Pragmatic Skills in Late Adulthood

Abstract

Research investigating pragmatic abilities in healthy aging suggests that both production and comprehension might be compromised; however, it is not clear how pragmatic abilities evolve in late adulthood, as well as when difficulties are more likely to arise. The aim of this study is to investigate the decline of pragmatic skills in aging, and to explore what cognitive and demographic factors support pragmatic competence. We assessed pragmatic production skills, including discourse abilities such as speech, informativeness, information flow, paralinguistic aspects, as well as the ability to produce informative descriptions of pictures, and pragmatic comprehension skills, which encompassed the ability to understand discourse and the main aspects of a narrative text, to infer non-literal meanings and to comprehend verbal humor in a group of elderly individuals and in a sample of younger participants. Moreover, specific cognitive functions (short-term memory, verbal and visuospatial working memory, inhibition Theory of Mind, and Cognitive Reserve) were assessed in both groups. Pragmatic difficulties seem to occur in late adulthood, likely around 70 years, and emerge more prominently when participants are asked to understand verbal humor. Age was the only predictor of general pragmatic performance in a sample of cognitively unimpaired older adults; conversely, when elderly individuals with less intact inhibitory control are considered, a general role of inhibition emerged, in addition to working memory and ToM in specific tasks.

Appendices

Appendix A

Cognitive tests

Cognitive Reserve Index questionnaire (CRIq) (Nucci et al., 2012). CRI-Education includes years of formal education and any additional training courses lasted at least 6 months. CRI-WorkingActivity refers to the cognitive load and personal responsibility of an occupation, combined with the number of years for which the occupation has been carried out, for a minimum of 5 years. Lastly, CRI-LeisureTime measures the frequency and the amount of intellectual, social, and physical activities (e.g., reading newspapers or books, playing music, participation in charitable activities, traveling, playing sports, etc.) carried out for a minimum of 5 years. The questionnaire also includes additional items about life-long experiences that require a certain cognitive load (e.g., years of bank account management). The CRI Total score is an estimation of Cognitive Reserve. It is the average of the three subscores standardized and transposed to a scale with a mean of 100 and a standard deviation of 15 (see Nucci et al., 2012 for details). The CRI Total score can be classified into five ordered levels: Low (less than 70), Medium–low (70–84), Medium (85–114), Medium–high (115–130), and High (more than 130).

Digit Span forward (Spinnler & Tognoni, 1987). A maximum of 7 lists of digits are read to participants one at a time and they are asked to repeat the numbers in the exact same order. The length of the lists gradually increases from three to nine digits. If participants correctly repeat a given set of digits, another list one digit longer is presented; conversely, if they fail, a second list of the same length is read. If they succeed this second list, a list one digit longer is presented. If they fail on the second list, the test is ended. The span is established as the length of the longest list correctly recalled. The final score is corrected for age and education (Monaco et al., 2013).

Digit Span backward (Monaco et al., 2013). The procedure is the same as for the forward version, except that participants are now asked to repeat the digit sequences in the reverse order. The longest list consists of eight numbers. The scoring procedure is the same as for the forward version.

Stroop task (Caffarra et al., 2002). Three color names and three colored circles were selected as stimuli: color names were giallo (yellow), verde (green), and blu (blue), and colored circles were yellow, green and blue. The task included a training session and three experimental sessions. Participants were provided with instructions at the beginning of each session. In the training session, participants were presented with color names written in white ink and with colored circles, which appeared one at a time in random order. Each stimulus appeared on a black screen, with a maximum time limit of 2000 ms. Participants were instructed to press the key corresponding to the name of the color or to the color of the circle as fast as possible: they were asked press the “g” key if the word giallo or the yellow circle appeared, “v” if the word verde or the green circle appeared, and “b” if the word blu or the blue circle appeared on the screen. In the first experimental session (first congruence condition), 30 color names written in white ink appeared one at a time on a black screen. Participants were required to press the key corresponding to the color name as fast as possible (e.g., they pressed “v” if the word verde appeared). In the second experimental session (second congruence condition), 30 colored circles appeared one at a time on a black screen. Participants were required to press the key corresponding to the color of the circle as fast as possible (e.g., they pressed “b” if the blue circle appeared). The last experimental session (incongruence condition) consisted of 30 color names written in an inconsistent color ink (e.g., the word giallo -yellow- written in blue ink), and participants were asked to press the key corresponding to the color of the ink (they pressed “b” since the word is written in blue ink). Late responses (> 2000 ms) were registered as errors. An output table displayed both reaction time and accuracy for each stimulus separately for each session. The IES (inverse efficiency score) is obtained by computing the mean RT of the correct responses for each condition, which is then divided by the proportion of the correct responses (PC). The IES takes into account the number of errors, and increases proportionally the average RT of each participant. Since RTs are expressed in milliseconds (ms) and divided by proportions, IES is measured in ms as well (Vandierendonck, 2017). A time interference effect (i.e., difference in responses in incongruent compared to congruent conditions) was calculated with IES values, instead of RTs, following the procedure described in Caffarra et al. (2002), and was then used for the analyses.

Faux Pas. Participants read 6 shorts stories containing a faux pas, as well as 8 control stories. Participants had no time limit and were allowed to read the stories as many times as necessary in order to fully understand them. Each story was followed by a series of questions: (1) a faux pas detection question (Did someone say something they shouldn’t have said?), (2) a person identification question (Who said something they shouldn’t have said?), (3–4) faux pas related questions (Why shouldn’t they have said what they said?; Why do you think they said what they said?), (5) a false belief question (e.g., Did X know that Y and Z did not know each other?), (6) an affective ToM question (How do you think X felt?), and (7–8) control questions (Where was X in the story?; Did X and Y know each other?). Cognitive ToM was assessed via the false belief question (5), which tested whether participants understood the false belief of who committed the faux pas. Affective ToM was assessed via the affective question (6), which tested the emphatic understanding of how the person in the story would feel. Questions 2 to 6 were asked only if participants detected the faux pas (i.e., only if they answered Yes to the first question). If they did not detect the faux pas, they were presented with control questions only. Stories with faux pas were scored differently from control stories. Correct answers to questions 1 to 6 were rated as 1 in the stories with faux pas; conversely, a score of 2 was assigned when participants correctly answered the first question of the control stories. Wrong answers were rated as 0. Answers to the control questions were scored either 0 or 1 depending of the (in)correct response.

Appendix B

See Tables 7, 8, 9, 10

Table 7 Differences in the APACS test over four age groups

Table 8 Multiple regression analysis–general predictors of pragmatic abilities

Table 9 Multiple regression analysis–predictors of pragmatic abilities in healthy aging (n = 29)

Table 10 Multiple regression analysis–predictors of pragmatic abilities in healthy aging (n = 31)