“I remember when … ”: The impact of reminiscence therapy on discourse production in older adults with cognitive impairment

<b>Purpose:</b> Positive outcomes following reminiscence therapy have been reported for older adults with mild cognitive impairment and dementia in cognition and quality of life and, in a small number of studies, communication. Despite the close relationship between cognition and language, the impact on communication has received limited attention. This study aimed to investigate whether the spoken discourse of older adults with mild cognitive impairment or dementia could be improved within the genre of <i>nostalgic recounts</i> following group reminiscence therapy, and whether change generalised to everyday discourse. <b>Method:</b> Four females (mean: 87 years, SD: 7.3) who lived in a residential aged care facility and were diagnosed with mild (<i>n</i> = 2) or major (<i>n</i> = 2) neurocognitive impairment were recruited to attend a group reminiscence programme delivered in eight one-hour treatment sessions over four weeks. Multiple baseline samples of discourse were obtained in the week prior to intervention to monitor stability. Macrostructure, rate, informativeness and efficiency of discourse production were measured to identify change within nostalgic recounts and monitor evidence of generalised change in everyday discourse genres. Cognitive performance and quality of life were also monitored. <b>Result:</b> While variability was evident, significant increases in macrostructure and richness of nostalgic recounts were found for two participants, with significant generalisation to everyday discourse. Both participants had diagnoses of mild cognitive impairment. No significant improvements were seen in cognition or quality of life with all participants. <b>Conclusion:</b> This study provides promising evidence for the spoken recall of memories having the potential to improve the communication of people with neurocognitive disorders, with some indication that people with milder impairment may be more amenable to this form of intervention. Nostalgic recounts may provide an explicit context in which speech-language pathologists can facilitate the planning of spoken production in people with cognitive impairment, and influence speaking in everyday contexts.

**研究目的**：既往研究表明，回忆疗法（reminiscence therapy）对轻度认知障碍（mild cognitive impairment）及痴呆（dementia）老年群体的认知功能与生活质量具有积极改善效果，少数研究还发现其对沟通能力存在影响。尽管认知与语言密切相关，但现有研究对该疗法在沟通方面的影响关注不足。本研究旨在探讨团体回忆疗法后，轻度认知障碍或痴呆老年人的怀旧叙事（nostalgic recounts）类口语语篇能否得到改善，且此类改善是否能泛化至日常语篇场景中。
**研究方法**：本研究招募了4名女性受试者，平均年龄87岁（标准差7.3），均居住于养老机构（residential aged care facility），且被诊断为轻度（n=2）或重度（n=2）神经认知障碍（neurocognitive impairment）。受试者参与为期4周、共8次、每次1小时的团体回忆治疗项目。干预前一周采集多份语篇基线样本，以监测受试者语篇表现的稳定性。研究人员对受试者语篇产出的宏观结构、语速、信息性及效率进行量化测量，以识别其在怀旧叙事类语篇中的变化，并监测改善效果泛化至日常语篇体裁的证据。同时对受试者的认知表现与生活质量进行监测。
**研究结果**：尽管个体差异较为显著，但2名轻度认知障碍受试者的怀旧叙事的宏观结构与丰富度均得到显著提升，且该改善效果显著泛化至日常语篇中。所有受试者的认知功能与生活质量均未出现显著改善。
**研究结论**：本研究为记忆的口语回忆训练可改善神经认知障碍患者的沟通能力提供了具有前景的证据，且提示轻度认知受损群体或许更易接受此类干预方案。怀旧叙事可为言语语言病理学家（speech-language pathologist）为认知障碍患者开展口语产出规划训练提供明确的干预场景，并对患者日常会话中的言语表现产生积极影响。