Charting the decline of pragmatics in adults with neurodegenerative disorders

Louise Cummings

doi:10.1515/ip-2025-3002

Article

Charting the decline of pragmatics in adults with neurodegenerative disorders

Louise Cummings
Louise Cummings is Visiting Professor at York St John University in the UK. She conducts research in pragmatics, clinical linguistics, speech-language pathology, and health communication. She is the author and editor of over 20 books, including The Oxford Handbook of Communication Disorders in Neurodegenerative Diseases (Oxford University Press, 2026) and Language in Dementia (Cambridge University Press, 2020). She is Editor of Cambridge Elements in Health Communication and Routledge Research in Speech-Language Pathology, Consulting Editor of Pragmatics, Philosophy & Psychology (Springer), and Associate Editor of the journal Language and Health. Professor Cummings is a member of the Royal College of Speech and Language Therapists and the Health and Care Professions Council in the UK.

Published/Copyright: October 15, 2025

Published by

Become an author with De Gruyter Brill

Author Information

From the journal Intercultural Pragmatics Volume 22 Issue 3

Abstract

Neurodegenerative diseases are one of the biggest health challenges of our time. They deprive individuals of their independence, reduce a person’s quality of life, and are a significant health and economic burden on societies around the world. A wide range of clinicians is involved in assessing, diagnosing and treating people with neurodegenerative diseases. But while neurologists, psychiatrists and geriatricians bring extensive medical expertise to the clinical care of patients, they lack knowledge of the language and communication processes that are disrupted by neurodegenerative disease. The assessment and treatment of language and communication in such patients falls within the remit of speech-language pathologists. This article examines what speech-language pathologists need to know in order to assess pragmatic language impairments in adults with neurodegenerative disease. Authentic language data are used to develop an informal ‘checklist’ that speech-language pathologists can consult to characterize the pragmatic language skills of adults with neurodegenerative disorders. The article begins with some general observations about assessment, such as the need to consider pragmatic strengths as well as weaknesses. It concludes with recommendations that, if adopted, can facilitate the pragmatic assessment of patients with neurodegenerative disorders by speech-language pathologists.

Keywords: communication; discourse; language; neurodegenerative disease; pragmatic language assessment; speech-language pathologist

Corresponding author: Louise Cummings, York St John University, York, UK, E-mail: l.cummings@yorksj.ac.uk

About the author

Louise Cummings

Louise Cummings is Visiting Professor at York St John University in the UK. She conducts research in pragmatics, clinical linguistics, speech-language pathology, and health communication. She is the author and editor of over 20 books, including The Oxford Handbook of Communication Disorders in Neurodegenerative Diseases (Oxford University Press, 2026) and Language in Dementia (Cambridge University Press, 2020). She is Editor of Cambridge Elements in Health Communication and Routledge Research in Speech-Language Pathology, Consulting Editor of Pragmatics, Philosophy & Psychology (Springer), and Associate Editor of the journal Language and Health. Professor Cummings is a member of the Royal College of Speech and Language Therapists and the Health and Care Professions Council in the UK.

References

Bara, Bruno G., Monica Bucciarelli & Giuliano Carlo Geminiani. 2000. Development and decay of extra-linguistic communication. Brain and Cognition 43(1–3). 21–27.Search in Google Scholar

Bologna, Matteo, Giovanni Fabbrini, Luca Marsili, Giovanni Defazio, Philip D. Thompson & Alfredo Berardelli. 2013. Facial bradykinesia. Journal of Neurology Neurosurgery and Psychiatry 84(6). 681–685. https://doi.org/10.1136/jnnp-2012-303993.Search in Google Scholar

Boschi, Veronica, Eleonora Catricalà, Monica Consonni, Cristiano Chesi, Andrea Moro & Stefano F. Cappa. 2017. Connected speech in neurodegenerative language disorders: A review. Frontiers in Psychology 8. 269. https://doi.org/10.3389/fpsyg.2017.00269.Search in Google Scholar

Chen, Athena L., David E. Riley, Susan A. King, Anand C. Joshi, Alessandro Serra, Ke Liao, Mark L. Cohen, Jorge Otero-Millan, Susana Martinez-Conde, Michael Strupp & R. John Leigh. 2010. The disturbance of gaze in progressive supranuclear palsy: Implications for pathogenesis. Frontiers in Neurology 1. 147. https://doi.org/10.3389/fneur.2010.00147.Search in Google Scholar

Chiò, Adriano, Giancarlo Logroscino, Orla Hardiman, Robert Swingler, Douglas Mitchell, Ettore Beghi, Bryan G. Traynor & Eurals Consortium. 2009. Prognostic factors in ALS: A critical review. Amyotrophic Lateral Sclerosis 10(5-6). 310–323. https://doi.org/10.3109/17482960802566824.Search in Google Scholar

Cruice, Madeline, Nicola Botting, Jane Marshall, Mary Boyle, Deborah Hersh, Madeleine Pritchard & Lucy Dipper. 2020. UK speech and language therapists’ views and reported practices of discourse analysis in aphasia rehabilitation. International Journal of Language & Communication Disorders 55(3). 417–442. https://doi.org/10.1111/1460-6984.12528.Search in Google Scholar

Cuerva, Augustina Garcia, Liliana Sabe, G. Kuzis, C. Tiberti, Flavia Dorrego & S. E. Starkstein. 2001. Theory of mind and pragmatic abilities in dementia. Neuropsychiatry, Neuropsychology, and Behavioral Neurology 14(3). 153–158.Search in Google Scholar

Cummings, Louise. 2013. Clinical pragmatics and theory of mind. In Alessandro Capone, Franco Lo Piparo & Marco Carapezza (eds.), Perspectives on linguistic pragmatics (Perspectives in pragmatics, philosophy & Psychology 2), 23–56. Cham, Switzerland: Springer International Publishing AG.10.1007/978-3-319-01014-4_2Search in Google Scholar

Cummings, Louise. 2014. Pragmatic disorders and theory of mind. In Louise Cummings (ed.), Cambridge handbook of communication disorders, 559–577. Cambridge: Cambridge University Press.10.1017/CBO9781139108683.036Search in Google Scholar

Cummings, Louise. 2015. Pragmatic and discourse disorders: A workbook. Cambridge: Cambridge University Press.10.1017/CBO9781316162866Search in Google Scholar

Cummings, Louise. 2017. Cognitive aspects of pragmatic disorders. In Louise Cummings (ed.), Research in clinical pragmatics (Perspectives in pragmatics, philosophy & psychology 11), 587–616. Cham, Switzerland: Springer International Publishing AG.10.1007/978-3-319-47489-2_22Search in Google Scholar

Cummings, Louise. 2019a. Describing the cookie theft picture: Sources of breakdown in Alzheimer’s dementia. Pragmatics and Society 10(2). 151–174. https://doi.org/10.1075/ps.17011.cum.Search in Google Scholar

Cummings, Louise. 2019b. Narrating the Cinderella story in adults with primary progressive aphasia. In Alessandro Capone, Marco Carapezza & Franco Lo Piparo (eds.). Further advances in pragmatics and philosophy. Part 2: Theories and applications, 301–329. Cham, Switzerland: Springer International Publishing AG.10.1007/978-3-030-00973-1_18Search in Google Scholar

Cummings, Louise. 2020. Language in dementia. Cambridge: Cambridge University Press.Search in Google Scholar

Cummings, Louise. 2021. Language case files in neurological disorders. New York: Routledge.10.4324/9781003153559Search in Google Scholar

Cummings, Louise (ed.). 2026. Oxford handbook of communication disorders in neurodegenerative diseases. Oxford: Oxford University Press.Search in Google Scholar

Darling-White, Meghan, Zeina Anspach & Jessica E. Huber. 2022. Longitudinal effects of Parkinson’s disease on speech breathing during an extemporaneous connected speech task. Journal of Speech, Language, and Hearing Research 65(4). 1402–1415. https://doi.org/10.1044/2022_JSLHR-21-00485.Search in Google Scholar

Emery, V. Olga. 2000. Language impairment in dementia of the Alzheimer type: A hierarchical decline? International Journal of Psychiatry in Medicine 30(2). 145–164. https://doi.org/10.2190/x09p-n7au-ucha-vw08.Search in Google Scholar

Folder, Naomi, Emma Power, Rachael Rietdijk, Iben Christensen, Leanne Togher & Deborah Parker. 2024. The effectiveness and characteristics of communication partner training programs for families of people with dementia: A systematic review. The Gerontologist 64(4). gnad095. https://doi.org/10.1093/geront/gnad095.Search in Google Scholar

Forsaa, Elin Bjelland, J. P. Larsen, T. Wentzel-Larsen & Guido Alves. 2010. What predicts mortality in Parkinson disease? A prospective population-based long-term study. Neurology 75(14). 1270–1276. https://doi.org/10.1212/WNL.0b013e3181f61311.Search in Google Scholar

Forsgren, Emma, Malin, Antonsson & Charlotta, Saldert. 2012. Training conversation partners of persons with communication disorders related to Parkinson’s disease – A protocol and a pilot study. Logopedics Phoniatrics Vocology 38(2). 82-90. https://doi.org/10.3109/14015439.2012.731081Search in Google Scholar

Hall, Karinna, Christopher Lind, Jessica A. Young, Elise Okell & Willem van Steenbrugge. 2018. Familiar communication partners’ facilitation of topic management in conversations with individuals with dementia. International Journal of Language & Communication Disorders 53(3). 564–575. https://doi.org/10.1111/1460-6984.12369.Search in Google Scholar

Healey, Meghan, Erica Howard, Molly Ungrady, Christopher A. Olm, Naomi Nevler, David J. Irwin & Murray Grossman. 2021. More than words: Extra-sylvian neuroanatomic networks support indirect speech act comprehension and discourse in behavioral variant frontotemporal dementia. Frontiers in Human Neuroscience 14. 598131. https://doi.org/10.3389/fnhum.2020.598131.Search in Google Scholar

Hödl, Anna K., Elfriede Hödl, Daniela V. Otti, Brigitte Herranhof, Rottraut Ille & Raphael M. Bonelli. 2008. Ideomotor limb apraxia in Huntington’s disease: A case-control study. Journal of Neurology 255(3). 331–339. https://doi.org/10.1007/s00415-008-0577-4.Search in Google Scholar

Khan, Gulfaraz & M. Jawad Hashim. 2025. Epidemiology of multiple sclerosis: Global, regional, national and sub-national-level estimates and future projections. Journal of Epidemiology and Global Health 15. 21. https://doi.org/10.1007/s44197-025-00353-6.Search in Google Scholar

Kindell, Jacqueline, John Keady, Karen Sage & Ray Wilkinson. 2017. Everyday conversation in dementia: A review of the literature to inform research and practice. International Journal of Language & Communication Disorders 52(4). 392–406. https://doi.org/10.1111/1460-6984.12298.Search in Google Scholar

Kortazar-Zubizarreta, Izaro, Rebeca Ruiz-Onandi, Arrate Pereda, Yerai Vado, Gonzalo González-Chinchon, Hasier Eraña, Guiomar Perez de Nanclares & Joaquín Castilla. 2021. Sporadic Creutzfeldt-Jakob disease with extremely long 14-year survival period. European Journal of Neurology 28(9). 2901–2906. https://doi.org/10.1111/ene.14946.Search in Google Scholar

March, Evrim G., Roger Wales & Pip Pattison. 2006. The uses of nouns and deixis in discourse production in Alzheimer’s disease. Journal of Neurolinguistics 19(4). 311–340. https://doi.org/10.1016/j.jneuroling.2006.01.001.Search in Google Scholar

Maziero, Maria Paula, Ariella Fornachari Ribeiro Belan, Marina von Zuben de Arruda Camargo, Marcela Lima Silagi, Vicente Forlenza Orestes & Marcia Radanovic. 2021. Textual inference comprehension in mild cognitive impairment: The influence of semantic processing and verbal episodic memory. Frontiers in Aging Neuroscience 13. 735633. https://doi.org/10.3389/fnagi.2021.735633.Search in Google Scholar

Mendez, Mario F. 2017. Early-onset Alzheimer disease. Neurologic Clinics 35(2). 263–281. https://doi.org/10.1016/j.ncl.2017.01.005.Search in Google Scholar

Mentis, Michelle, Jan Briggs-Whittaker & Gary D. Gramigna. 1995. Discourse topic management in senile dementia of the Alzheimer’s type. Journal of Speech & Hearing Research 38(5). 1054–1066. https://doi.org/10.1044/jshr.3805.1054.Search in Google Scholar

Montemurro, Sonia, Sara Mondini, Matteo Signorini, Anna Marchetto, Valentina Bambini & Giorgio Arcara. 2019. Pragmatic language disorder in Parkinson’s disease and the potential effect of cognitive reserve. Frontiers in Psychology 10. 1220. https://doi.org/10.3389/fpsyg.2019.01220.Search in Google Scholar

Murdoch, Bruce E., Helen J. Chenery, Vicki Wilks & Richard S. Boyle. 1987. Language disorders in dementia of the Alzheimer type. Brain and Language 31(1). 122–137. https://doi.org/10.1016/0093-934x(87)90064-2.Search in Google Scholar

National Institute on Aging. 2022. Parkinson’s disease: Causes, symptoms, and treatments. https://www.nia.nih.gov/health/parkinsons-disease/parkinsons-disease-causes-symptoms-and-treatments (accessed 12 August 2025).Search in Google Scholar

O’Rourke, Angela, Emma Power, Robyn O’Halloran & Rachael Rietdijk. 2018. Common and distinct components of communication partner training programmes in stroke, traumatic brain injury and dementia. International Journal of Language & Communication Disorders 53(6). 1150–1168. https://doi.org/10.1111/1460-6984.12428.Search in Google Scholar

Ripich, Danielle N., Brian D. Carpenter & Elaine W. Ziol. 2000. Conversational cohesion patterns in men and women with Alzheimer’s disease: A longitudinal study. International Journal of Language & Communication Disorders 35(1). 49–64. https://doi.org/10.1080/136828200247241.Search in Google Scholar

Schüβler, Ingrid, & Rosemary, Tzschoppe. 1972. So ein Dackel! 22 Bildgeschichten für den Sprachunterricht, Illustrator Hans Kossatz, Stuttgart: Ernst Klett Verlag.Search in Google Scholar

Varela Suárez, Ana. 2024. A tutorial on discourse analysis in healthy and pathological ageing. International Journal of Language & Communication Disorders 59(1). 94–109. https://doi.org/10.1111/1460-6984.12919.Search in Google Scholar

Volkmer, Anna. 2013. Assessment and therapy for language and cognitive communication difficulties in dementia and other progressive diseases. Guildford: J&R Press.Search in Google Scholar

Volkmer, Anna, Holly Walton, Kate Swinburn, Aimee Spector, Jason D. Warren & Suzanne Beeke. 2023. Results from a randomised controlled pilot study of the Better Conversations with Primary Progressive Aphasia (BCPPA) communication partner training program for people with PPA and their communication partners. Pilot and Feasibility Studies 9(1). 87. https://doi.org/10.1186/s40814-023-01301-6.Search in Google Scholar

World Health Organization. 2025. Dementia. https://www.who.int/news-room/fact-sheets/detail/dementia (accessed 12 August 2025).Search in Google Scholar

Published Online: 2025-10-15

Published in Print: 2025-06-26

You are currently not able to access this content.

Articles in the same Issue

https://doi.org/10.1515/ip-2025-3002

Keywords for this article

communication; discourse; language; neurodegenerative disease; pragmatic language assessment; speech-language pathologist