Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Oct 16;38(6):1100-1117.
doi: 10.1080/02687038.2023.2257356. eCollection 2024.

Muddles and puzzles: Metaphor use associated with disease progression in Primary Progressive Aphasia

Anna Volkmer  1 , Jade Cartwright  2 , Leanne Ruggero  3 , Maria Loizidou  1   2   3   4   5 , Chris Jd Hardy  4 , Deborah Hersh  5
Affiliations

Muddles and puzzles: Metaphor use associated with disease progression in Primary Progressive Aphasia

Anna Volkmer et al. Aphasiology. .

Abstract

Background: Primary Progressive Aphasia describes a language-led dementia and its variants. There is little research exploring the experiences of living with this disease. Metaphor, words that represent something else, have been studied extensively in health-related narratives to gain a more intimate insight into health experiences.

Aims: This study explored the metaphors used spontaneously by people with PPA, their care partners (family), and speech and language therapists/pathologists (SLT/Ps) providing support along the continuum of care.

Methods & procedures: This study examined two previously collected data sets comprising naturalistic talk where metaphors were not the specific focus, the first from focus groups conducted with people with PPA and their families and the second from focus groups conducted with SLT/Ps working with people with PPA. Transcribed data were analysed for metaphor use through an iterative narrative approach.

Outcomes & results: In all, 237 examples of metaphorical language were identified in the data, with 14 metaphors from people with PPA, 116 from the families and 106 from SLT/Ps. Different metaphors were used by participants to describe their experiences depending on which variant of PPA they were living with, and people also described their disease differently over time. SLT/Ps also used metaphors, however, their language reflected the structured, professional perspective of delivering speech and language therapy services.

Conclusions & implications: SLT/Ps should listen for and recognise the metaphorical language used by people with PPA and their families to ensure therapeutic alignment, see beyond the PPA to recognise the individual's needs, and provide person-centred and empathic support.

Keywords: Metaphor; Primary progressive aphasia; dementia; language; speech and language therapy.

PubMed Disclaimer

Conflict of interest statement

No potential conflict of interest was reported by the author(s).

Figures

Figure 1.
Figure 1.
Different metaphors used by participants to describe their experiences depending on variant of PPA and time since diagnosis.
Figure 2.
Figure 2.
Case example accompanied with suggested responses using six-steps to illustrate how to respond to metaphorical language
See this image and copyright information in PMC

References

    1. Beales, A., Bates, K., Cartwright, J., & Whitworth, A. (2019). Lost for words: Perspectives and experiences of people with primary progressive aphasia and Alzheimer’s disease and their families of participation in a lexical retrieval intervention. International Journal of Speech-Language Pathology, 21(5), 483–492. - PubMed
    1. Brooks, R. B. (1985). The beginning sessions of child therapy: Of messages and metaphors. Psychotherapy: Theory, Research, Practice, Training, 22(4), 761.
    1. Bryden, C. (2018). A continuing sense of self in the lived experience of dementia. Journal of Religion, Spirituality & Aging, 30(3), 279–290.
    1. Brotherhood, E. V., Stott, J., Windle, G., Barker, S., Culley, S., Harding, E., … Crutch, S. J. (2020). Protocol for the rare dementia support impact study: RDS impact. International Journal of Geriatric Psychiatry, 35(8), 833–841. - PubMed
    1. Castaño, E. (2020). Discourse analysis as a tool for uncovering the lived experience of dementia: Metaphor framing and well-being in early-onset dementia narratives. Discourse & Communication, 14(2), 115–132.

LinkOut - more resources