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Background: Core lexicon (CL) analysis is a time efficient and possibly reliable measure that captures discourse production abilities. For people with aphasia, CL scores have demonstrated correlations with aphasia severity, as well as other discourse and linguistic measures. It was also found to be clinician‐friendly and clinically sensitive enough to capture longitudinal changes in aphasia. To our knowledge, CL has never been investigated in individuals with neurologically progressive disease. Aims: As a preliminary investigation, we sought to investigate (1) whether CL scores correlate with dementia severity, (2) whether CL scores correlate with measures of discourse quality, and (3) whether CL scores correlate with other measures of lexical/semantic access. Methods & Procedures: Twelve participants with a cognitive impairment associated with dementia of the Alzheimer's type (DAT) completed several measures of language and cognitive ability, as well as provide a language sample from the wordless picture book, Picnic. Results & Conclusion: Results are informative, as they provide insight into characteristics of CL and provide support for potential use of CL in individuals with neurologically progressive disease. The results indicated that CL scores do correlate with dementia severity and several measures of language ability, indicating they may provide a useful measure of language abilities in DAT, but more research is needed. WHAT THIS PAPER ADDS: What is already known on the subject: Core lexicon (CL) analysis is an assessment measure of discourse ability, most closely related to informativeness or productivity, used in aphasiology that is easier to use and less time consuming than previous measures of informativeness, such as correct information units or type‐token ratio (TTR). For people with aphasia, CL analysis correlates with aphasia severity, measures of informativeness, as well as other measures of discourse quality. It has also been shown to be faster and more reliable between scorers than other informativeness measures. What this study adds: Core lexicon analysis is a new simple and online method for assessing the informativeness of a discourse sample without the need to record or transcribe the language sample. CL is receiving a lot of attention in aphasia, correlating with everything from aphasia severity to measures of productivity and lexical access, as well as measures of informativeness. Unfortunately, no one has investigated CL analysis in dementia. The study demonstrates the first evidence that CL analysis may be a useful measure for determining dementia severity and language quality in people with dementia. What are the clinical implications of this work?: Core lexicon analysis may provide clinicians and researchers with an easy method for assessing the discourse of people with a cognitive impairment associated with dementia of the Alzheimer's type. This will improve initial assessment, as well as improve ongoing language assessment that may provide clues into their functional ability to communicate effectively. [ABSTRACT FROM AUTHOR]

Background: Disfluency is a multifactorial concept that can be linked to several of the language production levels, in both typical and atypical populations. In children, the language system is still developing and few studies have explored disfluency patterns. In typical development (TD), in particular, studies have shown discrepancies according to the language being considered. In neurodevelopmental disorders, such as developmental dyslexia (DD), it is still unclear whether the pattern of disfluency is similar to TD. Aims: To analyse the type of disfluency and their evolution in French children aged 8–12 years. Also to compare the pattern of disfluency in DD and TD, and to test whether disfluencies were correlated with reading difficulties. Methods & Procedures: A total of 25 children with DD and 21 children with TD aged 8–12.6 years produced an autobiographical narrative. Seven types of disfluencies were coded: part‐word repetitions; repetitions of monosyllabic words; other types of repetitions (words and phrases); filled pauses; revisions—substitutions; revisions—additions; and abandoned utterances. We compared the proportion of each disfluency in DD and TD. Spearman correlations were then performed between disfluencies, reading performance and age. Outcomes & Results: The results showed that both DD and TD children mainly produced filled pauses, repetitions of monosyllabic words and substitutions. Both groups displayed a high rate of disfluency (> 10%). No correlations with age were found. Correlations with reading performance were significant in the TD group only. Conclusions & Implications: The study showed that DD is not characterized by a specific pattern of disfluency. Additionally, disfluency rates were similar in children aged 8–12 years. In contrast to other languages, the current study suggests that French‐speaking children have a high rate of disfluency. The study also suggests that disfluency should be interpreted with caution in DD, given that TD children also have a high rate of disfluency. Therefore, it seems important to adapt the pathological threshold of disfluency to the language being spoken in order to avoid an overestimation of the prevalence of these deficits in French‐speaking children. WHAT THIS PAPER ADDS: What is already known on this subject: TD children produce a high rate of disfluency, which is also influenced by the language being spoken. No study looked at the effect of DD on disfluency production. Nonetheless, problems in reading comprehension and reduced reading experience may impact lexical development and speech fluency. What this paper adds to the existing knowledge: In our study, both groups (French‐speaking children) produced a substantial amount of disfluency as compared with other languages (> 10%). Additionally, the pattern of disfluency was similar in TD and DD (namely, filled pauses, prolongations repetitions of monosyllabic words and substitutions). In the DD group, disfluency production was not correlated with reading performance. What are the potential or actual clinical implications of this work?: These results indicate that it is crucial to consider the language being spoken when examining disfluency in order to avoid an overestimation of language difficulties in some languages, such as in French. Moreover, the production of disfluencies in DD should not be considered as language dysfunction since the pattern of disfluency what quite similar in TD and DD, and did not correlate with their reading difficulties. [ABSTRACT FROM AUTHOR]

Background: Impaired discourse production is commonly reported for individuals with traumatic brain injury (TBI). Discourse deficits can negatively impact community integration, return to employment and quality of life. COVID‐19 restrictions have reduced in‐person assessment services for people with communication impairments. Advances in telehealth may help speech and language therapists (SLTs) to assess monologic discourse more systematically and improve access to services for patients who may find it difficult to attend in‐person. Aims: To examine the feasibility of telehealth administration of narrative and procedural discourse tasks with individuals with TBI and matched controls. Methods & Procedures: A total of 20 individuals with TBI and 20 healthy controls, aged 18–55 years, were directly recruited from the UK and indirectly recruited from the US. For participants with TBI, time post‐injury was at least 3 months with no diagnosis of aphasia. Control participants were matched for sex and as closely as possible for age. Feasibility of measures was based upon the time to administer both narrative tasks, the report of any technological problems, and participant feed. Discourse samples were transcribed verbatim and analysed using story grammar analysis (for narrative discourse) and identification of propositions (for procedural discourse). Interrater reliability was calculated using percentage agreement for 50% of the data. Non‐parametric analyses were used to analyse the performance of the two groups. Outcomes & Results: Narrative and procedural discourse samples were collected via telehealth in approximately 10 min with no reported technical difficulties or complaints from any participants. For narrative discourse performance, there were significant differences for the TBI and control groups for measures of complete episodes (p < 0.001) and missing episodes (p = 0.005). No significant group differences were noted for any of the procedural discourse measures. Conclusions & Implications: Results support the feasibility of collecting discourse samples via telehealth. Although the participants' discourse performance distinguished the TBI and control groups on the narrative task, no differences between the groups were noted for the procedural task. The narrative discourse task may have been more difficult than the procedural task, or video cue support reduced the cognitive load of the procedural task. This finding suggests the use of more complex procedural tasks without video cue support may be needed. WHAT THIS PAPER ADDS: What is already known on this subject: Although little research has explored the feasibility of administering discourse assessments for individuals with TBI via telehealth, some studies have found that discourse interventions can be feasibly administered via telehealth. It is also well established that individuals with TBI struggle with the supra‐structural and macro‐linguistic elements of discourse production. Both procedural and narrative discourse tasks have been found to differentiate individuals with TBI from healthy controls. What this paper adds to existing knowledge: Few studies have investigated the feasibility of, and procedures for, administering discourse tasks via telehealth. Additionally, the inclusion of multiple types of discourse tasks to parse cognitive–communication abilities is lacking in the current literature. Findings from this study support that narrative and procedural discourse can be feasibly sampled via telehealth and that international collaboration for research on this topic can facilitate such studies. Individuals with TBI performed more poorly on three measures of narrative discourse. No differences between groups were identified for the procedural task. What are the potential or actual clinical implications of this work?: Telehealth assessment for discourse provides flexibility for both the individual with TBI and the speech–language therapist and does not compromise the quality of data collected. The administration of discourse tasks and collection of data was not time‐consuming and was well accepted by the study participants. Additionally, international research collaboration not only expands potential participation in research but increases the opportunity to recruit and study more diverse groups. [ABSTRACT FROM AUTHOR]

Background: Narrative discourse is central to effective participation in conversations. When discourse is assessed in people with communication disability, structured tasks (e.g., picture descriptions) provide experimental control, while unstructured tasks (e.g., personal narratives) represent more natural communication. Immersive virtual reality (VR) technology may provide a solution by creating standardized experiences for narrative retell, therefore balancing ecological validity and experimental control in discourse assessment. Research is needed to understand how VR immersion affects narrative retell, first for adults with no communication disability, before application with adults with aphasia or related communication disability. Aims: To assess (1) the effects of VR immersion on the linguistic content and structure of narrative retells in a healthy adult population; and (2) whether VR immersion can influence the way a narrative is retold so that the speaker conveys their own experience, rather than the experience of the characters they are watching. Methods & Procedures: In this pilot cohort study, 13 healthy adult participants with no reported communication disability watched an animated short film and a comparable immersive VR short film in a randomized order. Participants were asked to retell the events of the story after each condition in as much detail as possible. Outcomes & Results: Mean length of utterance (in morphemes) was significantly higher in the video condition compared with the VR condition. Significantly more first‐person pronouns were used in the VR condition compared with the video condition. No other measures of linguistic content or structure were significantly different between the VR and video conditions. Conclusions & Implications: Increased morpho‐syntactic length and complexity in the video condition may suggest effects of elicitation stimulus on the narrative produced. The larger number of first‐person pronouns in the VR condition may reflect that participants experienced a sense of presence in the virtual environment, and therefore were able to retell their communication experience rather than narrating the experiences of characters from an external perspective. Given the increasing need for more functional assessment of discourse in people with communication disability, further research is needed to validate these findings. WHAT THIS PAPER ADDS: What is already known on this subject: As an ecologically valid tool, discourse analysis is often used to assess daily communicative exchanges in adults with acquired communication disability. Clinicians and researchers using narrative discourse assessment must balance the experimental control and diagnostic reference sample capabilities of structured tasks with the ecological validity and real‐life transferability of unstructured personal narratives. What this study adds to existing knowledge: This study explores the use of immersive VR technologies to create standardized, replicable, immersive experiences as a foundation for narrative discourse assessment. It highlights how the 'sense of presence' in a virtual world can prompt healthy adult speakers to retell a narrative of a personal experience that can be replicated for many different participants. The results suggest that immersive VR narrative assessment for adults with communication disability may balance ecological validity with measurement reliability in discourse assessment. What are the potential or actual clinical observations of this work?: Immersion in VR resulted in the production of narratives with morpho‐syntactic features that aligned with typical narrative generation, rather than retell. Participants used more first‐person pronouns, suggesting retelling of personal experience. Though further study is needed, these preliminary findings suggest clinicians can use immersive VR stimuli to generate structured story generations that balance experimental and diagnostic control with ecological validity in narrative discourse assessment for adults with communication disability. [ABSTRACT FROM AUTHOR]

Background: Patients with anomic aphasia experience difficulties in narrative processing. General discourse measures are time consuming and require necessary skills. Core lexicon analysis has been proposed as an effort‐saving approach but has not been developed in Mandarin discourse. Aims: This exploratory study was aimed (1) to apply core lexicon analysis in Mandarin patients with anomic aphasia at the discourse level and (2) to verify the problems with core words among people with anomic aphasia. Methods & Procedure: The core nouns and verbs were extracted from narrative language samples from 88 healthy participants. The production of core words for 12 anomic aphasia and 12 age‐ and education‐matched controls were then calculated and compared. The correlation between the percentages and the Aphasia Quotients of the revised Western Aphasia Battery was analyzed as well. Outcomes & Results: The core nouns and verbs were successfully extracted. Patients with anomic aphasia produced fewer core words than healthy people, and the percentages differed significantly in different tasks as well as word classes. There was no correlation between the core lexicon use and the severity of aphasia in patients with anomic aphasia. Conclusions & Implications: Core lexicon analysis may potentially serve as a clinician‐friendly manner of quantifying core words produced at the discourse level in Mandarin patients with anomic aphasia. WHAT THIS PAPER ADDS: What is already known on the subject: Discourse analyses in aphasia assessment and treatment have increasingly garnered attention. Core lexicon analysis based on English AphasiaBank has been reported in recent years. It is correlated with microlinguistic and macrolinguistic measures in aphasia narratives. Nevertheless, the application based on Mandarin AphasiaBank is still under development in healthy individuals and patients with anomic aphasia. What this paper adds to existing knowledge: A Mandarin core lexicon set was developed for different tasks. The feasibility of core lexicon analysis to evaluate the corpus of patients with anomic aphasia was preliminarily discussed and the speech performance of patients and healthy people was then compared to provide a reference for the evaluation and treatment of clinical aphasia corpus. What are the potential or actual clinical implications of this work?: The purpose of this exploratory study was to consider the potential use of core lexicon analysis to evaluate core word production in narrative discourse. Moreover, normative and aphasia data were provided for comparison to develop clinical use for Mandarin patients with anomic aphasia. [ABSTRACT FROM AUTHOR]

Background: Discourse analysis has recently received much attention in the aphasia literature. Even if post‐stroke language recovery occurs throughout the longitudinal continuum of recovery, very few studies have documented discourse changes from the hyperacute to the chronic phases of recovery. Aims: To document a multilevel analysis of discourse changes from the hyperacute phase to the chronic phase of post‐stroke recovery using a series of single cases study designs. Methods & Procedures: Four people with mild to moderate post‐stroke aphasia underwent four assessments (hyperacute: 0–24 h; acute: 24–72 h; subacute: 7–14 days; and chronic: 6–12 months post‐onset). Three discourse tasks were performed at each time point: a picture description, a personal narrative and a story retelling. Multilevel changes in terms of macro‐ and microstructural aspects were analysed. The results of each discourse task were combined for each time point. Individual effect sizes were computed to evaluate the relative strength of changes in an early and a late recovery time frame. Outcomes & Results: Macrostructural results revealed improvements throughout the recovery continuum in terms of coherence and thematic efficiency. Also, the microstructural results demonstrated linguistic output improvement for three out of four participants. Namely, lexical diversity and the number of correct information units/min showed a greater gain in the early compared with the late recovery phase. Conclusions & Implications: This study highlights the importance of investigating all discourse processing levels as the longitudinal changes in discourse operate differently at each phase of recovery. Overall results support future longitudinal discourse investigation in people with post‐stroke aphasia. What This Paper Adds: What is already known on the subject: Multi‐level discourse analysis allows for in‐depth analysis of underlying discourse processes. To date, very little is known on the longitudinal discourse changes from aphasia onset through to the chronic stage of recovery. This study documents multi‐level discourse features in four people with mild to moderate aphasia in the hyperacute, acute, subacute and chronic stage of post‐stroke aphasia recovery. What this paper adds to existing knowledge: The study found that most discourse variables demonstrated improvement throughout time. Macrostructural variables of coherence and thematic units improved throughout the continuum whereas microstructural variables demonstrated greater gains in the early compared to the late period of recovery. What are the potential or actual clinical implications of this work?: This study suggests that multilevel discourse analysis will allow a better understanding of post‐stroke aphasia recovery, although more research is needed to determine the clinical utility of these findings. Future research may wish to investigate longitudinal discourse recovery in a larger sample of people with aphasia with heterogenous aphasia profiles and severities. [ABSTRACT FROM AUTHOR]

Background: Light verbs are highly frequent and semantically impoverished words. It is currently not known whether light verb production in discourse tasks differs by age or for people with dementia of the Alzheimer's type (DAT). Aims: The purpose of the current study was two‐fold: (1) to determine whether there is a relationship between age and the proportion of light verbs produce during a narrative discourse task; and (2) to determine whether people with DAT produce a different proportion of light verbs compared with neurotypical adults. Methods & Procedures: A total of 469 neurotypical adults and 12 participants with DAT produced narratives from a wordless picture book. Outcome & Results: The results indicated that light verb production increases as a function of age, even when controlling for education, and people with DAT produced a higher light verb–word ratio compared with neurotypical adults when matched for age and education. Conclusion & Implication: Light verb use may increase as a function of age due to declines in retrieval ability. These declines are not only more pronounced in people with DAT, but also semantic knowledge deficits may contribute to a reliance on light verbs. What this paper adds: Light verbs are typically some of the first verbs learned due to their simple semantic construction and high frequency. However, two things are unknown: (1) how light verbs changed across the adult lifespan; and (2) whether cognitive impairment changes light verb production. The study found that light verb production increases as a function of age, and that people with DAT used a higher ratio of light verbs to words in a narrative task compared with neurotypical adults. However, despite the findings, more research is needed to determine their clinical utility. Future research may wish to investigate whether light verbs (1) facilitate comprehension in older adults or (2) may be used in cognitive–linguistic assessments for cognitive impairments. [ABSTRACT FROM AUTHOR]

Background: Knowledge of the discourse performance of non‐brain‐damaged individuals is critical not only for its differentiation from disordered expression but also for more accurate models of ageing and communication. The effect of ageing and cognitive skills on the cohesive adequacy of discourse has, until now, presented a confusing and ambiguous picture. Aims: To examine comprehensively the effects of both age and cognitive skills on the discourse cohesion of 32 non‐brain‐damaged males divided into four age groups. Methods & Procedures: A large body of narrative and procedural samples (394 samples) was elicited from the participants. Their cognitive skills were determined using three tests, whilst their discourse cohesion was analyzed and correlated with the cognitive test results. Outcomes & Results: This extensive investigation of ageing effects on discourse cohesion and their relationship to cognitive behaviour did not provide neat generalizable results. It showed that ageing significantly increases the number of cohesive errors and reduces the quantity of referential ties in picture‐sequence narratives. The changes with age were limited to two aspects of cohesion and not linear across age groups. The participants' cognitive skills declined with age. Correlations between some cognitive tests and certain cohesive changes suggest co‐occurring deficits rather than a causal explanation of cohesive decline with age. Conclusions & Implications: With ageing there are increased cohesive errors and decreased referential ties, co‐occurring with declining cognitive skills. This study yields important guidance for future research, suggesting that picture‐sequence narrative is the most effective tool for clinical evaluation of discourse, but also that findings from one discourse sample may be misleading. [ABSTRACT FROM AUTHOR]

Abstract: Background: Cognitive impairment, particularly of executive functioning, has been implicated in deficits in spoken discourse production following acquired brain injury (ABI). However, due to variation in the methodologies and heterogeneity of findings across studies, the nature and extent of this association is not well understood. Aims: This review aims to synthesize the literature investigating associations between cognitive deficits and discourse impairment after ABI. It is reported in accordance with guidelines of The Preferred Reporting Items of Systematic Reviews and Meta‐Analyses. Data sources: Searches were conducted of a variety of databases including Medline, PsycINFO, EMBASE, CINAHL, ProQuest, Cochrane and ERIC. Additional studies were identified via reference harvesting. Eligibility criteria: Studies were included if they reported data on participants with ABI, assessed spoken discourse production and cognitive function, and performed statistical analyses to determine the association between discourse and cognitive variables. This review excluded non‐English sources and those not published in peer‐reviewed journals. Meta‐analyses were not conducted due to variability across tools and terminology used to describe participant injury‐ and non‐injury‐related characteristics and outcomes. Results: Twenty‐five observational studies were included in the review. Findings revealed significant associations between multiple cognitive functions and discourse across micro‐linguistic to super‐structural measures. Methodological and terminological inconsistencies were identified across studies, which limited systematic comparison of the results. Conclusions: This review revealed present, yet heterogeneous, relationships between cognitive and discourse deficits in speakers with ABI. Associations were interpreted in light of a well‐established model of discourse processing. Greater comparison across studies would have been facilitated by a standard nomenclature in relation to cognitive constructs and standardized discourse assessment. Future research should explore the influence of injury‐ and participant‐related factors on discourse–cognitive relationships. The lack of information on conversational discourse and paediatric ABI limits the generalizability of this review to daily interaction following ABI. While applicable across the lifespan, in‐depth investigation of discourse following ABI in childhood and adolescence is a priority due to complex changes in language and cognition, and the potential for impairments profoundly impact social, emotional and academic progression into adulthood. Given the centrality of remediating cognitive‐communication difficulties in ABI, the interrelationships between discourse and cognition should retain a critical focus of research. This will inform clinical management and future research with this population. Findings have implications for our theoretical understanding of discourse and the nature of its breakdown in ABI. [ABSTRACT FROM AUTHOR]

Background Social communication problems are common in adults with traumatic brain injury (TBI), particularly problems in spoken discourse. Social communication problems are thought to reflect underlying cognitive impairments. Aims To measure the contribution of two cognitive processes, executive functioning (EF) and theory of mind (ToM), to the communication of adults with TBI, and to investigate the relationships between discourse performance and potential communication partners' perceptions. Methods & Procedures Twenty-one adults with moderate-to-severe TBI and 23 uninjured adults completed a discourse task in which EF and ToM demands were manipulated across three conditions: baseline, high-EF and high-ToM. Dependent variables were fluency (for EFs), number of mental state terms (MSTs; for ToM) and speech rate. Discourse from high-EF/ToM conditions was judged by naïve raters for social acceptability. Outcomes & Results The TBI group produced significantly fewer MSTs than the comparison group across conditions and also spoke at a slower rate, and there were significant effects of condition on both measures (MST: high-EF < baseline = high-ToM; speech rate: high-EF < high-ToM < baseline). There were no significant between-groups differences in fluency or interaction of fluency with condition. MST use and fluency were associated with social acceptability ratings. Conclusions & Implications Results added further evidence of social communication problems in adults with TBI and demonstrated that discourse behaviours may negatively affect how a speaker is perceived. Results also indicated that task manipulations can affect discourse performance, suggesting that general cognitive demands may influence social communication after TBI. [ABSTRACT FROM AUTHOR]