Communication Study
Towards diagnostic conversational profiles of patients presenting with dementia or functional memory disorders to memory clinics

https://doi.org/10.1016/j.pec.2015.05.021Get rights and content

Highlights

  • Differentiates patients with dementia from those with non-organic conditions.

  • Differential diagnosis based on patients’ conversational patterns.

  • Non-intrusive diagnostic technique, easy to administer.

  • Conversational cues can be used to aid the screening and referral process.

  • Usable by GPs and other healthcare professionals.

Abstract

Objective

This study explores whether the profile of patients’ interactional behaviour in memory clinic conversations with a doctor can contribute to the clinical differentiation between functional memory disorders (FMD) and memory problems related to neurodegenerative diseases.

Methods

Conversation Analysis of video recordings of neurologists’ interactions with patients attending a specialist memory clinic. “Gold standard” diagnoses were made independently of CA findings by a multi-disciplinary team based on clinical assessment, neuropsychological testing and brain imaging.

Results

Two discrete conversational profiles for patients with memory complaints emerged, including (i) who attends the clinic (i.e., whether or not patients are accompanied), and (ii) patients’ responses to neurologists’ questions about memory problems, such as difficulties with compound questions and providing specific and elaborated examples and frequent “I don’t know” responses.

Conclusion

Specific communicative difficulties are characteristic of the interaction patterns of patients with a neurodegenerative pathology. Those difficulties are manifest in memory clinic interactions with neurologists, thereby helping to differentiate patients with dementia from those with FMD.

Practical implications

Our findings demonstrate that conversational profiles based on patients’ contributions to memory clinic encounters have diagnostic potential to assist the screening and referral process from primary care, and the diagnostic service in secondary care.

Section snippets

Introduction/background

The clinical differentiation of memory complaints attributable to progressive neurodegenerative disorders leading to dementia (ND) and that of similar complaints due to functional memory disorders (FMD, i.e., non-progressive memory deficits) [1] is a frequent challenge in specialist memory clinics. Recent observations in the United Kingdom (UK) suggest that up to 50% of patients referred to memory clinics are diagnosed with FMD rather than memory complaints secondary to ND [2]. Previous

Study design

The study design parallels prior research that identified, described and tested profiles of interactional, linguistic and topical features as aids in the differential diagnosis of patients with epilepsy or psychogenic non-epileptic seizures [16], [17], [18]. Using similar analytic methods, we aimed to distinguish between conversational patterns observable in interactions with patients whose memory complaints are due either to ND (such as Alzheimer's disease) or FMD. FMD diagnostic criteria were

Results

We identified working conversational profiles that distinguished between the two patient groups, i.e., patients with memory complaints due to ND and patients with FMD. Broadly the profile is separated into two areas: who attends the memory clinic, and how patients respond to neurologists’ questions during history-taking.

Discussion – summary

The principal aim of this research was to develop conversational profiles, which could help distinguish between the interactional behaviour of patients with FMD and that of patients with memory problems due to ND. We have identified and explored a range of conversational indicators that can aid the diagnostic process. Patients with ND were more likely than those independently diagnosed with FMD to be accompanied during their visit to the memory clinic. The companions of patients with ND were

Conflicts of interest

None declared.

Funding

This article presents independent research funded by the National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme [grant reference number PB-PG-0211-24079]. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

NIHR had no involvement in designing or conducting the study and was not involved in the process of writing this article.

Acknowledgements

We are most grateful to the patients who agreed to participate in this study, and to the medical staff who managed the patient recruitment and data collection. We recognise that for patients visits to the memory clinic can be stressful, and that NHS staff experience immense workload pressures. We greatly appreciate, therefore, the engagement of both patients and NHS staff in this study.

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