Language-Mixing in Discourse in Bilingual Individuals with Non-Fluent Aphasia

Language-mixing (LM) as defined by Chengappa (2009, p. 417) is an “intra-sentential phenomenon referred to as the mixing of various linguistic units (morphemes, words, modifiers, phrases, etc.), primarily from two participating grammatical systems”. LM is influenced by grammatical, environmental, and social constraints (e.g., Milroy & Wei, 1995; Bhat & Chengappa, 2005). Researchers have suggested that LM in patients with aphasia is a communicative strategy used to achieve successful exchanges between speakers; the effectiveness of this mixing, however, had yet to be demonstrated quantitatively. In the current study we investigated whether LM is present in bilingual speakers with aphasia, and if so, at which linguistic level(s) (morphological, lexical, pragmatic, and phrase) LM is found. Once these questions were addressed, we asked whether the LM patterns were typical or atypical in nature in such individuals. Finally, we investigated the differences in pertinent discourse measures (productivity, dysfluencies, coherence, and communicative success) in bilingual speakers with and without aphasia in order to assess if LM truly helps them to produce a more successful form of communication. A total of 64 individuals – one group of 32 bilingual individuals with non-fluent aphasia and another group of 32 bilingual healthy control participants were recruited from local hospitals in Mysore, India. The study made use of two types of discourse elicitation tasks: personal narratives and picture description. Healthy control and aphasia participant groups were encouraged to mix languages in one condition. Their performance in this condition was compared to when they were constrained from mixing in Kannada-only and English-only conditions. Investigating brain damaged and non-brain damaged bilingual speakers from the same speech community allowed for the interpretation of typical and atypical patterns of language usage. The LM patterns that were similar in both groups, hence typical in nature were direction of LM, LM at various levels, LM frequency across tasks, and LM in different word classes. We observed four atypical patterns of language-mixing in individuals with aphasia: 1) they produced a higher percentage of mixing compared to the healthy control participants; 2) they produced a higher percentage of mixing in the Kannada-only condition than the English-only condition, i.e., they did not follow the instructions provided by the examiner during the Kannada-only condition; 3) they produced Kannada matrix language utterances in the English-only condition, which is atypical in the local Kannada-English speaking community; and 4) they produced more word-level mixing during Kannada-only and language-mixed condition than the English-only condition. It is common practice for clinicians and researchers to promote the usage of two or more languages, as they believe it enhances communication (e.g., Muñoz et al., 1999; Chengappa, et al., 2004). However, in the current study, we found that the ability to use more than one language did not lead to a more successful form of communication. We found that individuals with aphasia produced more morphemes, words, phrases, and utterances when they mixed languages, but they did not score higher on the communicative success and coherence scales compared to when they were constrained from mixing

Dementia diagnosis in seven languages: the Addenbrooke’s Cognitive Examination-III in India

OBJECTIVE: With the rising burden of dementia globally, there is a need to harmonize dementia research across diverse populations. The Addenbrooke's Cognitive Examination-III (ACE-III) is a well-established cognitive screening tool to diagnose dementia. But there have been few efforts to standardize the use of ACE-III across cohorts speaking different languages. The present study aimed to standardize and validate ACE-III across seven Indian languages and to assess the diagnostic accuracy of the test to detect dementia and mild cognitive impairment (MCI) in the context of language heterogeneity.  METHODS: The original ACE-III was adapted to Indian languages: Hindi, Telugu, Kannada, Malayalam, Urdu, Tamil, and Indian English by a multidisciplinary expert group. The ACE-III was standardized for use across all seven languages. In total, 757 controls, 242 dementia, and 204 MCI patients were recruited across five cities in India for the validation study. Psychometric properties of adapted versions were examined and their sensitivity and specificity were established.  RESULTS: The sensitivity and specificity of ACE-III in identifying dementia ranged from 0.90 to 1, sensitivity for MCI ranged from 0.86 to 1, and specificity from 0.83 to 0.93. Education but not language was found to have an independent effect on ACE-III scores. Optimum cut-off scores were established separately for low education (≤10 years of education) and high education (>10 years of education) groups.  CONCLUSIONS: The adapted versions of ACE-III have been standardized and validated for use across seven Indian languages, with high diagnostic accuracy in identifying dementia and MCI in a linguistically diverse context

Language-Mixing, Discourse Length and Discourse Quality in Bilingual Aphasia

Some researchers assert that “normal” mixing of words from one language into another occurs more often in multilingual individuals with aphasia (PWA) than in matched healthy controls (HC) (e.g., Chengappa et al., 2004). In one case-study, language-mixing was seen to help PWA increase their communication (Sebastian et al., 2012). Our discourse experiment compared lexical language-mixing in bilingual PWAs and matched HCs to determine its effects on discourse length and quality. Participants Our participants were 8 Kannada-English speakers, 5 mild to moderate non-fluent aphasia (according to the WAB) (X = 36.4 months post-onset;) and 3 matched controls (Mean age of participants: 57.83; mean years of education: 14.76). Methods Each participant recounted three personal narratives and described three pictures in three language conditions. In the first condition participants were shown a photo of a Kannada-speaker and told in recorded Kannada that the assigned-listener spoke only Kannada, so they should speak only Kannada. The second condition was for English, mutatis mutandis. In the third condition participants heard, in appropriately language-mixed instructions, that the assigned listener was bilingual so they should use both languages. Transcription and Scoring All discourse recordings were transcribed by two bilingual Kannada-English SLPs, inter-rater reliability was assured. Total words per narrative, percent of language-mixed words, and ratings of ‘overall success’ per narrative (1: extremely poor; 7: excellent) were analyzed. Results Overall, the PWA produced fewer total words (X = 43.21) than the HC (X = 87.58). The HC produced most words in the Kannada-only condition (98.83 vs. 83.16 in the English-only condition and 80.8 in the ok-to-mix condition). The PWA, by contrast, produced most words in the ok-to-mix condition, especially in the personal narratives where they produced many more words in the mixed-language condition (68.8) than in the English-only condition (31.6). Mixing occurred most often in the personal narratives of the PWA: 14% of the time vs. 4.32% for the PWA for picture description; for HC, 2.54% and 2.12% respectively. However the greater amount of mixing PWA included in the personal narratives was not associated with marked differences in overall narrative success for the personal narratives (3.77) and the picture descriptions (3.37). Conclusion In sum, while PWA may not altogether avoid language-mixing with monolingual listeners, they appear to mix less when they know their listeners are monolinguals, not bilinguals. PWAs’ personal narratives are markedly longer when their listener is bilingual, though ratings of ‘overall success’ of the discourse are not linked to the degree of patients’ mixing. The lack of differences in the rated success of the more- and less-mixed samples suggests that, contrary to our hypothesis, language-mixing did not improve quality of communication

Expert group meeting on aphasia: A report

A multidisciplinary team of experts took stock of the current state of affairs about many aspects of aphasia in India, including community burden, diagnostic assessment, therapy, rehabilitation, research, education, and advocacy. The broad spectrum of aphasiology was matched by the types of participants ranging from neurologists, speech-language pathologists, clinical psychologists, linguists, to experts in neuroimaging and computer sciences. Threadbare discussion in 16 sessions over 3 days leads to the identification of pressing problems and possible solutions. Many action plans have been envisaged and recommendations made. A few examples with high priority are community-based and hospital-based study incidence and prevalence of aphasia, development of test batteries for the assessment of many components of speech and communication in Indian languages which are validated on rigorous psychometric, and linguistic criteria, national registry for aphasia, educational modules about aphasia for different target groups, resources for advocacy and its training, a bank of research questions and outlines of research protocols for young professionals to pursue. The expert group will continue to oversee execution of some of the actionable plans in short and long term