global coherence were impaired. In discourse impairment, the mildly demented group was worse in all the categories and in their discourse we found abrupt topic shifts. The analyses and findings indicated that there was a correlation between discourse coherence and semantic and working memory since the coherence of the discourse must be realized by the appropriate used of semantic devices. In order to maintain a global coherence, the speaker had to make good references and connections between clauses, an impaired working memory prevented the speaker from maintaining the wholeness and harmony of his or her discourse. The healthy counterpart of this study did not have the problem of maintaining discourse global coherence.The thesis consists of ten chapters. The first chapter is an introduction to the background, purposes, significance and data collection of the study. So far as the significance of the study is concerned, two points are taken into consideration. The first is to make an organic integration of SFL and clinical linguistic studies. The second is to provide linguistics evidence for the diagnosis and assessment of the early Alzheimer's disease.The second chapter is to give a review of the literature pertaining to the present study. This chapter first defines the clinical linguistics and its scope and the approach to do clinical linguistic studies. Secondly, the author gives a reasoned discussion of the guiding linguistic theory of this study. Meanwhile, a discussion of the motive and access of doing clinical discourse analysis under SFL will be given in this chapter.The third chapter is a discussion of the theoretical foundation of the present study. Firstly, this chapter gives a critical review of the implication of SFL for discourse analysis of the Alzheimer's patients. Secondly, the chapter discusses the linguistic guidelines for clinical discourse analysis. Thirdly, an SFL motive and approach of doing clinical discourse analyses would be elaborated.Chapter Four elaborates the methodology of the study. The key points of this chapter are the tagging of the samples, the demographic information of the subject and the specific methods of discourse analysis used in this study. Generally speaking, both quantitative and qualitative methods would be employed in the study because the aim of the thesis was to make a multi-dimensional analysis of the samples.The fifth chapter is the analyses of theme in the discourse of the Alzheimer's patients. Specifically, the analyses are made in three ways, i.e. the markedness of theme, the patterns of theme progression and multiple themes. In the analyses, the differences between the mildly demented and their counterpart in the above aspects would be addressed.Chapter Six "A cohesion and coherence analysis of the discourse of the Alzheimer's patients" is carried out in three categories, i.e. discourse building, cohesion and discourse impairing. The aim of this chapter is to build an organic correlation between Alzheimer's patients' discourse and their semantic and working memory.Chapter Seven is the analyses of the interpersonal meanings of discourse of the Alzheimer's patients. The study is carried out in three aspects, i.e. mood, modality and appraisal system. The mood analysis which focuses on nominal groups resonates well with the transitivity analysis in Chapter Six. While the modality analysis would give us a thorough understanding of the stance and certainty of the speakers' discourse, the appraisal analysis makes it possible to evaluate the quality of the discourse in terms of semantic resources.The eighth chapter is a transitivity analysis of the discourse of the Alzheimer's patients. The focus of the analysis is the construction of participant and circumstance in terms of nominal groups. As previous studies have pointed out that the Alzheimer's patients have difficulties in naming, the participant and circumstance analysis would make a better assessment of the nominal resources of the Alzheimer's patients.Based on the findings in quantitative and qualitative analyses, the nineth chapter makes discussions on the results and finds out the implications of the analyses.Chapter Ten concludes the thesis with a discussion of the limitations of the study and suggestions for further research.