阿尔茨海默症患者话语的系统功能语言学研究
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摘要
本研究的目的是：从理论层面探讨临床语言研究的系统功能语言学理据及途径,从实践操作层面尝试基于系统功能语言学理论框架的阿尔茨海默症患者话语分析,为该言语失调症的早期评估和诊断提供语言学证据。
临床语言研究在当今社会具有重要的理论和实践价值。就临床语言研究的理论价值而论,其研究发现将对主流语言学作出有益的补充,并从语言的病理表现检验主流语言学的理论构建。从临床语言研究的实践价值而言,对各类言语失调现象作基于语言学的科学研究,有助于对言语失调患者的语言功能作出准确和明晰的评估,从而为言语失调的医学诊断和干预提供基于语言学的证据,为言语失调患者的语言康复制定合理的目标和计划。国外临床语言学的研究已经渗透到各类言语失调症,呈现出蓬勃发展,欣欣向荣的局面；相形之下,国内临床语言学无论在研究的覆盖面、研究队伍、语料建设、专业刊物还是文献资料等方面均有待改进。当前,国内临床语言的研究侧重于失语症和手语,其它言语失调症,如口吃、唇腭裂、孤独症和因疾病等因素导致的特殊脑损伤、阿尔茨海默症等疾病患者的言语失调现象尚未获得足够重视。另外,国内临床语言的研究以实用主义为导向,侧重于言语康复训练,一定程度上忽视了临床语言学的理论构建。
传统临床语言研究以结构主义语言学和生成语法为理论蓝图,注重言语缺陷的音系、词法和句法研究,忽视了语言的实际使用和意义发生的社会语境。当今临床语言研究的趋势是以言语失调患者的真实话语为语料,注重语言的实际使用,将社会和文化语境作为重要的参项,关注言语失调的跨语言表现,并将临床语言的研究推进到语篇层面。Halliday (1994:F55-56)认为语言学有21种用途,其中四种涉及临床语言的评估和干预。为推动系统功能语言学与临床语言研究的整合,Halliday(2005：133-135)就系统功能语言学对临床语言研究的意义作了精辟的阐述。此后,国外基于系统功能语言学分析框架的临床语言研究逐年增加,吸引着越来越多学者的关注。然而,基于此框架的临床语言研究只涉及系统功能语言学的个别侧面,还不够系统和全面,国内至今尚无学者开展相关研究。
系统功能语言学以解决语言之外的问题为理论构建之价值诉求,其工作目标是为话语(语篇)分析构建一部语法。本文以系统功能语言学为理论框架,借助该理论的分析方法对英语轻度阿尔茨海默症患者和健康老年人的话语作多维度的研究,具体而言,就是将系统功能语言学的三个元功能作为操作进路,从主位结构、人际意义、及物性、衔接与连贯四个维度对二组话语展开研究,从小句到语篇层面对轻度阿尔茨海默症患者的语言功能作出较为全面的分析和评估。
主位研究从三个方面展开,分别是主位的标记性、主位推进模式和多重主位；人际意义的研究也从三个方面进行,分别是语气、情态和评价；及物性研究重点从表征参与者和环境成分的词汇语法资源着手；衔接与连贯研究从三个大的方面铺开,即话语构建、衔接和话语损伤,这三方面分别由不同的指标构成。由于四个维度的研究均由不同的范畴构成,在具体分析中我们根据研究需要对语料作了细致的标记。
研究结果表明,在主位的标记性方面,患者组和健康组的主位标记性均不高,说明二组被试倾向于使用无标记主位作为小句的出发点；在主位的推进方面,患者组和健康组均以线性主位推进模式和重复性主位推进模式为主,二组被试在线性主位推进方面不存在显著差别,而在重复性主位推进模式方面,患者组明显高于健康组,说明轻度阿尔茨海默症患者在言语交际中多使用重复性语义资源,反映出患者在词汇提取方面存在一定的困难；在多重主位方面,二组语料均呈现出简化的特征,没有发现由语篇、人际和概念成分共同构成的多重主位,在患者组语料的多重主位中,多以人际+话题成分构成,语篇成分较少。
在人际意义层面,语气分析重点考查了主语和补语的构成,结果发现患者组和健康组用于表征主语和补语的名词性词汇资源多为简单名词词组,不同之处是,患者组语料中使用的名词性语义资源具体性不强,出现用上位词代替具体名词的现象,如用"thing"取代目标名词,另外,患者组语料中使用的指示词较健康组语料多。这二种现象表明患者存在名词提取故障,从而不得不求助于概括性的上位词或指示词。在情态分析中,着重考查患者组和健康组在情态助动词使用方面的情况,从而对被试在完成语言任务时话语的情态意义作出评估,分析结果表明,患者组所使用的情态助动词明显多于健康组。在患者组所使用的情态助动词中,肯定性和否定性助动词均以中值和低值为主,表明轻度阿尔茨海默症患者在对语言事件进行表征时不够确定,话语的归向性(polarity)不明确,从而采取一种协商的立场,而健康组被试较少使用情态助动词则说明他们对自己的话语有足够的信心。评价资源的分析重点从表达说话人态度的语义资源入手,结果表明,患者在完成语言任务时基本没有使用态度类评价语义资源,而健康组被试则较多使用了表达态度的语义资源,这从侧面表明轻度阿尔茨海默症患者的语义资源不够丰富,话语内容不够具体,在完成语言任务时缺乏语言多样性。
在及物性层面,研究首先考查了轻度阿尔茨海默症患者和健康被试表征过程的能力,结果发现,和健康老年人一样,患者能够表征各类过程类型,二组语料占前三位的过程类型分别是物质过程、心理过程和关系过程。在此基础上,我们对三类主要过程的参与者和环境成分的构成作了分析,结果发现,患者组在参与者和环境成分构成的复杂性方面没有健康组高,多使用简单名词词组、上位词"thing"和指示词(如‘'that","this").在患者所使用的复合名词词组中,较少使用对中心词的性质、特征、分类等作限定或说明的成分,表明患者在参与者和环境成分的表征方面缺乏具体性,导致话语的内容空洞贫乏,反映出患者在名词性词汇资源方面存在提取困难和缺乏对其进行修饰加工的能力。
在衔接与连贯层面,研究从话语与语义记忆和工作记忆的关系着手,着重从话语构建、衔接和话语损伤三方面对二组语料作了分析。结果表明,患者组在话语构建和衔接性语言指标的使用方面明显低于健康组,在话题维系和整体连贯方面健康组明显优于患者组,而患者组在话语损伤指标方面则显著高于健康组,同时患者组在话语进行中还存在话题骤转现象。上述分析结果表明,话语的语义记忆与衔接具有关联性,衔接手段中的照应、时间衔接和话题维系均需借助语义资源的合理布局和使用才能实现,而整体连贯则和语言使用者的工作记忆相关,因为整体连贯涉及话题的一致性和话语内容的协调性,如果说话者的工作记忆受损,那么他的话语可能会出现话题转移从而发生言语内容前后不一致的情况。从对患者组和健康组语料的衔接与连贯的分析结果来看,轻度阿尔茨海默症患者无论在语义记忆还是在工作记忆方面均受到了损伤,而健康老年人不存在类似情况。
本文共分十章。第一章“导论”阐明研究的背景、目的、意义和语料收集的方法。从研究的意义而言,本文旨在从理论和实践二方面展示系统功能语言学在临床语言研究中的独特价值,并通过实证研究为早期阿尔茨海默症的诊断和语言功能的评估提供语言学证据。
第二章“文献综述”是对本文的主要理论和方法发展现状的总体回顾和评述。本章主要内容有：首先对临床语言学的相关概念和研究范围作简要说明,明确其操作路径；其次,对阿尔茨海默症患者的语言功能作简要评述；再次,探讨话语与语义记忆和工作记忆的关系；最后,对系统功能语言学指导下的与本研究相关的研究作评述。
第三章“理论基础”对本研究所依赖的指导性理论作阐述。首先,我们对系统功能语言学对本研究的意义和启示作宏观的探讨,然后对临床话语研究的语言学理论框架作简要的评述,探讨各理论框架的优点和不足,最后明确临床话语分析的系统功能语言学理据及途径。
第四章“研究设计”首先对本文依托的方法论作简要说明,然后阐明语料的标记方法和实证分析方法,并呈现本研究被试的人口学信息。总体而言,本文采用了质性和量性相结合的研究方法,目的是对语料作多维度、全方位的研究。
第五章“阿尔茨海默症患者话语的主位结构分析”从主位的标记性、主位推进模式和多重主位三方面对被试的语料作详尽的分析。在具体分析中,着重从主位的构成、标记性主位的特征、线性和重复性主位推进模式、多重主位的组成成分对患者组和健康组的语料作对比分析,揭示二者在主位这一语言构式方面的使用情况。
第六章“阿尔茨海默症患者话语的衔接研究”从三方面展开,分别是话语构建、衔接和话语损伤。本章的目的是对患者在语篇生成过程中所使用的话语构建和衔接性语义资源作评估和分析,揭示患者话语损伤的具体方面,并将被试的话语表现与语义记忆和工作记忆建立关联,从这二方面对患者话语的衔接与连贯问题进行解释。
第七章“阿尔茨海默症患者话语的人际意义研究”着重从语气、情态和评价三方面入手,对患者组和健康组在语气的主语和补语构成、情态助动词的使用和评价系统中态度类语义资源的使用情况作综合研究。语气研究中的主语和补语的分析与第七章的及物性分析具有互补性,而情态分析则揭示了患者在表达个人情感和立场时的语言使用情况。评价系统中的态度分析则进一步对患者和健康老年人在表达个人态度时的语义资源作出描述,从而对被试话语的质量作出评估。
第八章“阿尔茨海默症患者话语的及物性分析”重点分析患者组和健康组的名词性语义资源。以往研究发现,阿尔茨海默症患者存在名词提取困难,集中表现为命名缺陷,本章的及物性分析正好可以从名词词组的角度对先前的研究结论进行检验。研究从过程类型分析出发,进而对三类主要过程的参与者和环境成分作系统分析,重点是参与者和环境成分的构成,以此揭示患者在表征参与者和环境成分时的名词性词汇语法资源的使用情况。
第九章“讨论与启示”对研究结果进行探讨,明确研究结果的启示。
第十章“结论”对整个研究的发现作总结,在此基础上探讨研究的不足和今后努力的方向。
The present study has two purposes. The first purpose is to theoretically address the Systemic functional linguistic (SFL) motive and approach of clinical discourse analysis. The second purpose is to practically conduct a discourse analysis of the Alzheimer's patients within the framework of SFL and to provide linguistics evidence for the assessment and intervention of the Alzheimer's disease.
Studies of language disorder are both theoretically and practically significant in our times. So far as the theoretical significance is concerned, the findings of clinical linguistic studies are valuable supplements to the mainstream linguistics. In the meantime, disordered language is a touchstone which serves to the test, remediation and development of the mainstream linguistic theories. In terms of the practical value of language disorder studies, a linguistics-based study of the disordered language would make a clear and accurate assessment of the language functions of the clinical population. A linguistics-based assessment of the language function is essential for the medical diagnosis and intervention of language disorders. Furthermore, it serves as the evidence for making feasible plans and approachable goals for language function remediation. Clinical linguistic studies abroad have reached to all the disordered syndromes and made great achievements in the past few years. In comparison to the prosperity of clinical linguistic studies abroad, we are falling far behind in the scope of certain disordered areas, the research staff, the bank of material, academic journals and references. Currently, Chinese clinical linguistic studies are focused on aphasia and sign language, for other language disorders, such as stuttering, cleft palate, autism and other brain damage induced or disease induced disorders like Specific Brain Impairment and the dementia of Alzheimer's type are not yet given due recognition. Meanwhile, Chinese clinical linguistic studies are pragmaticism guided which pay more attention to remediation rather than theory construction.
Conventional clinical linguistic studies were mainly conducted under the guidelines of structural linguistics and generative grammar which focused on phonology, lexicon and syntax and discarded the social context of authentic language use and meaning making. The tendency of clinical linguistic studies is to analyze the disordered language users' discourse and synthesize the social and cultural contexts in the analysis. Meanwhile, cross language performance of the disordered language users is now becoming an emergent area in clinical linguistic studies. In taking the authentic language use and context into consideration, clinical linguistic studies are called to be conducted on discourse level rather than sentence level. The analytic framework of this thesis is the systemic functional linguistics (SFL) for its unique advantages in discourse analysis. The aims of the study were a multi-dimensional investigation of the mild Alzheimer's narrative description of the Cookie Theft Picture. The analyses of the Alzheimer's disease were carried out in accordance with SFL's metafunctions, i.e. ideational, interpersonal and texture with detailed tagging of the discourse in the quantitative and qualitative analyses. The metafunctional analyses of the discourse of the Alzheimer's patients have made it possible to deal with the discourse from clause to text which yielded a comprehensive assessment of the language function of the Alzheimer's patients.
Firstly, the textural metafunction of the discourse was analyzed in the markedness of themes, the patterns of theme progression and multiple themes. Secondly, the analyses of the interpersonal meanings of the discourse were carried out in mood, modality and appraisal system. Thirdly, the ideational meanings of the discourse were analyzed in transitivity system with special attention given to the construction of participant and circumstance of the clause. Fourthly, the thesis gave a detailed analysis of the cohesion and coherence of the Alzheimer's patients'discourse in three aspects, i.e. discourse building, cohesion and discourse impairment. SFL provides a unitary framework for discourse analysis, but the three metafuntional analyses of the discourse needed different tagging of the samples. In order to meet the goals of the study, the discourse samples were finely tagged.
In terms of theme analyses, the results showed that both the Alzheimer's subject and their counterpart used less marked themes as the departure of the clauses which indicated that both groups tended to use unmarked themes. In theme progression, both groups tended to use linear and iterative patterns and there was no significant difference in linear progression. The mildly demented group used more iterative theme progression which indicated that they might have difficulty in vocabulary retrieval. In multiple theme analyses, the study found no multiple themes which were constructed with textural, interpersonal and ideational elements and most of the multiple themes consisted of interpersonal and topical elements which indicated a simplified multiple theme construction of both groups.
Interpersonal meaning analyses were conducted in three aspects. Mood analysis investigated the construction of subjects and complements of the clause. The results showed that in constructing subjects and complements, both groups tended to use simple nominal groups and the difference was that the mildly demented group's nominal groups were less specific and informative. The demented group frequently used superordinate and deictic terms to denote target nouns. The most frequently used superordinate term was thing, the deictic terms were that and this. The findings in the way the demented group constructing their subjects indicated a less efficient retrieval of the noun. The modality analyses investigated the use of auxiliary modal verbs in both groups'discourse. The results showed that in representing the speakers'modal meanings, the mildly demented group used more modal auxiliary verbs and most of the verbs were median and low value ones which meant that the mildly demented subject were less certain about their discourse and they took a negotiating stance in their speaking while their counterpart were more confident in their speaking. The appraisal analyses investigated the subject's semantic resources used to express their attitudes. The results indicated that the mildly demented group did not use appraisal resources in their discourse while the control group made frequent use of this semantic resource. The findings of appraisal analyses reflected a poor semantic resource of the demented subject in expressing their attitudes because of semantic impairment.
In transitivity analyses, the study first made an analysis of the processes of the clauses in both groups'discourse. The results showed that both groups were capable of producing all the process types with material, relational and mental processes as the major ones. Secondly, the study investigated the construction of participant and circumstance of the major process types which found that in representing participants and circumstances, the complexity of these two categories of the mildly demented group was much lower than that of the control group. The mildly demented group used more simple nominal groups in representing participants and circumstances. In the complex nominal groups the mildly demented groups used, a lack of modifier, classifier or qualifier of the head nouns could be found which indicated that the discourse of the demented was not as specific and informative as that of the control group.
In cohesion and coherence analyses, the study aimed to find out the correlations between discourse and the semantic and working memory of the mildly demented Alzheimer's patients. The analyses were conducted in three aspects, i.e. discourse building, cohesion and discourse impairment. The results showed that in discourse building and cohesion, the mildly demented group used less linguistic resources to build their discourse. The mildly demented group's topic maintenance and global coherence were impaired. In discourse impairment, the mildly demented group was worse in all the categories and in their discourse we found abrupt topic shifts. The analyses and findings indicated that there was a correlation between discourse coherence and semantic and working memory since the coherence of the discourse must be realized by the appropriate used of semantic devices. In order to maintain a global coherence, the speaker had to make good references and connections between clauses, an impaired working memory prevented the speaker from maintaining the wholeness and harmony of his or her discourse. The healthy counterpart of this study did not have the problem of maintaining discourse global coherence.
The thesis consists of ten chapters. The first chapter is an introduction to the background, purposes, significance and data collection of the study. So far as the significance of the study is concerned, two points are taken into consideration. The first is to make an organic integration of SFL and clinical linguistic studies. The second is to provide linguistics evidence for the diagnosis and assessment of the early Alzheimer's disease.
The second chapter is to give a review of the literature pertaining to the present study. This chapter first defines the clinical linguistics and its scope and the approach to do clinical linguistic studies. Secondly, the author gives a reasoned discussion of the guiding linguistic theory of this study. Meanwhile, a discussion of the motive and access of doing clinical discourse analysis under SFL will be given in this chapter.
The third chapter is a discussion of the theoretical foundation of the present study. Firstly, this chapter gives a critical review of the implication of SFL for discourse analysis of the Alzheimer's patients. Secondly, the chapter discusses the linguistic guidelines for clinical discourse analysis. Thirdly, an SFL motive and approach of doing clinical discourse analyses would be elaborated.
Chapter Four elaborates the methodology of the study. The key points of this chapter are the tagging of the samples, the demographic information of the subject and the specific methods of discourse analysis used in this study. Generally speaking, both quantitative and qualitative methods would be employed in the study because the aim of the thesis was to make a multi-dimensional analysis of the samples.
The fifth chapter is the analyses of theme in the discourse of the Alzheimer's patients. Specifically, the analyses are made in three ways, i.e. the markedness of theme, the patterns of theme progression and multiple themes. In the analyses, the differences between the mildly demented and their counterpart in the above aspects would be addressed.
Chapter Six "A cohesion and coherence analysis of the discourse of the Alzheimer's patients" is carried out in three categories, i.e. discourse building, cohesion and discourse impairing. The aim of this chapter is to build an organic correlation between Alzheimer's patients' discourse and their semantic and working memory.
Chapter Seven is the analyses of the interpersonal meanings of discourse of the Alzheimer's patients. The study is carried out in three aspects, i.e. mood, modality and appraisal system. The mood analysis which focuses on nominal groups resonates well with the transitivity analysis in Chapter Six. While the modality analysis would give us a thorough understanding of the stance and certainty of the speakers' discourse, the appraisal analysis makes it possible to evaluate the quality of the discourse in terms of semantic resources.
The eighth chapter is a transitivity analysis of the discourse of the Alzheimer's patients. The focus of the analysis is the construction of participant and circumstance in terms of nominal groups. As previous studies have pointed out that the Alzheimer's patients have difficulties in naming, the participant and circumstance analysis would make a better assessment of the nominal resources of the Alzheimer's patients.
Based on the findings in quantitative and qualitative analyses, the nineth chapter makes discussions on the results and finds out the implications of the analyses.
Chapter Ten concludes the thesis with a discussion of the limitations of the study and suggestions for further research.
临床语言研究在当今社会具有重要的理论和实践价值。就临床语言研究的理论价值而论,其研究发现将对主流语言学作出有益的补充,并从语言的病理表现检验主流语言学的理论构建。从临床语言研究的实践价值而言,对各类言语失调现象作基于语言学的科学研究,有助于对言语失调患者的语言功能作出准确和明晰的评估,从而为言语失调的医学诊断和干预提供基于语言学的证据,为言语失调患者的语言康复制定合理的目标和计划。国外临床语言学的研究已经渗透到各类言语失调症,呈现出蓬勃发展,欣欣向荣的局面；相形之下,国内临床语言学无论在研究的覆盖面、研究队伍、语料建设、专业刊物还是文献资料等方面均有待改进。当前,国内临床语言的研究侧重于失语症和手语,其它言语失调症,如口吃、唇腭裂、孤独症和因疾病等因素导致的特殊脑损伤、阿尔茨海默症等疾病患者的言语失调现象尚未获得足够重视。另外,国内临床语言的研究以实用主义为导向,侧重于言语康复训练,一定程度上忽视了临床语言学的理论构建。
传统临床语言研究以结构主义语言学和生成语法为理论蓝图,注重言语缺陷的音系、词法和句法研究,忽视了语言的实际使用和意义发生的社会语境。当今临床语言研究的趋势是以言语失调患者的真实话语为语料,注重语言的实际使用,将社会和文化语境作为重要的参项,关注言语失调的跨语言表现,并将临床语言的研究推进到语篇层面。Halliday (1994:F55-56)认为语言学有21种用途,其中四种涉及临床语言的评估和干预。为推动系统功能语言学与临床语言研究的整合,Halliday(2005：133-135)就系统功能语言学对临床语言研究的意义作了精辟的阐述。此后,国外基于系统功能语言学分析框架的临床语言研究逐年增加,吸引着越来越多学者的关注。然而,基于此框架的临床语言研究只涉及系统功能语言学的个别侧面,还不够系统和全面,国内至今尚无学者开展相关研究。
系统功能语言学以解决语言之外的问题为理论构建之价值诉求,其工作目标是为话语(语篇)分析构建一部语法。本文以系统功能语言学为理论框架,借助该理论的分析方法对英语轻度阿尔茨海默症患者和健康老年人的话语作多维度的研究,具体而言,就是将系统功能语言学的三个元功能作为操作进路,从主位结构、人际意义、及物性、衔接与连贯四个维度对二组话语展开研究,从小句到语篇层面对轻度阿尔茨海默症患者的语言功能作出较为全面的分析和评估。
主位研究从三个方面展开,分别是主位的标记性、主位推进模式和多重主位；人际意义的研究也从三个方面进行,分别是语气、情态和评价；及物性研究重点从表征参与者和环境成分的词汇语法资源着手；衔接与连贯研究从三个大的方面铺开,即话语构建、衔接和话语损伤,这三方面分别由不同的指标构成。由于四个维度的研究均由不同的范畴构成,在具体分析中我们根据研究需要对语料作了细致的标记。
研究结果表明,在主位的标记性方面,患者组和健康组的主位标记性均不高,说明二组被试倾向于使用无标记主位作为小句的出发点；在主位的推进方面,患者组和健康组均以线性主位推进模式和重复性主位推进模式为主,二组被试在线性主位推进方面不存在显著差别,而在重复性主位推进模式方面,患者组明显高于健康组,说明轻度阿尔茨海默症患者在言语交际中多使用重复性语义资源,反映出患者在词汇提取方面存在一定的困难；在多重主位方面,二组语料均呈现出简化的特征,没有发现由语篇、人际和概念成分共同构成的多重主位,在患者组语料的多重主位中,多以人际+话题成分构成,语篇成分较少。
在人际意义层面,语气分析重点考查了主语和补语的构成,结果发现患者组和健康组用于表征主语和补语的名词性词汇资源多为简单名词词组,不同之处是,患者组语料中使用的名词性语义资源具体性不强,出现用上位词代替具体名词的现象,如用"thing"取代目标名词,另外,患者组语料中使用的指示词较健康组语料多。这二种现象表明患者存在名词提取故障,从而不得不求助于概括性的上位词或指示词。在情态分析中,着重考查患者组和健康组在情态助动词使用方面的情况,从而对被试在完成语言任务时话语的情态意义作出评估,分析结果表明,患者组所使用的情态助动词明显多于健康组。在患者组所使用的情态助动词中,肯定性和否定性助动词均以中值和低值为主,表明轻度阿尔茨海默症患者在对语言事件进行表征时不够确定,话语的归向性(polarity)不明确,从而采取一种协商的立场,而健康组被试较少使用情态助动词则说明他们对自己的话语有足够的信心。评价资源的分析重点从表达说话人态度的语义资源入手,结果表明,患者在完成语言任务时基本没有使用态度类评价语义资源,而健康组被试则较多使用了表达态度的语义资源,这从侧面表明轻度阿尔茨海默症患者的语义资源不够丰富,话语内容不够具体,在完成语言任务时缺乏语言多样性。
在及物性层面,研究首先考查了轻度阿尔茨海默症患者和健康被试表征过程的能力,结果发现,和健康老年人一样,患者能够表征各类过程类型,二组语料占前三位的过程类型分别是物质过程、心理过程和关系过程。在此基础上,我们对三类主要过程的参与者和环境成分的构成作了分析,结果发现,患者组在参与者和环境成分构成的复杂性方面没有健康组高,多使用简单名词词组、上位词"thing"和指示词(如‘'that","this").在患者所使用的复合名词词组中,较少使用对中心词的性质、特征、分类等作限定或说明的成分,表明患者在参与者和环境成分的表征方面缺乏具体性,导致话语的内容空洞贫乏,反映出患者在名词性词汇资源方面存在提取困难和缺乏对其进行修饰加工的能力。
在衔接与连贯层面,研究从话语与语义记忆和工作记忆的关系着手,着重从话语构建、衔接和话语损伤三方面对二组语料作了分析。结果表明,患者组在话语构建和衔接性语言指标的使用方面明显低于健康组,在话题维系和整体连贯方面健康组明显优于患者组,而患者组在话语损伤指标方面则显著高于健康组,同时患者组在话语进行中还存在话题骤转现象。上述分析结果表明,话语的语义记忆与衔接具有关联性,衔接手段中的照应、时间衔接和话题维系均需借助语义资源的合理布局和使用才能实现,而整体连贯则和语言使用者的工作记忆相关,因为整体连贯涉及话题的一致性和话语内容的协调性,如果说话者的工作记忆受损,那么他的话语可能会出现话题转移从而发生言语内容前后不一致的情况。从对患者组和健康组语料的衔接与连贯的分析结果来看,轻度阿尔茨海默症患者无论在语义记忆还是在工作记忆方面均受到了损伤,而健康老年人不存在类似情况。
本文共分十章。第一章“导论”阐明研究的背景、目的、意义和语料收集的方法。从研究的意义而言,本文旨在从理论和实践二方面展示系统功能语言学在临床语言研究中的独特价值,并通过实证研究为早期阿尔茨海默症的诊断和语言功能的评估提供语言学证据。
第二章“文献综述”是对本文的主要理论和方法发展现状的总体回顾和评述。本章主要内容有：首先对临床语言学的相关概念和研究范围作简要说明,明确其操作路径；其次,对阿尔茨海默症患者的语言功能作简要评述；再次,探讨话语与语义记忆和工作记忆的关系；最后,对系统功能语言学指导下的与本研究相关的研究作评述。
第三章“理论基础”对本研究所依赖的指导性理论作阐述。首先,我们对系统功能语言学对本研究的意义和启示作宏观的探讨,然后对临床话语研究的语言学理论框架作简要的评述,探讨各理论框架的优点和不足,最后明确临床话语分析的系统功能语言学理据及途径。
第四章“研究设计”首先对本文依托的方法论作简要说明,然后阐明语料的标记方法和实证分析方法,并呈现本研究被试的人口学信息。总体而言,本文采用了质性和量性相结合的研究方法,目的是对语料作多维度、全方位的研究。
第五章“阿尔茨海默症患者话语的主位结构分析”从主位的标记性、主位推进模式和多重主位三方面对被试的语料作详尽的分析。在具体分析中,着重从主位的构成、标记性主位的特征、线性和重复性主位推进模式、多重主位的组成成分对患者组和健康组的语料作对比分析,揭示二者在主位这一语言构式方面的使用情况。
第六章“阿尔茨海默症患者话语的衔接研究”从三方面展开,分别是话语构建、衔接和话语损伤。本章的目的是对患者在语篇生成过程中所使用的话语构建和衔接性语义资源作评估和分析,揭示患者话语损伤的具体方面,并将被试的话语表现与语义记忆和工作记忆建立关联,从这二方面对患者话语的衔接与连贯问题进行解释。
第七章“阿尔茨海默症患者话语的人际意义研究”着重从语气、情态和评价三方面入手,对患者组和健康组在语气的主语和补语构成、情态助动词的使用和评价系统中态度类语义资源的使用情况作综合研究。语气研究中的主语和补语的分析与第七章的及物性分析具有互补性,而情态分析则揭示了患者在表达个人情感和立场时的语言使用情况。评价系统中的态度分析则进一步对患者和健康老年人在表达个人态度时的语义资源作出描述,从而对被试话语的质量作出评估。
第八章“阿尔茨海默症患者话语的及物性分析”重点分析患者组和健康组的名词性语义资源。以往研究发现,阿尔茨海默症患者存在名词提取困难,集中表现为命名缺陷,本章的及物性分析正好可以从名词词组的角度对先前的研究结论进行检验。研究从过程类型分析出发,进而对三类主要过程的参与者和环境成分作系统分析,重点是参与者和环境成分的构成,以此揭示患者在表征参与者和环境成分时的名词性词汇语法资源的使用情况。
第九章“讨论与启示”对研究结果进行探讨,明确研究结果的启示。
第十章“结论”对整个研究的发现作总结,在此基础上探讨研究的不足和今后努力的方向。
The present study has two purposes. The first purpose is to theoretically address the Systemic functional linguistic (SFL) motive and approach of clinical discourse analysis. The second purpose is to practically conduct a discourse analysis of the Alzheimer's patients within the framework of SFL and to provide linguistics evidence for the assessment and intervention of the Alzheimer's disease.
Studies of language disorder are both theoretically and practically significant in our times. So far as the theoretical significance is concerned, the findings of clinical linguistic studies are valuable supplements to the mainstream linguistics. In the meantime, disordered language is a touchstone which serves to the test, remediation and development of the mainstream linguistic theories. In terms of the practical value of language disorder studies, a linguistics-based study of the disordered language would make a clear and accurate assessment of the language functions of the clinical population. A linguistics-based assessment of the language function is essential for the medical diagnosis and intervention of language disorders. Furthermore, it serves as the evidence for making feasible plans and approachable goals for language function remediation. Clinical linguistic studies abroad have reached to all the disordered syndromes and made great achievements in the past few years. In comparison to the prosperity of clinical linguistic studies abroad, we are falling far behind in the scope of certain disordered areas, the research staff, the bank of material, academic journals and references. Currently, Chinese clinical linguistic studies are focused on aphasia and sign language, for other language disorders, such as stuttering, cleft palate, autism and other brain damage induced or disease induced disorders like Specific Brain Impairment and the dementia of Alzheimer's type are not yet given due recognition. Meanwhile, Chinese clinical linguistic studies are pragmaticism guided which pay more attention to remediation rather than theory construction.
Conventional clinical linguistic studies were mainly conducted under the guidelines of structural linguistics and generative grammar which focused on phonology, lexicon and syntax and discarded the social context of authentic language use and meaning making. The tendency of clinical linguistic studies is to analyze the disordered language users' discourse and synthesize the social and cultural contexts in the analysis. Meanwhile, cross language performance of the disordered language users is now becoming an emergent area in clinical linguistic studies. In taking the authentic language use and context into consideration, clinical linguistic studies are called to be conducted on discourse level rather than sentence level. The analytic framework of this thesis is the systemic functional linguistics (SFL) for its unique advantages in discourse analysis. The aims of the study were a multi-dimensional investigation of the mild Alzheimer's narrative description of the Cookie Theft Picture. The analyses of the Alzheimer's disease were carried out in accordance with SFL's metafunctions, i.e. ideational, interpersonal and texture with detailed tagging of the discourse in the quantitative and qualitative analyses. The metafunctional analyses of the discourse of the Alzheimer's patients have made it possible to deal with the discourse from clause to text which yielded a comprehensive assessment of the language function of the Alzheimer's patients.
Firstly, the textural metafunction of the discourse was analyzed in the markedness of themes, the patterns of theme progression and multiple themes. Secondly, the analyses of the interpersonal meanings of the discourse were carried out in mood, modality and appraisal system. Thirdly, the ideational meanings of the discourse were analyzed in transitivity system with special attention given to the construction of participant and circumstance of the clause. Fourthly, the thesis gave a detailed analysis of the cohesion and coherence of the Alzheimer's patients'discourse in three aspects, i.e. discourse building, cohesion and discourse impairment. SFL provides a unitary framework for discourse analysis, but the three metafuntional analyses of the discourse needed different tagging of the samples. In order to meet the goals of the study, the discourse samples were finely tagged.
In terms of theme analyses, the results showed that both the Alzheimer's subject and their counterpart used less marked themes as the departure of the clauses which indicated that both groups tended to use unmarked themes. In theme progression, both groups tended to use linear and iterative patterns and there was no significant difference in linear progression. The mildly demented group used more iterative theme progression which indicated that they might have difficulty in vocabulary retrieval. In multiple theme analyses, the study found no multiple themes which were constructed with textural, interpersonal and ideational elements and most of the multiple themes consisted of interpersonal and topical elements which indicated a simplified multiple theme construction of both groups.
Interpersonal meaning analyses were conducted in three aspects. Mood analysis investigated the construction of subjects and complements of the clause. The results showed that in constructing subjects and complements, both groups tended to use simple nominal groups and the difference was that the mildly demented group's nominal groups were less specific and informative. The demented group frequently used superordinate and deictic terms to denote target nouns. The most frequently used superordinate term was thing, the deictic terms were that and this. The findings in the way the demented group constructing their subjects indicated a less efficient retrieval of the noun. The modality analyses investigated the use of auxiliary modal verbs in both groups'discourse. The results showed that in representing the speakers'modal meanings, the mildly demented group used more modal auxiliary verbs and most of the verbs were median and low value ones which meant that the mildly demented subject were less certain about their discourse and they took a negotiating stance in their speaking while their counterpart were more confident in their speaking. The appraisal analyses investigated the subject's semantic resources used to express their attitudes. The results indicated that the mildly demented group did not use appraisal resources in their discourse while the control group made frequent use of this semantic resource. The findings of appraisal analyses reflected a poor semantic resource of the demented subject in expressing their attitudes because of semantic impairment.
In transitivity analyses, the study first made an analysis of the processes of the clauses in both groups'discourse. The results showed that both groups were capable of producing all the process types with material, relational and mental processes as the major ones. Secondly, the study investigated the construction of participant and circumstance of the major process types which found that in representing participants and circumstances, the complexity of these two categories of the mildly demented group was much lower than that of the control group. The mildly demented group used more simple nominal groups in representing participants and circumstances. In the complex nominal groups the mildly demented groups used, a lack of modifier, classifier or qualifier of the head nouns could be found which indicated that the discourse of the demented was not as specific and informative as that of the control group.
In cohesion and coherence analyses, the study aimed to find out the correlations between discourse and the semantic and working memory of the mildly demented Alzheimer's patients. The analyses were conducted in three aspects, i.e. discourse building, cohesion and discourse impairment. The results showed that in discourse building and cohesion, the mildly demented group used less linguistic resources to build their discourse. The mildly demented group's topic maintenance and global coherence were impaired. In discourse impairment, the mildly demented group was worse in all the categories and in their discourse we found abrupt topic shifts. The analyses and findings indicated that there was a correlation between discourse coherence and semantic and working memory since the coherence of the discourse must be realized by the appropriate used of semantic devices. In order to maintain a global coherence, the speaker had to make good references and connections between clauses, an impaired working memory prevented the speaker from maintaining the wholeness and harmony of his or her discourse. The healthy counterpart of this study did not have the problem of maintaining discourse global coherence.
The thesis consists of ten chapters. The first chapter is an introduction to the background, purposes, significance and data collection of the study. So far as the significance of the study is concerned, two points are taken into consideration. The first is to make an organic integration of SFL and clinical linguistic studies. The second is to provide linguistics evidence for the diagnosis and assessment of the early Alzheimer's disease.
The second chapter is to give a review of the literature pertaining to the present study. This chapter first defines the clinical linguistics and its scope and the approach to do clinical linguistic studies. Secondly, the author gives a reasoned discussion of the guiding linguistic theory of this study. Meanwhile, a discussion of the motive and access of doing clinical discourse analysis under SFL will be given in this chapter.
The third chapter is a discussion of the theoretical foundation of the present study. Firstly, this chapter gives a critical review of the implication of SFL for discourse analysis of the Alzheimer's patients. Secondly, the chapter discusses the linguistic guidelines for clinical discourse analysis. Thirdly, an SFL motive and approach of doing clinical discourse analyses would be elaborated.
Chapter Four elaborates the methodology of the study. The key points of this chapter are the tagging of the samples, the demographic information of the subject and the specific methods of discourse analysis used in this study. Generally speaking, both quantitative and qualitative methods would be employed in the study because the aim of the thesis was to make a multi-dimensional analysis of the samples.
The fifth chapter is the analyses of theme in the discourse of the Alzheimer's patients. Specifically, the analyses are made in three ways, i.e. the markedness of theme, the patterns of theme progression and multiple themes. In the analyses, the differences between the mildly demented and their counterpart in the above aspects would be addressed.
Chapter Six "A cohesion and coherence analysis of the discourse of the Alzheimer's patients" is carried out in three categories, i.e. discourse building, cohesion and discourse impairing. The aim of this chapter is to build an organic correlation between Alzheimer's patients' discourse and their semantic and working memory.
Chapter Seven is the analyses of the interpersonal meanings of discourse of the Alzheimer's patients. The study is carried out in three aspects, i.e. mood, modality and appraisal system. The mood analysis which focuses on nominal groups resonates well with the transitivity analysis in Chapter Six. While the modality analysis would give us a thorough understanding of the stance and certainty of the speakers' discourse, the appraisal analysis makes it possible to evaluate the quality of the discourse in terms of semantic resources.
The eighth chapter is a transitivity analysis of the discourse of the Alzheimer's patients. The focus of the analysis is the construction of participant and circumstance in terms of nominal groups. As previous studies have pointed out that the Alzheimer's patients have difficulties in naming, the participant and circumstance analysis would make a better assessment of the nominal resources of the Alzheimer's patients.
Based on the findings in quantitative and qualitative analyses, the nineth chapter makes discussions on the results and finds out the implications of the analyses.
Chapter Ten concludes the thesis with a discussion of the limitations of the study and suggestions for further research.
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