On this week’s episode, Dr. Kimberly Mueller helps explain connected language and how studying conversations can help detect early signs of cognitive impairment. Guest: Dr. Kimberly Mueller, Assistant Professor Department of Communications Sciences and Disorders, University of Wisconsin-Madison
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Transcript
Intro: Welcome to Dementia Matters, a podcast presented by the Wisconsin Alzheimer's Disease Research Center. Our podcast is here to educate you on the latest research, caregiver strategies, and available resources for fighting back against Alzheimer's disease. I'm your host, Nathaniel Chin. Thanks for joining us.
Dr. Nathaniel Chin: Welcome back to Dementia Matters. I'm pleased to be here with Dr. Kimberly Mueller. Dr. Mueller, thank you for joining us.
Dr. Kimberly Mueller: Thank you for having me.
Chin: Now, Dr. Mueller is an assistant professor at the Department of Communication Sciences and Disorders at UW–Madison. She received her master's degree in speech-language pathology from Columbia University and worked clinically as a speech language pathologist with children and adults in New York City for nine years before moving to Madison in 2005. She started working in research at the Wisconsin Alzheimer's Institute in 2006 and earned her PhD in 2017 in communication disorders with a focus on preclinical Alzheimer's disease. Dr Mueller's work is focused on understanding how and when speech changes on the Alzheimer's disease continuum and what cognitive and communication therapies can be effective in preventing or slowing the progression of cognitive decline. To begin, Dr. Mueller, talk to me about language changes in someone with mild cognitive impairment and dementia due to Alzheimer's disease.
Mueller: I think it's first important to talk about what we know about changes to language in normal aging. You might notice, and you probably will notice, that word finding becomes a little bit more difficult. You might start to experience this tip-of-the-tongue phenomenon, where you have the word there but it's just hard to pull it out, but also in normal aging people's vocabulary actually increases throughout the lifespan. You wouldn't see a loss of vocabulary; it just is a little bit harder and takes a little bit more time to retrieve the words but they don't go away in normal aging.
Chin: That's a really tricky thing because one of the most common complaints in my clinic is, “I'm having a hard time finding words.” Sometimes that can be explained by other conditions or just a part of normal aging?
Mueller: That's right, yes. So in normal aging, though, if you're having trouble retrieving a word, typically what happens is it'll come back to you. It'll either come back to you in a few seconds in a few minutes or maybe even later on when the conversation's well over and then you think of it and you get kind of mad that you thought of it later. In mild cognitive impairment or some other cause of a real word retrieval problem, the word actually really might not come back to you and it can be disruptive to the conversation, so meaning where the word retrieval problems are more frequent than what you would see in normal aging. The difficulty might cause someone to sort of change the subject or talk around the word in a way that makes it difficult to follow what they're trying to say. Then these problems get progressively worse as mild cognitive impairment might progress toward dementia. In early dementia, the word retrieval problems are very severe and cause a lot of this circumlocution, or people start to talk around things to a point where the the conversation gets really disrupted and it's kind of hard to follow the thread of what that person is saying.
Chin: Well some of your research is focused on what's called connected language. Could you explain, to me and the audience, what is connected language and how does that relate to researching cognition?
Mueller: Yeah, so typically if you're getting a language test and someone wants to see what your language is like, it might be where you show a bunch of pictures and ask people to name things. That's one way of testing language. Connected language is actually just having someone talk like we're doing here, and in that way you can kind of more assess, maybe if someone is having word-finding problems, what is the impact on actually having a conversation. It's a more functional way of looking at language in context so in conversation.
Chin: Well I sure hope you're not assessing me right now.
Mueller: Absolutely not. (laughs)
Chin: I must tell you I did not have all the coffee I usually drink, so if I'm a little bit slow let's not count that. I imagine in your field though you must listen to conversation and at times wonder if a person's sentence structure or how they're communicating might be abnormal.
Mueller: Sometimes I do but I think the key to understanding connected language, or using connected language as a way of assessing someone, the key really is looking at how that person's connected speech changes because everybody has different communication styles, different ways of speaking. It's really difficult to just assess someone on one time of hearing them. Rather you want to look at how it might change over time.
Chin: I see. What I like about this connected language is that it's really nerve-wracking and anxiety-inducing to go in for brain testing –
Mueller: Yeah.
Chin: – and, in general, people are fearful of the, “I have to remember 15 words and I have to remember them 20 minutes later and recall as many as possible.” That's stressful but what you're proposing with connected language is that some someone simply sitting down with you and talking. You're obviously guiding the conversation right but you can assess a person's language function based on that conversation.
Mueller: Yeah, I think, more so, I can assess – or one can assess – the change in how possible brain changes are impacting on a functional activity, yeah.
Chin: Well so what has your research shown, as far as connected language and the very earliest cognitive changes in people who may or may not have actual complaints?
Mueller: The people that I've been studying are part of the Wisconsin Registry for Alzheimer's Prevention, or the WRAP study. These participants are healthy; they do not have dementia. They are at risk because they had a family history of dementia but by and large they're healthy and on the younger side, roughly around 64 years old at this point. I've been looking at their spontaneous speech or their connected language for several years now at several different time points. What I'm seeing there is that basically that people who are showing changes to their memory based on those other tests that you talked about – the word list learning and those other kinds of difficult tests – people who are showing kind of declines in those tests that we wouldn't expect for normal aging are also showing changes in their connected speech. The kinds of changes that I'm seeing at this very early stage are not so much that there's apparent word-finding problems where their sentences are kind of empty like we might see in dementia. Rather they might just be taking a little bit longer to express the same amount of ideas and words as previously. Then also there's this kind of increase in what we call disfluencies or pauses or the use of these kind of filled words like “um” and “ah,” which are completely normal for regular conversation. If you listen to these speech samples, you wouldn't normally – you wouldn't actually pick up on anything wrong but if you look at that person changing over time, they're showing an increase in those behaviors more than those people who are not changing in their memory.
Chin: Clinically, the word finding, the word substitutions, the inability to complete sentences, those things are what impact a person with disease. Being able to identify those subtle changes and potentially find targets and interventions would be very meaningful for a person who already has Alzheimer's disease in his or her brain.
Mueller: That's right and that's the other part of my research that I'm really excited about looking into. By understanding these changes and when they're happening, speech-language pathologists have done lots and lots of research about stroke and the language – the abrupt language change that happens with stroke and how to help a person improve their quality of life after losing language. for example, kind of abruptly. There are lots of treatments for that, which is often called aphasia where someone has trouble producing language anymore. There are lots of evidence-based language treatments that speech pathologists have been using for decades on people with stroke. Less is true for dementia. It's a degenerative condition but that doesn't mean that we can't help people come up with either strategies for communicating more effectively or use some of these evidence-based treatments in someone with mild cognitive impairment or early dementia to actually improve word retrieval, for example. That's what I want to study in the future is are these targeted language interventions – word recall, for example, intervention – could these actually improve the quality of life, the quality of communication.
Chin: Well then a question I get frequently in clinic is, can people improve their language function by doing certain games or activities? What would you recommend to people if they wanted to make an effort to improve or prevent language decline?
Mueller: That is a good question. As I alluded to earlier, I think that there definitely needs to be more research in that to kind of understand, would focal language exercises actually improve language either in normal aging or in cognitive decline. I don't think there's enough evidence to say for sure one activity over another, but in general cognitive engagement – whether it's learning a new language or engaging in weekly discussions with friends about politics or just social interaction where you're having back and forth conversations – all of these things we think are going to be helpful for overall cognitive function. Whether or not that actually helps word retrieval is kind of an unknown in the field and a really good question. I think the best recommendation is to do things that engage your brain that you enjoy and that you're more likely to want to do and continue to do. If it involves other people, that's even better.
Chin: I think you touch on a really good point, which is it should be enjoyable. It should be something that you want to do and not feel forced to do, but it sounds like it's more than just an activity. Often people will say, “Well, I do a lot of crossword puzzles or word games.” I always respond, well if that's what you enjoy doing, that's great, but you're also saying simply having a meaningful conversation with other people is still in essence working that language function within your brain.
Mueller: That's exactly right. One thing that we see in mild cognitive impairment and early dementia is a withdrawal from those kinds of conversations. Just like you might want to encourage your loved one who might be experiencing memory problems to exercise more, for example, if there's some way you can engage them in conversations more as well or make an effort to do that, I think it will be beneficial for their actual engagement in life and conversation
Chin: Well, that's wonderful and it sounds to me like people should really have walking clubs and walk and talk at the same time.
Mueller: That sounds really good, yes, yes.
Chin: Well I want to thank you, Dr. Mueller, for coming on the show. When you have more evidence and more data that we can all benefit from, we'll have you come back.
Mueller: I would love that. Thanks so much for having me
Outro: Please subscribe to Dementia Matters on Apple Podcasts, Spotify, Podbean, or wherever you get your podcast. And rate us on your favorite podcast app; it helps other people find our show and lets us know how we're doing. Dementia Matters is brought to you by the Wisconsin Alzheimer's Disease Research Center. The Wisconsin Alzheimer's Disease Research Center combines academic, clinical, and research expertise from the University of Wisconsin School of Medicine and Public Health and the Geriatric Research Education and Clinical Center of the William S. Middleton Memorial Veterans Hospital in Madison, Wisconsin. It receives funding from private university, state, and national sources, including a grant from the National Institutes of Health for Alzheimer's Disease Centers. This episode was produced by Rebecca Wasieleski and edited by Bashir Aden. Our musical jingle is "Cases to Rest" by Blue Dot Sessions. Check out our website at adrc.wisc.edu. You can also follow us on Twitter and Facebook. If you have any questions or comments email us at dementiamatters@medicine.wisc.edu. Thanks for listening.
