The Relationship between Narrative Discourse Features and Cognitive Functions in Persian-Speaking Patients with Parkinson’s Disease
-
Kiana Ghasrhamidi
,
Arezoo Saffarian
,
Reyhane Mohammadi
,
Seyed Amir Hasan Habibi
,
Nahid Jalilevand
Abstract
Background: Parkinson's disease (PD) affects not only motor function but also cognition and language, including narrative discourse, which relies on linguistic processes and higher-order cognitive functions such as working memory and executive functions. So, the aim of this study was to investigate the relationship between narrative discourse features and cognitive functions in Persian-speaking PD patients.
Material and Methods: In this cross-sectional study, 26 PD patients and 26 age, sex, and education-matched healthy controls participated. Cognitive performance was assessed using the Persian Montreal Cognitive Assessment (MoCA-P), digit span, Stroop, verbal fluency, and the Persian Cognitive Reserve Index (CRIq). Narrative discourse was evaluated using the Persian Narrative Discourse Test. Data were analyzed with the Mann-Whitney test and Spearman correlation.
Results: In PD patients, syntactic complexity correlated positively with MoCA-P (p = 0.001, rₛ = 0.627), CRIq (p = 0.012, rₛ = 0.487), phonological verbal fluency (p = 0.032, rₛ = 0.420), and forward digit span (p = 0.015, rₛ = 0.472). Lexical cohesion correlated with MoCA-P (p = 0.012, rₛ = 0.484) and CRIq (p = 0.002, rₛ = 0.573), while conjunctive cohesion was associated with MoCA-P (p = 0.022, rₛ = 0.448) and semantic verbal fluency (fruits) (p = 0.041, rₛ = 0.404).
Conclusions: The results of this study demonstrate that higher levels of global cognition, working memory, verbal fluency, and cognitive reserve are associated with increased syntactic complexity and enhanced lexical and conjunctive cohesion in the narrative discourse of patients with PD. These findings indicate that cognitive decline adversely affects narrative organization and structural integrity.
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2. Kalia LV, Lang AE. Parkinson's disease. The lancet. 2015;386(9996):896-912.
3. Cooper JA, Sagar HJ, Jordan N, Harvey NS, Sullivan EV. Cognitive impairment in early, untreated Parkinson's disease and its relationship to motor disability. Brain. 1991;114(5):2095-122.
4. Levin BE, Llabre MM, Weiner WJ. Cognitive impairments associated with early Parkinson's disease. Neurology. 1989;39(4):557-.
5. Kudlicka A, Clare L, Hindle JV. Executive functions in Parkinson's disease: Systematic review and meta‐analysis. Movement disorders. 2011;26(13):2305-15.
6. Mak E, Su L, Williams GB, O'Brien JT. Neuroimaging correlates of cognitive impairment and dementia in Parkinson's disease. Parkinsonism Relat Disord. 2015;21(8):862-70.
7. Altmann LJ, Troche MS. High‐Level Language Production in Parkinson′ s Disease: A Review. Parkinson’s disease. 2011;2011(1):238956.
8. Smith KM, Caplan DN. Communication impairment in Parkinson’s disease: Impact of motor and cognitive symptoms on speech and language. Brain and language. 2018;185:38-46.
9. D’Ascanio S, Piras F, Banaj N, Assogna F, Pellicano C, Bassi A, et al. Narrative discourse production in Parkinson’s disease: Decoupling the role of cognitive-linguistic and motor speech changes. Heliyon. 2023;9(8).
10. Marini A, Andreetta S, del Tin S, Carlomagno S. A multi-level approach to the analysis of narrative language in aphasia. Aphasiology. 2011;25(11):1372-92.
11. Trabasso T, van den Broek P. Causal Thinking and the Representation of Narrative Events. Journal of Memory and Language. 1985;24:612-30.
12. Gagarina N, Klop D, Kunnari S, Tantele K, Välimaa T, Bohnacker U, et al. MAIN: Multilingual assessment instrument for narratives–Revised. ZAS papers in linguistics. 2019;63:20-.
13. Hickmann M. Children's discourse: person, space and time across languages: Cambridge University Press; 2002.
14. Košutar S, Kramarić M, Hržica G. The relationship between narrative microstructure and macrostructure: Differences between six-and eight-year-olds. Psychology of Language and Communication. 2022;26(1):126-53.
15. Holtgraves T, Fogle K, Marsh L. Pragmatic language production deficits in Parkinson¡¯s disease. Advances in Parkinson's Disease. 2013;Vol.02No.01:6.
16. Ash S, McMillan C, Gross RG, Cook P, Morgan B, Boller A, et al. The organization of narrative discourse in Lewy body spectrum disorder. Brain and language. 2011;119(1):30-41.
17. Ash S, Xie SX, Gross RG, Dreyfuss M, Boller A, Camp E, et al. The organization and anatomy of narrative comprehension and expression in Lewy body spectrum disorders. Neuropsychology. 2012;26(3):368-84.
18. Ellis C, Crosson B, Gonzalez Rothi LJ, Okun MS, Rosenbek JC. Narrative discourse cohesion in early stage Parkinson’s disease. Journal of Parkinson's disease. 2015;5(2):403-11.
19. Ash S, Jester C, York C, Kofman OL, Langey R, Halpin A, et al. Longitudinal decline in speech production in Parkinson's disease spectrum disorders. Brain Lang. 2017;171:42-51.
20. Lewis FM, Lapointe LL, Murdoch BE, Chenery HJ. Language impairment in Parkinson's disease. Aphasiology. 1998;12(3):193-206.
21. Silveira KA, Souza GB, Carpenedo CM, Rieder CRM, Beber BC. Associations between quality of life in communication and sociodemographic and clinical aspects of Parkinson's disease. Codas. 2025;37(5):e20240298.
22. Goetz CG, Poewe W, Rascol O, Sampaio C, Stebbins GT, Counsell C, et al. Movement Disorder Society Task Force report on the Hoehn and Yahr staging scale: status and recommendations the Movement Disorder Society Task Force on rating scales for Parkinson's disease. Movement disorders. 2004;19(9):1020-8.
23. Wong MN, Murdoch BE, Whelan B-M. Lingual Kinematics in Dysarthric and Nondysarthric Speakers with Parkinson′ s Disease. Parkinson’s disease. 2011;2011(1):352838.
24. Badrkhahan SZ, Sikaroodi H, Sharifi F, Kouti L, Noroozian M. Validity and reliability of the Persian version of the Montreal Cognitive Assessment (MoCA-P) scale among subjects with Parkinson’s disease. Applied Neuropsychology: Adult. 2019.
25. Ghayoumi Anaraki Z, Marini A, Yadegari F, Mahmoodi Bakhtiari B, Fakharian E, Rahgozar M, et al. Narrative discourse impairments in persian-speaking persons with traumatic brain injury: A pilot study. Folia Phoniatrica et Logopaedica. 2015;66(6):273-9.
26. Hay E, Moran C. Discourse formulation in children with closed head injury. 2005.
27. Lê K, Mozeiko J, Coelho C. Discourse analyses: Characterizing cognitive-communication disorders following TBI. The ASHA Leader. 2011;16(2):18-21.
28. Fiestas C, Bedore L, Peña E, Nagy VJ, Cohen J, McAlister KT, et al. Use of mazes in the narrative language samples of bilingual and monolingual 4-to 7-year old children. Proceedings of the 4th International Symposium on Bilingualism. 2005:730-40.
29. Kachroo B. Textual cohesion and translation. Meta. 1984;29(2):128-34.
30. Halliday MAK, & Hasan, R. (1976). Cohesion in English (1st ed.). Routledge. https://doi.org/10.4324/9781315836010. Cohesion in English. 1st ed. london1976.
31. Wright HH, Capilouto GJ, Koutsoftas A. Evaluating measures of global coherence ability in stories in adults. Int J Lang Commun Disord. 2013;48(3):249-56.
32. MacLeod CM. Half a century of research on the Stroop effect: an integrative review. Psychological bulletin. 1991;109(2):163.
33. Rezapour T, Soltani Nezhad Z, Ekhtiari H. Administration and Scoring Manual Persian Paper and Pencil Cognitive Assessment Package (PCAP). Tehran: Mehrsa Publication. 2013.
34. Rezapour T EH, Soltaninejad Z. [procedure and scoring of persian paper and pencil cognitive assessment package (PCAP)]. Tehran:, Persian. M.
35. Amunts J, Camilleri JA, Eickhoff SB, Heim S, Weis S. Executive functions predict verbal fluency scores in healthy participants. Scientific reports. 2020;10(1):11141.
36. Ebrahimipour M, Shahbeigi S, Jenabi M, Amiri Y, Kamali M. Verbal fluency performance in patients with multiple sclerosis. Iranian Journal of Neurology. 2008;7(21):138-42.
37. Mousavi SZ, Mehri A, Maroufizadeh S, Koochak SE. Comparing Verb Fluency With Verbal Fluency in Patients With Alzheimer's Disease. Middle East Journal of Rehabilitation and Health. 2014;1(1).
38. Nucci M, Mapelli D, Mondini S. Cognitive Reserve Index questionnaire (CRIq): a new instrument for measuring cognitive reserve. Aging clinical and experimental research. 2012;24(3):218-26.
39. Hatami J, Feizi Khajeh A, Rahiminezhad A, Farahani H, Rezapour T. Validation of Persian Version of Cognitive Reserve Index Questionnaire (CRIq). Journal of Applied Psychological Research. 2020;11(1):87-99.
40. Cohen JSPAftBSneRhdo. Statistical Power Analysis for the Behavioral Sciences (2nd ed.). Routledge. 1988.
41. Ash S, McMillan C, Gross RG, Cook P, Morgan B, Boller A, et al. The organization of narrative discourse in Lewy body spectrum disorder. Brain Lang. 2011;119(1):30-41.
42. Marini A, Boewe A, Caltagirone C, Carlomagno S. Age-related differences in the production of textual descriptions. Journal of psycholinguistic research. 2005;34:439-63.
43. Cooke A, Zurif EB, DeVita C, Alsop D, Koenig P, Detre J, et al. Neural basis for sentence comprehension: Grammatical and short‐term memory components. Human brain mapping. 2002;15(2):80-94.
44. Martín-Aragoneses MT, Mejuto G, Del Río D, Fernandes SM, Rodrigues PF, López-Higes R. Task demands and sentence reading comprehension among healthy older adults: The complementary roles of cognitive reserve and working memory. Brain Sciences. 2023;13(3):428.
45. Caplan D, Waters GS. Verbal working memory and sentence comprehension. Behavioral and brain Sciences. 1999;22(1):77-94.
46. Delage H, Frauenfelder UH. Syntax and working memory in typically-developing children: Focus on syntactic complexity. Language, Interaction and Acquisition. 2019;10(2):141-76.
47. Ivanova I, Ferreira VS. The role of working memory for syntactic formulation in language production. J Exp Psychol Learn Mem Cogn. 2019;45(10):1791-814.
48. Yang CL, Perfetti CA, Schmalhofer F. Event-related potential indicators of text integration across sentence boundaries. Journal of Experimental Psychology: Learning, Memory, and Cognition. 2007;33(1):55.
49. Gordon PC, Hendrick R, Johnson M. Memory interference during language processing. Journal of experimental psychology: learning, memory, and cognition. 2001;27(6):1411.
50. Murray LL. Attention and other cognitive deficits in aphasia: Presence and relation to language and communication measures. 2012.
51. Coelho CA, Liles BZ, Duffy RJ. Impairments of discourse abilities and executive functions in traumatically brain-injured adults. Brain injury. 1995;9(5):471-7.
52. Siew CS, Wulff DU, Beckage NM, Kenett YN. Cognitive network science: A review of research on cognition through the lens of network representations, processes, and dynamics. Complexity. 2019;2019(1):2108423.
53. De Deyne S, Navarro DJ, Storms G. Better explanations of lexical and semantic cognition using networks derived from continued rather than single-word associations. Behavior research methods. 2013;45(2):480-98.
54. Morris J, Hirst G. Lexical cohesion computed by thesaural relations as an indicator of the structure of text. Computational linguistics. 1991;17(1):21-48.
55. Song H, Park B-y, Park H, Shim WM. Cognitive and neural state dynamics of narrative comprehension. Journal of Neuroscience. 2021;41(43):8972-90.
56. Kintsch W. The role of knowledge in discourse comprehension: a construction-integration model. Psychological review. 1988;95(2):163.
57. Ou J, Law S-P, Fung R. Relationship between individual differences in speech processing and cognitive functions. Psychonomic bulletin & review. 2015;22(6):1725-32.
2. Kalia LV, Lang AE. Parkinson's disease. The lancet. 2015;386(9996):896-912.
3. Cooper JA, Sagar HJ, Jordan N, Harvey NS, Sullivan EV. Cognitive impairment in early, untreated Parkinson's disease and its relationship to motor disability. Brain. 1991;114(5):2095-122.
4. Levin BE, Llabre MM, Weiner WJ. Cognitive impairments associated with early Parkinson's disease. Neurology. 1989;39(4):557-.
5. Kudlicka A, Clare L, Hindle JV. Executive functions in Parkinson's disease: Systematic review and meta‐analysis. Movement disorders. 2011;26(13):2305-15.
6. Mak E, Su L, Williams GB, O'Brien JT. Neuroimaging correlates of cognitive impairment and dementia in Parkinson's disease. Parkinsonism Relat Disord. 2015;21(8):862-70.
7. Altmann LJ, Troche MS. High‐Level Language Production in Parkinson′ s Disease: A Review. Parkinson’s disease. 2011;2011(1):238956.
8. Smith KM, Caplan DN. Communication impairment in Parkinson’s disease: Impact of motor and cognitive symptoms on speech and language. Brain and language. 2018;185:38-46.
9. D’Ascanio S, Piras F, Banaj N, Assogna F, Pellicano C, Bassi A, et al. Narrative discourse production in Parkinson’s disease: Decoupling the role of cognitive-linguistic and motor speech changes. Heliyon. 2023;9(8).
10. Marini A, Andreetta S, del Tin S, Carlomagno S. A multi-level approach to the analysis of narrative language in aphasia. Aphasiology. 2011;25(11):1372-92.
11. Trabasso T, van den Broek P. Causal Thinking and the Representation of Narrative Events. Journal of Memory and Language. 1985;24:612-30.
12. Gagarina N, Klop D, Kunnari S, Tantele K, Välimaa T, Bohnacker U, et al. MAIN: Multilingual assessment instrument for narratives–Revised. ZAS papers in linguistics. 2019;63:20-.
13. Hickmann M. Children's discourse: person, space and time across languages: Cambridge University Press; 2002.
14. Košutar S, Kramarić M, Hržica G. The relationship between narrative microstructure and macrostructure: Differences between six-and eight-year-olds. Psychology of Language and Communication. 2022;26(1):126-53.
15. Holtgraves T, Fogle K, Marsh L. Pragmatic language production deficits in Parkinson¡¯s disease. Advances in Parkinson's Disease. 2013;Vol.02No.01:6.
16. Ash S, McMillan C, Gross RG, Cook P, Morgan B, Boller A, et al. The organization of narrative discourse in Lewy body spectrum disorder. Brain and language. 2011;119(1):30-41.
17. Ash S, Xie SX, Gross RG, Dreyfuss M, Boller A, Camp E, et al. The organization and anatomy of narrative comprehension and expression in Lewy body spectrum disorders. Neuropsychology. 2012;26(3):368-84.
18. Ellis C, Crosson B, Gonzalez Rothi LJ, Okun MS, Rosenbek JC. Narrative discourse cohesion in early stage Parkinson’s disease. Journal of Parkinson's disease. 2015;5(2):403-11.
19. Ash S, Jester C, York C, Kofman OL, Langey R, Halpin A, et al. Longitudinal decline in speech production in Parkinson's disease spectrum disorders. Brain Lang. 2017;171:42-51.
20. Lewis FM, Lapointe LL, Murdoch BE, Chenery HJ. Language impairment in Parkinson's disease. Aphasiology. 1998;12(3):193-206.
21. Silveira KA, Souza GB, Carpenedo CM, Rieder CRM, Beber BC. Associations between quality of life in communication and sociodemographic and clinical aspects of Parkinson's disease. Codas. 2025;37(5):e20240298.
22. Goetz CG, Poewe W, Rascol O, Sampaio C, Stebbins GT, Counsell C, et al. Movement Disorder Society Task Force report on the Hoehn and Yahr staging scale: status and recommendations the Movement Disorder Society Task Force on rating scales for Parkinson's disease. Movement disorders. 2004;19(9):1020-8.
23. Wong MN, Murdoch BE, Whelan B-M. Lingual Kinematics in Dysarthric and Nondysarthric Speakers with Parkinson′ s Disease. Parkinson’s disease. 2011;2011(1):352838.
24. Badrkhahan SZ, Sikaroodi H, Sharifi F, Kouti L, Noroozian M. Validity and reliability of the Persian version of the Montreal Cognitive Assessment (MoCA-P) scale among subjects with Parkinson’s disease. Applied Neuropsychology: Adult. 2019.
25. Ghayoumi Anaraki Z, Marini A, Yadegari F, Mahmoodi Bakhtiari B, Fakharian E, Rahgozar M, et al. Narrative discourse impairments in persian-speaking persons with traumatic brain injury: A pilot study. Folia Phoniatrica et Logopaedica. 2015;66(6):273-9.
26. Hay E, Moran C. Discourse formulation in children with closed head injury. 2005.
27. Lê K, Mozeiko J, Coelho C. Discourse analyses: Characterizing cognitive-communication disorders following TBI. The ASHA Leader. 2011;16(2):18-21.
28. Fiestas C, Bedore L, Peña E, Nagy VJ, Cohen J, McAlister KT, et al. Use of mazes in the narrative language samples of bilingual and monolingual 4-to 7-year old children. Proceedings of the 4th International Symposium on Bilingualism. 2005:730-40.
29. Kachroo B. Textual cohesion and translation. Meta. 1984;29(2):128-34.
30. Halliday MAK, & Hasan, R. (1976). Cohesion in English (1st ed.). Routledge. https://doi.org/10.4324/9781315836010. Cohesion in English. 1st ed. london1976.
31. Wright HH, Capilouto GJ, Koutsoftas A. Evaluating measures of global coherence ability in stories in adults. Int J Lang Commun Disord. 2013;48(3):249-56.
32. MacLeod CM. Half a century of research on the Stroop effect: an integrative review. Psychological bulletin. 1991;109(2):163.
33. Rezapour T, Soltani Nezhad Z, Ekhtiari H. Administration and Scoring Manual Persian Paper and Pencil Cognitive Assessment Package (PCAP). Tehran: Mehrsa Publication. 2013.
34. Rezapour T EH, Soltaninejad Z. [procedure and scoring of persian paper and pencil cognitive assessment package (PCAP)]. Tehran:, Persian. M.
35. Amunts J, Camilleri JA, Eickhoff SB, Heim S, Weis S. Executive functions predict verbal fluency scores in healthy participants. Scientific reports. 2020;10(1):11141.
36. Ebrahimipour M, Shahbeigi S, Jenabi M, Amiri Y, Kamali M. Verbal fluency performance in patients with multiple sclerosis. Iranian Journal of Neurology. 2008;7(21):138-42.
37. Mousavi SZ, Mehri A, Maroufizadeh S, Koochak SE. Comparing Verb Fluency With Verbal Fluency in Patients With Alzheimer's Disease. Middle East Journal of Rehabilitation and Health. 2014;1(1).
38. Nucci M, Mapelli D, Mondini S. Cognitive Reserve Index questionnaire (CRIq): a new instrument for measuring cognitive reserve. Aging clinical and experimental research. 2012;24(3):218-26.
39. Hatami J, Feizi Khajeh A, Rahiminezhad A, Farahani H, Rezapour T. Validation of Persian Version of Cognitive Reserve Index Questionnaire (CRIq). Journal of Applied Psychological Research. 2020;11(1):87-99.
40. Cohen JSPAftBSneRhdo. Statistical Power Analysis for the Behavioral Sciences (2nd ed.). Routledge. 1988.
41. Ash S, McMillan C, Gross RG, Cook P, Morgan B, Boller A, et al. The organization of narrative discourse in Lewy body spectrum disorder. Brain Lang. 2011;119(1):30-41.
42. Marini A, Boewe A, Caltagirone C, Carlomagno S. Age-related differences in the production of textual descriptions. Journal of psycholinguistic research. 2005;34:439-63.
43. Cooke A, Zurif EB, DeVita C, Alsop D, Koenig P, Detre J, et al. Neural basis for sentence comprehension: Grammatical and short‐term memory components. Human brain mapping. 2002;15(2):80-94.
44. Martín-Aragoneses MT, Mejuto G, Del Río D, Fernandes SM, Rodrigues PF, López-Higes R. Task demands and sentence reading comprehension among healthy older adults: The complementary roles of cognitive reserve and working memory. Brain Sciences. 2023;13(3):428.
45. Caplan D, Waters GS. Verbal working memory and sentence comprehension. Behavioral and brain Sciences. 1999;22(1):77-94.
46. Delage H, Frauenfelder UH. Syntax and working memory in typically-developing children: Focus on syntactic complexity. Language, Interaction and Acquisition. 2019;10(2):141-76.
47. Ivanova I, Ferreira VS. The role of working memory for syntactic formulation in language production. J Exp Psychol Learn Mem Cogn. 2019;45(10):1791-814.
48. Yang CL, Perfetti CA, Schmalhofer F. Event-related potential indicators of text integration across sentence boundaries. Journal of Experimental Psychology: Learning, Memory, and Cognition. 2007;33(1):55.
49. Gordon PC, Hendrick R, Johnson M. Memory interference during language processing. Journal of experimental psychology: learning, memory, and cognition. 2001;27(6):1411.
50. Murray LL. Attention and other cognitive deficits in aphasia: Presence and relation to language and communication measures. 2012.
51. Coelho CA, Liles BZ, Duffy RJ. Impairments of discourse abilities and executive functions in traumatically brain-injured adults. Brain injury. 1995;9(5):471-7.
52. Siew CS, Wulff DU, Beckage NM, Kenett YN. Cognitive network science: A review of research on cognition through the lens of network representations, processes, and dynamics. Complexity. 2019;2019(1):2108423.
53. De Deyne S, Navarro DJ, Storms G. Better explanations of lexical and semantic cognition using networks derived from continued rather than single-word associations. Behavior research methods. 2013;45(2):480-98.
54. Morris J, Hirst G. Lexical cohesion computed by thesaural relations as an indicator of the structure of text. Computational linguistics. 1991;17(1):21-48.
55. Song H, Park B-y, Park H, Shim WM. Cognitive and neural state dynamics of narrative comprehension. Journal of Neuroscience. 2021;41(43):8972-90.
56. Kintsch W. The role of knowledge in discourse comprehension: a construction-integration model. Psychological review. 1988;95(2):163.
57. Ou J, Law S-P, Fung R. Relationship between individual differences in speech processing and cognitive functions. Psychonomic bulletin & review. 2015;22(6):1725-32.
| Issue | Articles in Press | |
| Section | Research Article(s) | |
| Keywords | ||
| Parkinson's disease; Narrative Discourse; Cognition; Persian Language | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Ghasrhamidi K, Saffarian A, Mohammadi R, Habibi SAH, Jalilevand N. The Relationship between Narrative Discourse Features and Cognitive Functions in Persian-Speaking Patients with Parkinson’s Disease. jmr. 2026;(-).
