Department of Psychiatry, University of Tuebingen, Tuebingen, Germany.
J Int Neuropsychol Soc. 2011 Mar;17(2):207-18. doi: 10.1017/S1355617710001682. Epub 2011 Jan 18.
The use of nonliteral language in clinical assessment, especially testing the patients' ability to interpret proverbs, has a long tradition in psychiatry. However, its diagnostic sensitivity and specificity in dementias is not yet clear. The aim of this review article is to examine the current evidence on nonliteral/figurative language (proverb, metaphor, metonymy, idiom, irony, sarcasm) comprehension in Alzheimer's disease and related disorders. A comprehensive literature search identified 25 studies (16 proverb, 3 metaphor, 0 metonymy, 5 idiom, 3 sarcasm) on nonliteral language comprehension in dementia. Studies predominantly indicate a deficit. Most studies investigated Alzheimer's dementia. Applied correctly, nonliteral language is a worthwhile diagnostic tool to evaluate language and abstract thinking in dementias. During assessment, familiarity testing (e.g., by asking "are you familiar with the proverb XY") is obligatory. Still, future research is needed in several areas: evidence on decline of nonliteral language over the course of the illness is limited. So far, almost no studies delineated proverb comprehension in high risk populations such as patients with mild cognitive impairment. Currently, there is a lack of studies addressing performance in direct comparison to relevant differential diagnosis like older-age depression, delirium, brain lesion, or other psychiatric conditions.
在临床评估中使用非字面语言，特别是测试患者理解谚语的能力，在精神病学中有着悠久的传统。然而，它在痴呆症中的诊断敏感性和特异性尚不清楚。本文的目的是探讨当前关于阿尔茨海默病及相关疾病中非字面/比喻性语言（谚语、隐喻、转喻、成语、反讽、讽刺）理解的证据。全面的文献检索确定了 25 项关于痴呆症中非字面语言理解的研究（16 项谚语、3 项隐喻、0 项转喻、5 项成语、3 项讽刺）。研究主要表明存在缺陷。大多数研究都调查了阿尔茨海默病痴呆症。正确应用时，非字面语言是评估痴呆症患者语言和抽象思维的一种有价值的诊断工具。在评估过程中，必须进行熟悉度测试（例如，询问“你是否熟悉谚语 XY”）。然而，仍需要在几个领域进行未来的研究：关于疾病过程中非字面语言下降的证据有限。到目前为止，几乎没有研究在轻度认知障碍等高危人群中描述谚语理解。目前，缺乏与相关鉴别诊断（如老年抑郁症、谵妄、脑损伤或其他精神疾病）直接比较的研究。
