Limited communicative resources due to dementia-related memory problems can be consequential for opportunities to claim epistemic rights and initiate and pursue communicative projects for persons living with dementia. This conversation analytic case study of a video-recorded homecare visit between Koki and his homecare nurse focuses on an extended negotiation concerning a factual disagreement related to a practical problem. The study explores how Koki manages to mobilize remaining communicative resources for initiating and pursuing a topical agenda, as well as how the caregiver recognizes and supports these initiatives. The analysis describes how a person with dementia manages to influence the course of action and, in collaboration with the interlocutor, succeeds in achieving two interrelated projects, one being within an epistemic domain and the other within a deontic domain. Koki’s persistent use of first actions, with repeated and upgraded knowledge claims, as well as embodied and verbal displays of a practical problem, contributes to influencing both the topical agenda and action agenda. The analysis shows how an attentive interlocutor may collaborate in identifying a practical problem and finding a solution to it, and thereby assist the person with dementia in taking control over his everyday life despite limited communicative resources.

This chapter explores how differing expectations and experiences manifest in diagnostic interactions in the memory clinic. We do this by microanalysing communication in dementia diagnosis feedback meetings, focusing on instances of misalignment between doctors and the person living with dementia. We examine three videos from a dataset of 101 recordings from two areas in the UK, collected as part of the ShareD study. We present different interactional contexts where the person receiving a dementia diagnosis choose to align or misalign with the doctors’ interactional projects of diagnosis delivery, prescribing medication and recommending support. Examination of these instances suggests that misalignment between the assessment of symptoms may, at least in part, reflect interactional facework in the face of dementia as a challenge to self-identity.

Singing may be a relative strength for people with dementia, yet little is known of how individuals leverage it as a communicative resource in everyday interaction. This study analyzes how Dan, a man living with vascular dementia, modifies lyrics based on prior talk and the physical environment during interactions with his wife, Morgan. Using Conversation Analysis, I describe the emergent structure of his singing and what it accomplishes. Dan uses singing to do a range of interactional jobs (such as complimenting, complaining, and requesting), and his lyrics are susceptible to evaluation based on their construction and relevance to previous talk. Both participants treat his singing as humorous and creative wordplay, but the laughability of his singing is contingent on how he modifies the formulaic lyrics based on the current discursive context. Thus, singing is a way in which Dan situationally constructs himself as a funny, clever, and sociable person. Dan’s singing also indirectly indexes his close relationship with Morgan by assuming her shared musical knowledge. This analysis contributes to the study of identity construction by people with dementia, the understanding of how people adapt to changes in cognition, and the study of the structure and function of singing in everyday interaction.

In this chapter we use conversation analysis to analyse the use of tag questions by co-participants of people with dementia. Tag questions can function as a ‘current speaker selects next’ technique. They also prefer, and hence put interactional pressure on, the next speaker to produce a response that aligns with the tag-formatted turn. We examine three classes of co-participant-produced tag-formatted actions and analyse how their use is recipient-designed for people with dementia. Tag-formatted assertions and assessments present information that the person with dementia has already been told or might be expected to know, while simultaneously acknowledging that this information is, or should be, within the recipient’s epistemic domain. By eliciting agreement, they co-opt the person with dementia into the co-construction of this topical talk. Tag-formatted challenges are produced in response to an inappropriate turn by the person with dementia and, as well as challenging/complaining about that turn, act to elicit from the person with dementia an acknowledgement of its inappropriacy. We then show how tag questions are used to induce verbal acquiescence to a suggested activity. We discuss how these tag questions encroach into the person with dementia’s territories of knowledge, power and interactional competence, highlighting asymmetries between the person with dementia and the co-participant in these domains.

Chapter 2 delves into the intricate interactional dynamics of administering cognitive assessments, with a focus on the Addenbrooke’s Cognitive Examination-III (ACE-III). The chapter critically examines the standardisation challenges faced by clinicians in specialised memory assessment services, highlighting the nuanced reasons for non-standardized practices. While cognitive assessments play a pivotal role in diagnosing cognitive impairments, the study questions the assumed standardization of the testing process. Drawing on Conversation Analysis (CA), the authors analyse 40 video-recordings of the ACE-III being administered in clinical practice to reveal variations from standardized procedures. The chapter expands on earlier findings to show how clinicians employ recipient-design strategies during the assessment. It introduces new analyses of practitioner utterances in the third turn, suggesting deviations could be associated with practitioners’ working diagnoses. The chapter contends that non-standard administration is a nuanced response to the interactional and social challenges inherent in cognitive assessments. It argues that clinicians navigate a delicate balance between adhering to standardized procedures and tailoring interactions to individual patient needs, highlighting the complex interplay between clinical demands and recipient design. Ultimately, the chapter emphasizes the importance of understanding the social nature of cognitive assessments and provides insights into the valuable reasons for non-standardized practices in clinical settings.

People with intellectual disability (particularly those with Down syndrome) have a higher risk of developing dementia than the general population. The varied presentation, the course, and available treatments are covered.

Some factors shown to increase anxiety include very high levels of social contact, dysfunctional patient-caregiver relationships, and high physical dependency. Other factors that can negatively impact anxiety in older adults include boredom, social isolation, and unmet physical needs for proper nutrition, warmth, and cleanliness, for example. Pharmacologic treatment options for those with panic disorder can include a short course of benzodiazepines and long-term SSRIs or SNRIs. Cognitive behavioral therapy has proven to be a particularly effective nonpharmacologic approach to treatment of anxiety and panic. As-needed medications for anxiety can be helpful in the initial weeks of treatment as the therapeutic effect of SSRIs and SNRIs is approached. Useful medications for as-needed treatment of anxiety include low-dose trazodone (25 or 50mg every 4-6 hours as needed). Other options might include gabapentin, mirtazapine, or low-dose propranolol.

Current guidelines still support the use of an SSRI as first choice for the treatment of depression in older adults. Clinicians should keep in mind the old adage “Start low, go slow, but go” with regard to the prescribing of antidepressants in older patients. With older adults, it is a good idea to start at half or quarter of the normal adult starting dose but to increase the dose to well within the therapeutic range for a given antidepressant. Depression is prevalent in older adults in long-term care with estimated prevalence from 11-45%. Depression is associated with poor overall health outcomes and poor quality of life. Interventions are often effective if these patients are identified but treatment can be challenging and require multiple adjustments in medications or treatment strategies.

Chronic alcohol use disorder is an important cause of major neurocognitive disorder. There are several suggested mechanisms for how alcohol use disorder leads to major neurocognitive disorder. Medical treatment of alcohol use disorder can help limit the late effects of alcohol use. Alcohol-induced major neurocognitive disorder can be partially reversible with abstinence but this depends on the severity of the pathology.

Traumatic brain injury (TBI) is more common in older adults than any other age group. It is the most common fall-related injury in adults over the age of 65. The pathogenesis of TBI involves multiple mechanisms. Medications generally do not alter the course of the disease process but can treat the neuropsychiatric symptoms. Mood and anxiety disorders are commonly comorbid with TBI.

This chapter describes basic principles of neuropsychology, patterns of neuropsychological dysfunction, methods of neuropsychological assessment, and neuropsychological approaches to psychopathology. It presents a history of clinical neuropsychology and illustrates the ways in which clinical neuropsychologists perform assessments and help design interventions for patients who experience neurological, cognitive, and/or psychological dysfunction related to conditions stemming from developmental, medical, degenerative, or other kinds of problems. It also highlights their research on both normal and abnormal brain functioning, pointing out that this research has helped shed light on psychological disorders such as depression and schizophrenia, and on neurological disorders such as Alzheimer’s disease or the effects of a concussion. The chapter portrays clinical neuropsychology as a rapidly growing field for which specialized training is required. Its practitioners must understand brain–behavior relationships and develop competence with a variety of assessment and intervention techniques that are unique to the field.

This chapter looks at Alzheimer’s disease, the most common cause of dementia. Incidence and prevalence figures are reviewed, along with an explanation of the two abnormal proteins involved in the development of the disorder, and the ‘amyloid cascade’ hypothesis. Cognitive assessment of Alzheimer’s disease is considered in terms of where this fits within the diagnostic process and diagnostic criteria. The bulk of the chapter focuses on the typical form of Alzheimer’s disease, and the chapter concludes with discussion of some atypical variants, such as posterior cortical atrophy (PCA), logopenic primary progressive aphasia (lvPPA), and frontal variant.