Podcast – Language And Communication In The Dementias – London

Voice Over:

Welcoming to the dementia researcher podcast, brought to you by DementiaResearcher.nihr.ac.uk, a network for early career researchers.

Lakshini Mendis:

My name is Lakshini Mendis, and I’m an NIHR research project coordinator, based at University College London. Today we’re recording the second podcast of a two-part special on language and communication in dementias. So I’m very pleased to welcome, Anna Volkmer, Rosemary Varley, and Vitor Zimmerer to today’s NIHR dementia research podcast.

Lakshini Mendis:

Before we go on to this topic, let’s get to know our panellists a little bit better. Anna, Rosemary and Vitor are all working on language and cognition based at the Department of Psychology and Language Sciences here at UCL. So Rosemary Varley is a professor of acquired language disorders. Rosemary, you say we can find you wheeling around barrel-loads of manure during your spare time. Do you have lots of spare time?

Professor Rosemary Varley:

Not a lot. But it’s a good way to rest and relax your mind, to do something different, shovelling manure.

Lakshini Mendis:

Fair enough.

Professor Rosemary Varley:

And a metaphor for academic life as well. [crosstalk 00:01:13].

Lakshini Mendis:

And what inspired you to get into this area of research?

Professor Rosemary Varley:

I’m very interested in language, and brain language and mind. I worked as a speech and language therapist within the NHS for a number of years, and I’m endlessly fascinated by how language goes wrong, how it breaks. I think the condition for aphasia, which is a language impairment, can give you insights into the basic mechanisms of speech and language. And that in itself is fascinating. And working with people and their families who have language disorder, you feel you’re doing a really useful job.

Lakshini Mendis:

Well, welcome to today’s podcast. We’ll get into a little bit more about what you do soon. Next we have Vitor Zimmerer, a postdoctoral research associate. Vitor, do you want to share why you have a lost language, maybe, yourself with some of our listeners.

Dr Vitor Zimmerer:

Well, I should perhaps first say that losing a language in my case is very different from losing a language in the clinical sense. But when I start trying to think about how it is to have a communication impairment I do think about the 10% of my native language Portuguese that are maybe left. Because when I am in Brazil it’s easy to kind of feel lost in the very familiar environment.

Dr Vitor Zimmerer:

So yeah, I am a victim of what’s called language attrition. I came to Germany when I was quite young and lost most of my Portuguese. So it’s a typical question to ask linguists how many languages they speak, and it’s one less that I could name.

Lakshini Mendis:

Right. And what made you work in this sort of area of research?

Dr Vitor Zimmerer:

Well, I come from the field of linguistics, so I was always interested in how we produce language, how we understand language, and then slowly migrated to the clinical sciences. And one day I was working on this analysis that I think we’re going to talk about later, and I thought this is so fine. It would be interesting to apply this to dementia, where subtle differences matter. And this is how we started working on dementia, or I started on dementia.

Lakshini Mendis:

Sounds great. And last but not least, we have Anna Volkmer, who’s a regular panellist and blogger for Dementia Researcher. Welcome back, Anna.

Anna Volkmer:

Thank you.

Lakshini Mendis:

So can you tell our listeners who maybe haven’t met you yet a little bit more about yourself, and why you chose to work in dementia.

Anna Volkmer:

Yes. So I am also a speech and language therapist by background, and I worked with people with dementia clinically across England and Australia for many years. And I was working with people with dementia and their families, trying to support them in their communication, to maintain their communication, their interactions, their quality of life. And as I was working I looked to the research evidence to check everything, as a good clinician, trying to be of an evidence-based clinician, and really looked at that evidence. And there really wasn’t much around the kind of things we could deliver.

Anna Volkmer:

And so I decided that perhaps it would be useful for me to try and create some of that evidence, not only to support clinicians, but also to support speech and language therapy as a profession, to really emphasize the breadth of our service, to build our services, and hopefully, improve the quality of life for people with dementia and their families, ultimately. So that’s what drew me back to academia, and thus to UCL.

Lakshini Mendis:

Sounds inspiring. Thanks for sharing, Anna. Great. Since if you’re a regular Dementia Researcher podcast listener then you might have already heard our podcast. And Anna, you were on that one as well, that we talked communication training for people with language-led dementia, or primary progressive aphasia. And like I mentioned earlier, there’s the first part of this two-part special on communication and language in dementias, which was recorded with researchers at the University of Sydney, actually. So go listen to that.

Lakshini Mendis:

But let’s start into the work that you do. So Rosemary, maybe you give us a basic introduction to what you mean when you sort use that term language as well, in the context of the work and the research that you’re conducting.

Professor Rosemary Varley:

Well, I think it’s first of all worth noting that language is important for humans. It’s how you express your feelings, your emotions. It’s central to being employable. It’s necessary for education, if you can imagine a classroom with no language. So having a language impairment really impacts on your quality of life, your quality of your relationships with other people, and your ability to function in society.

Professor Rosemary Varley:

So when we talk about language we’re talking about the ability to understand language, as well as produce language. And it’s not just about spoken language. It’s about written language as well. So that’s the nature of what we’re dealing with.

Professor Rosemary Varley:

And typically linguists will approach language in terms of a set of levels. They’ll talk about the sound structure of a language, sometimes called phonology, the vocabulary, which is about words and their meaning, the grammatical structure, how words are combined together to form sentences.

Professor Rosemary Varley:

And in the introduction to this podcast we talked about language and communication. So there’s a bigger thing as well, in that language is structured beyond single sentences. So if I something like, “I broke my leg because it was green,” that’s kind of a weird sentence, because those two ideas don’t fit together very well.

Professor Rosemary Varley:

But also language is integrated with all sorts of non-verbal communication, like eye contact, and politeness. So if you will say to me, “Pass me some water,” and I… If you say to me, “Can you pass me some water,” and I go, “Yeah,” that’s impolite, because you’re actually asking me to pass you the water.

Professor Rosemary Varley:

So, there’s lots of ways in which language is structured, but it’s also integrated with all other sorts of behaviour.

Professor Rosemary Varley:

In terms of the brain, those various linguistic levels, vocabulary, the sound structure, grammar, have a little bit of dedicated machinery, but actually they’re all very closely connected together. And it’s interesting for dementia, because for example, the grammar and the sound structure are more at the frontal lobe end of the brain, whereas words and their meaning involve much more of the temporal lobe.

Professor Rosemary Varley:

And so then you have all this wiring. And so, things like the politeness thing, like, “Can you pass me the water,” “Yeah,” is about my social behaviour and my ability to be polite, to be cooperative with people.

Professor Rosemary Varley:

And because of that language is interesting. Because it kind of, it’s got a finger in lots of neural pies. And if something is going wrong somewhere in the brain you’re going to see signs of it. You’re going to see language change. And that’s the case, certainly, in the dementias.

Lakshini Mendis:

So I don’t want to skip ahead, but I’ve already some follow-up questions based on that.

Professor Rosemary Varley:

Yeah, sure.

Lakshini Mendis:

But I guess we’ll first go to… Well, so when you’re talking about, then, language and communication like that, and then within every certain kind of field, how do you measure language and communication?

Dr Vitor Zimmerer:

I mean, it’s a complex question, because there are different questions embedded within that question. The one is, what should we look at? And as Rosemary said, there are many different levels from sounds, words, sentences, appropriateness. And as we’re looking at different types of dementia, different ways dementia can change your brain, we can imagine that any of these levels, or a combination of these levels change. And also each of these levels itself is very complex. There’s many different aspects of grammar to look at, many different aspects of word processing, et cetera, et cetera.

Dr Vitor Zimmerer:

So the one question is, what should we even look at? And there’s a bit of a variable hunt at the moment, where different labs are trying figure out which variables to look at to profile different types of dementia, pick up change early, track change over time.

Dr Vitor Zimmerer:

And what we are looking at is, or one thing that we bring into the mix that is, I think, rather new, at least in this field, is the ability to produce rare language. So to say something that’s not very common, to produce a new word combination or a rare word combination. Because it turns out that this is harder than saying something that you hear all the time, okay?

Dr Vitor Zimmerer:

So what we hear all the time, sometimes called formulaic language, the word sequences are very fixed. They have a very specific meaning, for example, in conversation. There are only so many ways I can say you’re welcome, and you’re welcome is the most common way. That’s a formula.

Dr Vitor Zimmerer:

And it turns out that as my language system becomes affected by dementia the combination, my ability to come to form new sentences and phrases decreases. So I’m more restricted to what’s common. And it should perhaps not be a huge surprise, I think, because as we see dementia generally, that it becomes a challenge to be in a new situation, to handle new information. Turns out in language it’s just the same. It becomes difficult to do something new with your language system.

Dr Vitor Zimmerer:

And then the other part of the question is, how should we look at it? And in a clinically-meaningful sense. So, we can’t have humans sit there and transcribe everything, and hand-analyse every sample. It takes way too much time. Thankfully, with the advance of machine learning, computer analysis, et cetera, we’re getting closer and closer to the point where you do indeed just speak into a microphone and get maybe a meaningful signal out. That could mean that analysing language could be very, very cheap, right? Because if all you need is a big of software, and a computer and a microphone, that is much cheaper than putting someone inside an MRI scanner, for example.

Lakshini Mendis:

Great. So kind of fiddling on a little bit from what Rosemary was then talking about as well, like with language there is so many different parts of the brain that process different things. So like with the words and the meaning in the temporal lobe area. So with a degenerative disease like dementia, will there be aspects of language and communication that you lose at different times then, depending on how far along you are.

Professor Rosemary Varley:

I mean, we title this podcast Language and Communications in the Dementias, plural. So I’m following on from what Vitor was saying about this automatic measurement of language, that different dementias may have different signatures. So that if you have a dementia that particularly the degeneration starts in prefrontal cortex, we might see an alteration in this sort of politeness phenomena first. If you have a dementia that’s more of a temporal lobe condition, for example Alzheimer’s disease, we’re likely to see maybe changes in vocabulary as a first symptom.

Professor Rosemary Varley:

Anna in particular works with the primary progressive aphasias, frontal-temporal dementias, and there’s a bunch of those which the degeneration begins in part of the frontal lobe that’s very important for sound structure and grammar. And so you tend to see these grammatical alterations very early on. So they all have different signatures depending on where the degeneration starts.

Anna Volkmer:

That’s right. So for example, if we were to go into more detail around the three primary progressive aphasias, there’s actually three internationally-accepted variants, or subtypes. There may be more, but that’s up for debate. But at the minute there’s three.

Anna Volkmer:

And there’s one which is termed the semantic variant, where people present initially often with difficulties in thinking of words, or understanding words, because of a degradation of knowledge of word meanings. And these are people who are very, very fluent in their output, and very empty. So they might use fillers, like thing, and she, and he.

Anna Volkmer:

Whereas people with something called the logopenic variant of PPA have more difficulties in retrieving the word form. So they will present with difficulties often in constructing that word form, retrieving that word form. So they might make phonological errors, sound errors. There might be pauses as they’re trying to get that word. But their comprehension is much more intact.

Anna Volkmer:

They often have real difficulties with that idea of repeating back a digit span. So I often as a speech therapist call it phonological buffer. So often memory is a hard thing. It’s a very complex thing, but it often might be termed working memory as well. But I won’t get into a memory debate. But it’s that skill we use to remember a phone number. So people with logopenic variant PPA will find it very difficult to remember a string of numbers, or a longer sentence, and to really understand that, because if they’re not able to retain the entire word forms over a longer period.

Anna Volkmer:

And then there’s the logopenic, sorry, the nonfluent/agrammatic variant. That’s the third variant. And these are people who present with disfluent speech. So they are apraxic, we call that. So they present with, they really can’t make their muscles do what, or make their mouth produce the word form. So they really grope. It becomes effortful, really. It can often be very frustrating and stressful.

Anna Volkmer:

And these are often people who are so quite agrammatic. So over time, initially, it might not be really apparent. So it might just be a subtle simplicity in their grammatical forms. And over time they may even start developing more lists, like telegraphic, just single words, and they even become mute as well.

Anna Volkmer:

And all three variants progress, and often people describe it as they merge, that you kind of quiet. But really there’s not much research been done around the staging of these three variants, and how people progress entirely. But certainly people become more and more severely impaired in both language and other cognitive features as well, cognitive skills that becoming more difficult. That gives you an overview really.

Dr Vitor Zimmerer:

I mean, there’s a real challenge in picking up early change. And I mentioned there’s an increasing simplicity in the language. Because it doesn’t immediate manifest as language errors or anything like that. The language sounds fine. It’s just perhaps a bit simpler. But we’re used to hearing simple language as well. We’re used to hearing common language as well. So it’s really difficult to kind of intuitively detect early change, and this is where these new tools, analyses, can come in.

Professor Rosemary Varley:

And is that in addition to sort of identifying early change? That when somebody comes to clinic, and they have a diagnosis, often they come back with a printout from the internet saying, “So which type have I got?” Because when you have a bad diagnosis everybody needs information. And actually having information gives you control over your illness.

Professor Rosemary Varley:

And I used to work in a clinic where we often did early diagnosis, and often you would say, “We’re not entire sure yet. We have to see how it evolves, and what appears over the next six months to a year.” And that sounds satisfactory. So being able to identify these different signatures early is important for the individual with the and their families.

Professor Rosemary Varley:

But also it’s going to, as we learn about the underlying neurobiology of these different dementias, it could have very important treatment implications. For example, there might be different protein abnormalities involved. So come the day when we have better therapies, it will be critical to very early on to say, “You have this type,” or, “that type,” and the recommended care pathway, drug regime, whatever it might be, is going to be this.

Anna Volkmer:

And even now sometimes it’s really useful to try and subtype, particularly having worked in the primary progressive aphasia, for example logopenic variant is often more often caused by an Alzheimer’s pathology, and there may be trials, research trials that that individual is then able to participate in, because we really hone down the variant.

Anna Volkmer:

Equally, Rosemary touched on this idea of the family and the person themselves being out to prepare. So it’s not just about language and communication, but also preparing for one’s future, and understanding what’s going to happen to oneself, future healthcare decisions, future lifestyle decisions.

Lakshini Mendis:

So when you touch on family and partners, and that kind of thing… Because I’ve heard that often partners especially you can pick up sort of tiny changes, because you’ve known someone for such a long time. Have you seen anyone sort of who has come in and been like, well, there are kind of these, they’ve picked up on subtle changes, and then they’re kind of just looking for, I guess, yeah, answers around it?

Professor Rosemary Varley:

That can happen. I mean, certainly the clinic I worked in you get the worried well. So language does change as you get older, and the thing that you notice that changes is word finding, particularly people’s names. And discriminating that normal pattern of aging for something that’s pathological is really important, can put someone’s mind at rest, and say, no, this is just entirely normal.

Professor Rosemary Varley:

Families notice also, particularly with the unusual dementias, like primary progressive aphasia. These onset earlier in life. So they might onset in the 50s. So, people are at work, and sometimes co-workers start noticing that somebody’s charged with taking telephone message, and it gets garbled. Or they’re to take the minutes of a meeting, and somehow they’ve lost the thread of the meeting. So people around can notice these changes, and they often are the reason people come to clinic.

Anna Volkmer:

I’ve worked with lots of people, in fact, who maybe have changed jobs, or had some conflict in their job, or perhaps somebody has said, a family member or colleague has said, “They’re not listening to me as much anymore.” So they may not make a… Family and friends, or the employees may not make a specific observation on language, but it may be something more broad about relationships as well, and interaction, and how well someone is participating in what they were formerly really participating in quite well.

Professor Rosemary Varley:

And this is quite important, because often people go, people realize there’s something wrong, and they think they’re depressed or they’re anxious. And they spend a lot of time tracking around clinics. They get referred to the psychiatrist for anxiety.

Anna Volkmer:

Bouncing around.

Professor Rosemary Varley:

Bouncing around. And in a way a really important critical window for diagnosis is being lost, because as Anna said, making an advance directive, lifestyle decisions, all these things while you have full capacity are really, really important. So early diagnosis is critical.

Dr Vitor Zimmerer:

I have a question for you, Rosemary and Anna, because you’re the clinicians, and I come more from outside from the linguistics angle. Because the one realization that I think I got over the past years is that by the time someone goes into a memory clinic, because a family member notices that there’s something strange, or the person, him or herself, notice that there are any changes, it is very often much too late. You want the diagnosis to be much sooner.

Dr Vitor Zimmerer:

So it appears to me, listening to examples, or seeing some examples, that it’s hard to really rely just on family members picking up. Because by the time they have their diagnosis it seems to be much too late. When you have a neurologist saying, oh, it’s a good trick to ask the person how old they are, because if they struggle telling you how old they are they probably have dementia. By that time… You want to identify dementia much, much, sooner than that.

Professor Rosemary Varley:

And if we’re talking about therapeutics, you want to get in there as early as possible to stop this abnormal protein deposit. So the earlier we can identify someone is deviating from a normal trajectory, that’s really critical. So it’s the tools that Vitor was talking about, these automated computerized tools, and they’re heavily quantitative, and therefore very sensitive, that they may be able to detect that altered trajectory, at-risk status, mild cognitive impairment really quite early.

Anna Volkmer:

And yet, Vitor, to answer your question also in a more lateral sense, in a clinical sense, I’ve met people who just don’t want to know. We’re talking about communication and language, and we’re talking about organic things. But there’s also personality, culture. And lots of people I’ve met don’t wish to know, often because it’s stigmatized, either in their own family or in their age group, in their culture, in their religion.

Anna Volkmer:

And actually, that’s fine. Often they can cope for a very long time without having to acknowledge the change. And dementia is one of the most feared conditions. It’s all over the papers, and there’s headlines. It’s more feared than cancer amongst people in their 50s and 60s. And I think at the moment there are no viable therapeutic options that are well-known of in the public domain.

Anna Volkmer:

And that’s, I think, another reason why it’s really important to work in this area. Because it’s not only about, I mean, trials of medications, of preventative medicine are really important, but also trials of care, and trials of behaviour interventions, or communication, speech and language interventions, are also equally useful. If we can demonstrate that some of these really work it can offer hope. And I’ve been to a number of support groups where they’ve said often they go to their medical professional, or they’ve been diagnosed by their medical professional, and that’s it. They just get sent home.

Professor Rosemary Varley:

At diagnosis?

Anna Volkmer:

At diagnosis, with nothing else. Whereas if we were able to improve the care pathway, I mean, we’re getting into…

Professor Rosemary Varley:

Well, that is a path [crosstalk 00:24:58].

Anna Volkmer:

It is a pathway. [crosstalk 00:25:00].

Professor Rosemary Varley:

And a diagnosis and [inaudible 00:25:03].

Anna Volkmer:

We want an alternative pathway.

Lakshini Mendis:

But I think as speech and language therapists working in clinic, that is part of the care that you are then providing to these patients. But then also, because I remember touching on this in our previous podcast. We talked about with the approaches that you’re trying, it’s broader than just working with the person with dementia. And that’s something we’ve chatted about today as well, is sort of supporting that broad aspect of communication. It’s talking about how that might change with family members and partners and the carers then. But are there some approaches that work better than others? And I guess this is why you’re all in research, right?

Professor Rosemary Varley:

I would [crosstalk 00:25:52]. I mean, I think the first general point to make is that communication is dyadic. It takes two. So if you’re in a situation where one member of that communication dyad has got impaired cognition, because of changes going on in their brain, you maybe have another one who has entirely intact cognition, or is capable of new learning. And so that’s that whole basis for actually intervening with carers, rather than just maybe a traditional model of intervening with the patient. The evidence base, I think at the moment, is still pretty sparse. Anna will agree.

Anna Volkmer:

I’d agree.

Professor Rosemary Varley:

So that’s what the research is about in terms of how you can maximize the skill of the person with the diagnosis, so that they can maintain. There’s been some research on how you can maintain vocabulary for longer. But possibly the more promising, because of this notion of one person in the dyad has intact cognition, some of the promising interventions, it would be about altering the behaviour of the carers.

Professor Rosemary Varley:

And we’re not just talking about family members here. We might be talking about professional carers, so people in care homes, about how we can modify their behaviour so that when they’re interacting with somebody with dementia they’re using optimal behaviours that mean that person, eye contact, touch, what type of language is more comprehensible, rather than something terribly complicated. Backing up reference to something with a point. These types of behaviours.

Professor Rosemary Varley:

So at the moment there’s been not much in the way of big trials. Anna’s doing some she’ll probably tell us about in a minute. But we also need to get clever about how we measure the outcomes. So clever outcomes are looking at things like staff satisfaction, if you’re talking about care home environments. If staff are trained, do they stay in their jobs longer? So clever outcome measures, rather than maybe some of the more obvious.

Anna Volkmer:

Or even things around… So I often get asked, what’s the point in referring someone with dementia, where they’re quite far along in their journey? And they’re often non-verbal. They’re bed-bound, and it’s all about caring and grooming. And actually at those times I often think in term, coming back to getting clever with outcomes, it can be about, was the grooming task easier because you had an easier interaction?

Professor Rosemary Varley:

The individual was compliant rather than resistant.

Anna Volkmer:

That’s it.

Professor Rosemary Varley:

You didn’t have shouting, crying, slapping.

Anna Volkmer:

Pushing, slapping.

Professor Rosemary Varley:

Or whatever.

Anna Volkmer:

That’s it. Did you have to use less medications? I mean, I shouldn’t really talk about sedatives, but how did you manage with the-? Were the communication skills enough to manage that situation, that kind of more lateral thinking, I think. And it’s really important to acknowledge that, actually, we as speech and language therapists, these speech and language interventions can support a person not only kind of at the beginning of their journey, in the middle of their journey, but also right at the end stage, which is perhaps where there’s least evidence.

Anna Volkmer:

And I think to demonstrate that these interventions work is really difficult, because they’re really complex interventions. It’s not just one tablet that you’re giving someone. Particularly when you’re working with a dyad, you’re working with the person with the dementia, and you’re working with their partner. You’re having multiple sessions. You are doing multiple activities. You might be giving them tasks to do outside of the therapy session. You may be a very nice therapist.

Anna Volkmer:

What’s really difficult is to really show it’s the actual intervention that made the difference, and not something else. So often with things like speech and language therapy it’s really difficult to do rigorous controlled, randomized control trial work, which is where often it’s considered there’s a gold standard, and which is where consequently guidelines and care pathways, coming back to care pathways, come from. And so it can be really, really hard to do that kind of work with these complex therapies.

Anna Volkmer:

But going back again to what Rosemary was saying, that we’re getting cleverer also about knowing what strategies are working. It also, going full circle back to the work that Vitor is doing around formulaic language, there’s potential to use some of this work to guide interventions and the types of strategies we use. Really, perhaps, we… I’m hypothesizing long-term, but perhaps if we have a better idea of what formulas an individual is using or understands we could advise the people around them to use those specific formulas.

Professor Rosemary Varley:

So lots of charities have communication tips, and the actual evidence base as to whether they make language more comprehensible is actually very sparse. And Vitor, I think, wants to talk on this.

Dr Vitor Zimmerer:

Yeah, I mean, the anecdote is when, Rosie, you suggested looking at something at topic fronting. And that’s a strategy where you would announce the topic first before saying something about it. So instead of saying-

Professor Rosemary Varley:

So for example-

Anna Volkmer:

[crosstalk 00:31:12].

Professor Rosemary Varley:

… instead of saying, “What would you like for breakfast,” you say, “For breakfast, what would you like?”

Dr Vitor Zimmerer:

[crosstalk 00:31:17]. And so when I heard about it I thought, okay, I’ve never heard about this. So I come from linguistics. I don’t talk like this. I haven’t heard of this strategy. So let’s look into the literature, what the literature says. Turns out there’s nothing in the research literature.

Professor Rosemary Varley:

But it’s recommended. It’s there in the communication tips, but there’s no evidence. And there is reason, Vitor may go on to say-

Dr Vitor Zimmerer:

No, I think it taps into a really big question, and the big question is, what is easy and what is difficult language? And there are so many different dimensions to that. So one way to produce simpler language, that you think may be easy, is just to strip away stuff from language. So remove all the grammar. Have just a bunch of words. Really just like the core message.

Dr Vitor Zimmerer:

But what you may end up with is something that’s really atypical and novel, and weird, right? And that may be actually something that makes it harder, because someone with dementia may not be able to cope with a novel weird situation.

Dr Vitor Zimmerer:

So, the question is, where is the best trade-off between-? What does simplification even mean? Does it mean reduction of structure? Or does it mean using just more common language? Or is it a combination of both? And to be honest, we have some evidence that suggests that using common language may be an important factor, but we’re not there yet, where we know what the right mix is.

Lakshini Mendis:

This is why the research that all of you are doing is so, so important. And I just want to do… So this is kind of little bit left field, but just because personal kind of interest, I guess, as well, because I’m bilingual, does that have an effect then? Because often you get people who learn English maybe as a second language much later on. Does that sort of have an effect of when, how developing dementia is then affect kind of your language ability, and the different languages you speak maybe?

Anna Volkmer:

Are you talking about as a neuroprotective mechanism?

Professor Rosemary Varley:

No, so it’s about somebody who is bilingual.

Lakshini Mendis:

No, is bilingual.

Professor Rosemary Varley:

And what patterns of loss do you get.

Anna Volkmer:

So there was a really interesting talk. Sorry Rosemary.

Professor Rosemary Varley:

No, you go ahead.

Anna Volkmer:

In Sydney they had a whole plenary session at the international conference on frontal-temporal dementia on language-led dementia in people of bilingual origin. And as I’m also a bilingual person, I speak German. And one of the things that they said that really resonated with me as a bilingual person, and as a therapist, was that, and it feeds into what Vitor was saying, is perhaps it’s about the easiest language.

Anna Volkmer:

So they were talking about language switching. And they were saying that language switching is a really common phenomenon, and people just switch through languages back-and-forth. And they were saying, often with dementia people that happens too, and we have these theories that certain languages deteriorate in different ways. There’s patterns. But they were essentially that the ease of accessing word forms is something we haven’t considered. And that really reason-… I often switch through to the words in both languages, which I just-

Dr Vitor Zimmerer:

[German 00:34:28].

Anna Volkmer:

[German 00:34:29]. We’re shutting up now. But yeah, sorry. Vitor, go on.

Dr Vitor Zimmerer:

No, you’re answering-

Anna Volkmer:

You were going to add something. I know.

Dr Vitor Zimmerer:

No, no, no. That’s not correct. I was going to add a joke. I just want to complete your thought.

Anna Volkmer:

No, it’s great.

Professor Rosemary Varley:

I mean, the area of bilingualism and language disorder is really complicated, because it’s very hard to get a group of people, sort of 50 people who have identical pre-injury, pre-dementia language profiles. So bilinguals may, bilingual speakers may vary in which language they use most. So a typical pattern is the language that’s used most is the one that’s most resistant to loss. That can be the first language if it’s the home language, and the one that’s spoke with more frequency. But if somebody has migrated-

Lakshini Mendis:

[crosstalk 00:35:20].

Professor Rosemary Varley:

… from somewhere, and then learned a new language, and they’ve used that for 40, 50 years, then the second language would be more resistant to loss. So this notion of going back to Vitor’s starting point about common phrases, that the system is kind of weighting to retain this higher frequency stuff for longer. And that’s true of individual words, but also word combinations.

Dr Vitor Zimmerer:

I mean, unfortunately there’s a practice in the linguistic work where you want to have your sample as multilingual as possible. Because it’s hard enough to study one language, so let’s just exclude everyone who doesn’t speak… So we’re doing a study with English material, so let’s just exclude everyone whose first language is not English. And that’s just, yeah, stands in the way of research on the effects of bilingualism.

Dr Vitor Zimmerer:

Obviously, there are studies specifically targeting bilingualism, but there is also a bit of selection bias in studies where, for reasons which are understandable, but unfortunately not meaningful for real-life purposes, especially in a place here like London, where you want to select a sample that is as monolingual as possible.

Professor Rosemary Varley:

And the majority of the world’s population is bilingual, trilingual, multilingual.

Anna Volkmer:

Yeah, and unfort-…

Professor Rosemary Varley:

Sorry. Go on.

Anna Volkmer:

Unfortunately I have met other healthcare professionals who’ve said, “I didn’t refer the bilingual or non-English-speaking person, because I didn’t think you could help them as a speech and language therapist.”

Lakshini Mendis:

Comes back to then that broader sense of communication then as well, right? It’s not about just the-

Professor Rosemary Varley:

[crosstalk 00:37:07] language and communication.

Lakshini Mendis:

That’s right.

Anna Volkmer:

Yeah, it’s much broader.

Lakshini Mendis:

Well, it’s been a very fascinating talk and session, but unfortunately I think it’s time to start wrapping up. I think before we end the session though, do you have-? We’ll quickly go through to each of our panellists. Do you have any advice you’d like to share with early career researchers who may be thinking about following a similar path into this area of research? Vitor?

Dr Vitor Zimmerer:

I mean, I think one shouldn’t be discouraged by the fact that one does not have a clinical background. So it is possible to get into dementia research from a different field. You have to think that dementia affects so many aspects of life, that there are a lot of different research subjects that are not primarily about dementia or neurological pathologies, that can contribute, all right?

Dr Vitor Zimmerer:

So if you’re listening to this podcast because your partner is a speech and language therapist or neurologist, think about yourself, and what am I doing that may actually be relevant for some aspect, one part of life of someone with dementia? And in my case it was the work on language. But it can be anything else.

Lakshini Mendis:

And Anna, any-? [crosstalk 00:38:29].

Anna Volkmer:

Well, I probably sound like a broken record, but I always say that clinician speech and language therapists, allied healthcare professionals make really good researchers, in my opinion. I always used to think that academics and researchers were incredibly brainy, super clever, and that I could never possibly rise to those amazing levels.

Anna Volkmer:

But actually, having now stepped into a more of a research world I’ve realized that some of my skills as a communicator, as a networker, as a very determined motivated person with clinical experience, are actually just as available. You can learn to write and use statistics programs, or ask other people for help. But some of those other things, particularly communication skills, are really, really valuable skills.

Professor Rosemary Varley:

Yeah, for me I would say, well, first of all, dementia always used to be seen as a very bleak area to work, and it clearly is so important with increasing our aging profile.

Lakshini Mendis:

[crosstalk 00:39:40] ageing? Yeah.

Professor Rosemary Varley:

It’s going to be critical. And so if you want to work in a field which is going to be vibrant, where there’s going to be a, let’s be crude, there’s going to be grants and opportunities to do exciting research, dementia might be it for you. I think it’s a fascinating field to work in that you combining something like language with other cognitive systems, with the neurobiology of dementia. So if you like this multiple components to a problem, I think you could find it intellectually very intriguing.

Lakshini Mendis:

Thanks. Well, Rosemary, Vitor and Anna, thank you very much for taking time out of your busy schedules to join me today. It’s definitely been a pleasure. I’ve learned heaps about language and communication, and how it changes in dementias. I’m sure our listeners have learned heaps as well. Listeners, make sure you listen to our other podcasts on communication training for people with language-led dementia, and the first part of this two-part special on communication and language in dementias as well.

Lakshini Mendis:

You can also share your views on this topic by posting your comments in the dementia researcher forum, and engaging with us on Twitter using the hashtag #ECRDementia. You can also follow and engage with today’s panellists, I believe all three of you, on Twitter. Maybe. I know Anna is.

Professor Rosemary Varley:

I’m not. No.

Dr Vitor Zimmerer:

I am.

Anna Volkmer:

Yeah, we are.

Professor Rosemary Varley:

The professor is too old to do Twitter.

Lakshini Mendis:

And Anna and Vitor, what are your Twitter handles?

Anna Volkmer:

So mine is @volkmer, V-O-L-K, M for mother, E-R, underscore Anna with two N’s.

Dr Vitor Zimmerer:

Mine is @vit_zim. V-I-T, underscore, Z-I-M.

Lakshini Mendis:

Awesome. Thanks all. And finally, don’t forget to subscribe to the Dementia Researcher podcast. Leave us a review on SoundCloud and iTunes, preferably five stars, of course, but that’s completely up to you. And tell all your friends and colleagues about us. Thank you.

Voice Over:

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END