The role of pragmatics in the diagnosis of dementia

Dementia is a large and growing public health problem that poses considerable economic and social challenges to many countries around the world. The emphasis of clinical intervention is to delay the onset of severe functional limitations that are associated with poor outcomes and large health and social care costs. For this to be possible, however, clinicians must achieve earlier diagnosis of the condition than is currently the case. I argue that pragmatic language abilities hold promise as early behavioural markers of cognitive impairment. This article describes some empirical work on the search for pragmatic markers of early cognitive impairment in 27 English-speaking participants with neurodegenerative disorders. With one exception, none of the participants had received a diagnosis of mild cognitive impairment or dementia. Yet, their performance in discourse production tasks suggested they were experiencing early disruption of pragmatic language skills that had been masked in some cases by compensatory strategies.