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.

In this introductory chapter, we provide a brief overview of some of the main topics related to dementia communication research that are addressed by the different chapters in this edited volume: Dementia and Diagnostics, Dementia and Conversational Strategies, Dementia and Epistemics, and Communicative Challenges in Everyday Social Life. One of the central aims of this volume is to shed more light on how persons with dementia accomplish relevant goals in interaction and also how changes in an individual’s discursive abilities may impact how conversationalists negotiate a world in common and continue to build their social relationships. All contributions for this edited volume draw on the methods of Conversation Analysis (CA), an approach to social interaction that provides a detailed view of the moment-by-moment accomplishment of social life. By exploring interactional practices through the lens of CA, this volume seeks to explore interactions involving people with dementia in a variety of contexts (everyday and institutional), pointing to both the interactional difficulties that often arise, but also the creativity and collaboration within these interactional encounters. A summary of each of the volume’s chapters is also provided.

This chapter analyzes the discursive functions of a single interactional practice – the use of the phrase “now what” – that is recurrently employed by an individual diagnosed with behavioral variant frontotemporal dementia (bvFTD; pseudonym Robert). Robert’s use of “now what” recruits assistance from interlocutors when a wider array of recruitment resources may not be readily available. I show how this practice calls on collaborators to articulate the next step of a task-based activity for which Robert requires guidance. I also examine how Robert employs “now what” over the course of a year. Over time, Robert begins to employ “now what” to navigate non-task-based activities, such as when being reprimanded, showing how he extends its use as he faces new interactional challenges. Some research examines "dementia interactions" through a lens of deficit; other research emphasizes skillfulness. I show how “now what” illuminates both the troubles Robert faces while simultaneously demonstrating his resourcefulness to navigate such troubles. I argue that such "compensatory" practices point to both deficit and skill, and suggest that a dichotomous framework – identifying a practice or behavior as either only a deficit or a skill – is unlikely to adequately capture the social engagement of those diagnosed with neurological disorders.

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.

The aim of this chapter is to discuss the role of applied Conversation Analysis in the overarching area of dementia care for minority ethnic groups in Europe: people who often do not receive the same quality of dementia care as majority populations. Analysis of an episode from a video-recorded, interpreter-mediated dementia assessment and accounts from ethnographic interviews and informal conversations with stakeholders are used as a vehicle for discussing the role of applied CA to intervene in the problem of inequity in care for minority ethnic persons with dementia. Even when CA studies, for example on dementia, get published and researchers present numerous important implications for relevant stakeholders, the road towards actual application is often long and complex. This chapter builds on the international collaboration between CA scholars and different stakeholders conducted over a period extending for ten years, also resulting in an impact at a societal level in terms of recommendations not just within the scientific community but also at an international, political level.

In this chapter, we investigate how a couple where one of the spouses is diagnosed with dementia handle challenges in narrations of past shared events that arise when the spouse with dementia has limited access to these events. Partners of people diagnosed with dementia recurrently have to take into consideration that their spouse may not remember details in stories they tell, even though the person with dementia is a main participant in the events being retold. The design of such stories is complex as the interactants must keep track of both the content of the story and manage the potential sensitivity of telling a story that should already be known to both spouses. We show how the spouse without dementia (re)organizes the participation framework in resourceful ways and delicately deals with her spouse’s limited memory using a variety of face-saving practices. The analyses highlight how issues related to knowledge and dementia can benefit from using an interactional and distributed perspective. While access and rights to knowledge is usually divided between participants depending on the knowledge domain and the participants’ relation to the topic, in the case of a dementia disease a more flexible approach towards such divisions could be advantageous.

This chapter uses conversation analysis to investigate how different quiz formats facilitate or impede participation in group quizzes for people living with dementia. Quizzes are an important way to prompt social interaction and engage people living with dementia. However, their reliance on memory and cognition can present difficulties for staff and players alike. Despite quizzes being based on a question–answer format, the way they are enacted can vary in the following ways: question formulation and type; the type of appropriate answer (i.e., is there one, or more than one, possible correct answer?); the social structure of the quiz (Is the quiz played in teams or individually? Do players self-select to answer or do so in a mediated turn allocation format?); the way the players are spatially organised. All these variations impact the degree to which players can engage with the activity and with one another. Through the examination of different types of quiz format, this chapter outlines and make recommendations for quiz structures which facilitate high participation and uptake, and low threats to face. Data are taken from a corpus of ten quizzes recorded in four different group settings in England.