with the episodes in the tale have a bearing on the delayed recall. All but one of the patients can remember the story was about a lion; 67% subsequently remembered that the animal brought back the child totally unharmed and 47% that the tale involved a woman. The studied population showed more cases of intrusion (n = 36) than inversion in the later narration, whether items or episodes combining the two (n = 19). Nearly all the inversions were by patients whose MMSE was below 19 and the intrusions by patients whose MMSE was below 15 (Figure 1). Admittedly, intrusions are specific to AD pathology, where

Figure 1. Percentage of inversions (n = 19) and intrusions-n = 36) according to the MMSE. Chi2 with Yate’s correction: p < 0.05 for the number of intrusions or of inversions, cut-off MMSE < 15.

Table 2. Sociodemographic data and results in the diverse tests (N = 151). DFB: Dubois’s Frontal Battery; D5WT: Dubois’s 5 words test.

Table 3. “The Lion’s tale”: Global Score and episodes (Immediate and delayed recall) in the Barbizet’s test (n = 151).

we find their greatest occurrence. However, these results could suggest that intrusions are essentially linked to executive problems concerning response control. When referring to patients’ dysexecutive syndrome (DFT < 13; n = 77) it is to be remarked that, overall, inversions occur in the deficient group (Table 4). It is also to be remarked that inversions are observed to be more precocious when disease deteriorates textuality and prevents the pragmatics of communication. MMSE for the executive syndrome sub-group (n = 77) was 11.9 ± 2.9 against 20.9 ± 2.6 for the less seriously affected group (n = 74)

Table 5 shows the correlation matrix for the various parameters studied. Many parameters are correlated whence the choice of PLS for regression analysis. Table 6 shows this regressive analysis on standardized variables. The factor studied is the overall score for Barbizet’s test with the model including the variables of the previous figure.

The formal fluency remains the one that most influences the overall score with a coefficient of 0.224. The higher it is, the greater the success in the test and this influence is almost three times that of the lexical memory. Then, we will retain cultural level and, more accessorily, age, but all the others are less interesting.

Table 4. Number of intrusions and inversions according to the dysexecutive syndrome estimated by the score at the DFB (Maximum score in the DFB when there is no dysexecutive syndrome: 18). DFB: Dubois’s Frontal Battery.

Table 5. Correlations between the data in the various tests in the studied population. *= p < 0.05. DFB: Dubois’s Frontal Battery; D5WT: Dubois’s 5 words test. Lion’s tale: Global Score (Delayed recall) in the Barbizet’s test.

Table 6. Estimate of Regression Coefficients. Regression PLS. Studied factor: Global Score (Delayed recall) in the Barbizet’s test. Model including the variables of the previous picture. DFB: Dubois’s Frontal Battery; DWT: Dubois’s 5 words test.

4. Discussion

We are presenting here the results of a preliminary study on narrativity in AD based on consultation with the patients in an old-age psychiatric department. The very nature of the department explains the old age of those recruited. MMSE worsening in certain patients is an approach making their understanding of the text difficult and even the value of their consent. The aid of their family accompanying person was then precious and all the tests were those habitually carried out regularly on this type of patient under the specialised consultation of our establishment.

The correlation matrix in Table 5 evokes another aspect of this study: the serious collinearity between the variables observed that we have not wanted to push aside because language dysfunction can be explained by many factors, cognitive or not. This has encouraged us to use a Partial Least Squares regression on all the variables studied.

The executive disorders studied by the DFB and cognitive disorders estimated by the MMSE are strongly correlated, also it is difficult to know which verbal consequences result specifically from one of these factors or from the other one. The threshold of 13 was however chosen on one hand so that the sub-populations were balanced, and on the other hand for a clear cut-off with the existence or not of a dysexecutive syndrome connected to frontal disorders. The presence of a such dysexecutive syndrome, in case of late depression (with or without dementia), impacts on the cognitive status [49] . The depressive elderly present frequently changes of the verbal fluencies and the deficits of planning connected to frontal disorders [50] . The scores on the scale of Cornell are weak in the population of the study presented here. The depression is frequent in particular when the dementia progresses, in particular when the elderly live in nursing home [47] . The elderly included in this study lived at home. The scores on the scale of Cornell presented here are low (Table 2: 11.3 ± 4.5, depression’s threshold value > 8).

The non-mnesic disorders (linguistic, visual, behavioral) have to remind atypical Alzheimer’s diseases or other types of dementia, and should lead to a search for an association with a frontotemporal degeneration what today is the object of link between neurology and psychiatry [51] .

We shall notice in this study, the important progress of the textual disorders observed through the score in the delayed recall in « the lion’s tale », all the more degraded that the cognitive disorders are installed. Intrusions and inversions can result from cognitive disorders as well as from related executive disorders. Formal fluencies weigh in a significant way but in a modest way on the studied model of regression (CR = 0.224), so with a lesser scale the cultural level (CR = 0.117), the cognitive disorders of the dementia as well as the linguistic disorders being classically modulated by this one [29] [43] .

Even if the PLS model PLS is more influenced by the formal fluency the lexical semantic fluencies are more altered than the formal fluency (Table 2). Find a word beginning with a letter (“L” in French, “S” in English, for reasons of frequency of use of this letter in the beginning of a word) require a strategy of recovery based on the abstract lexical representation [52] . The degradation of the formal fluency testifies of a more important disorganization of the functions of the language

The concrete items with strong emotional connotation in “the lion’s tale” (A woman, a child, a lion…) are better memorized than more secondary (For a long time, fixedly…): even there the emotion appears clearly as the “power steering” of the reason and the memory.

5. Conclusion

The lexical semantic fluency is more altered than the formal fluency in the Alzheimer’s disease. The degradation of the formal fluency testifies an important disorganization of the functions of the language. The fluencies impairments have an impact on the memorization of a text, in parallel with developments of cognitive disorders. The cultural level also influences the narrative skills of the patient which remain sensitive to the emotional aspect of a story when assessed in a memory testing. This emotional mobilization is probably an interesting way of motivation in speech therapy, to lead preventively or to maintain lexical and textual capacities in the Alzheimer’s disease.

Financing

No personal financing sought for this study.

Conflicts

No conflicts of interest declared by its authors.

Cite this paper
Hazif-Thomas, C. , Billon, R. and Thomas, P. (2017) Narrativity and Memory Analysis in Alzheimer’s Disease. Open Journal of Psychiatry, 7, 307-317. doi: 10.4236/ojpsych.2017.74026.
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