Title: Using Conversation Analysis in the Differential Diagnosis of Memory Problems: a pilot study
Funder: Department of Health (England)

Abstract: This multi-disciplinary cross-professional study is designed to improve the early diagnosis and treatment of dementia by using CA to describe linguistic, topical and interactional features in patients' communication behaviour in the memory clinic, which could help clinicians with the distinction of dementia from more benign, non-progressive forgetfulness. The difficulties associated with this distinction are the most important reason why patients come to a memory clinic. At present the clinical differentiation is based on the history given by patient and additional informant (partner, friend, family member or carer). Brief neuropsychological screening instruments lack specificity and are only of modest additional diagnostic value [ 1 ] . For a 'gold standard' diagnosis, the findings based on the patients' history need to be supported by Magnetic Resonance Imaging (MRI) and more extensive neuropsychological testing [ 9 , 10 ] . However, expert neuropsychological assessment cannot be offered to all patients complaining of memory problems on a routine basis. In clinical reality the diagnosis of dementia often only becomes clear with the passage of time because the cognitive problems get worse. Our study will be based on the analysis of transcripts of audio- or video recordings of initial 'real life' memory clinic encounters between patients, accompanying persons and neurologists. CA is a qualitative research method of interaction, which has been used in many medical settings [ 11 ] . Most importantly for this study, some co-applicants have shown that CA can identify linguistic, topical and interactional features, which can help with the differential diagnosis in patients with epilepsy or Non-Epileptic Attack Disorder (NEAD), in which seizures resemble epilepsy but have emotional causes (see table 1 in section on Expected Outputs) [ 2 , 3 , 8 ] . Based on previous research on spontaneous speech in dementia (some of it carried out by co-applicants) [ 12 , 13 ] , we hypothesise that our work in the seizure clinic can be replicated in the memory clinic. As in the seizure clinic, where doctors need to differentiate between many different types of epilepsy and NEAD, we expect that the conversational differences will be most marked between patients with a form of dementia and those who are not dementing. This will be the starting point of our work in the memory clinic although conversational differences are also likely to exist between the different types of dementia [ 14 ] . In the proposed study, medical 'gold standard' diagnoses will be made by the patient's Consultant Neurologist on the basis of the patient's neurological assessment, brain MRI, and a report by a Neuropsychologist with particular expertise in the early diagnosis of dementia (AV) based on a detailed neuropsychological examination. Replicating the approach used in the epilepsy clinic [ 3 ] , the study will begin with an open, multidisciplinary phase in which Conversation Analysts, Neurologists and Neuropsychologists will look for distinguishing interactional and linguistic features in 20 consultations with patients with dementia and 20 with patients with benign, non-progressive forgetfulness. The initial focus will be on the methods individual patients use to communicate memory problems In a second step we will seek to distinguish between different patient groups on the basis of the conversational methods they use to communicate their complaint. Third, we will establish whether particular conversational profiles match the medical 'gold standard' diagnosis. In the final part of this pilot study a linguist blind to all medical information will attempt to predict the medical diagnosis on the basis of CA. This step will allow us to test the diagnostic potential of the identified linguistic and generate information for group size calculations for future confirmatory studies.


Research activity codes: 7.3 MANAGEMENT AND DECISION MAKING;4.2 EVALUATION OF MARKERS AND TECHNOLOGIES
Health categories: MENTAL HEALTH;NEUROLOGICAL