Language Performance of Individuals at Risk for Mild Cognitive Impairment

Capturing the Heterogeneity of Word Learners by Analyzing Persons

Accurately capturing children's word learning abilities is critical for advancing our understanding of language development. Researchers have demonstrated that utilizing more complex statistical methods, such as mixed-effects regression and hierarchical linear modeling, can lead to a more complete understanding of the variability observed within children's word learning abilities. In the current paper, we demonstrate how a person-centered approach to data analysis can provide additional insights into the heterogeneity of word learning ability among children while also aiding researchers' efforts to draw individual-level conclusions. Using previously published data with 32 typically developing and 32 late-talking infants who completed a novel noun generalization (NNG) task to assess word learning biases (i.e., shape and material biases), we compare this person-centered method to three traditional statistical approaches: (1) a t-test against chance, (2) an analysis of variance (ANOVA), and (3) a mixed-effects regression. With each comparison, we present a novel question raised by the person-centered approach and show how results from the corresponding analyses can lead to greater nuance in our understanding of children's word learning capabilities. Person-centered methods, then, are shown to be valuable tools that should be added to the growing body of sophisticated statistical procedures used by modern researchers.

The relation between cognitive functioning and activities of daily living in normal aging, mild cognitive impairment, and dementia: a meta-analysis

Literature suggests that dementia and, more generally, cognitive impairment affect the capacity to carry out activities of daily living (ADL) in aging. However, it is important to decipher the weight of specific cognitive domains and neurodegenerative profiles mainly related to ADL difficulties. A meta-analysis was conducted to investigate the nature and strength of the association between cognitive functioning and ADL in healthy older adults, mild cognitive impairment (MCI), and dementia. A comprehensive search of the PubMed, PsycINFO (PROQUEST), and Scopus databases for cross-sectional or longitudinal studies up until December 2022. Our meta-analytic results revealed that: overall, instrumental ADL (IADL) showed a significant association with executive functioning, in particular, abstraction ability/concept formation, set-shifting, and processing speed/complex attention/working memory, regardless of type of participants (i.e., healthy older adults, MCI, and dementia); whereas ADL (both basic ADL, BADL, and IADL) significantly correlated with global cognitive functioning and long-term verbal memory, with a moderator effect of clinical condition (e.g., increasing ES based on the level of cognitive impairment). Moreover, visuospatial and language abilities significantly correlated with ADL, mainly when performance-based tasks were used for ADL assessment. These findings emphasize the importance of neuropsychological assessment in aging to early identify people most at risk of functional decline and shed light on the need to consider specific cognitive abilities in rehabilitation programs.

Frail older people with decreased cognition can perceive reduced self-determination in self-care and social relationships

BACKGROUND

Self-determination in old age is essential for people's experiences of good subjective health and quality of life. The knowledge concerning how frail older people with decreased cognition perceive their ability to be self-determined in the different dimension in daily life is, however, limited. The aim of this study was therefore to explore the relationship of self-determination and cognition in frail older people.

METHODS

This study was a cross-sectional secondary data analysis using baseline data with 119 frail people 75 ≥ from a larger randomized control trial. Self-determination was measured with the statements from the Impact on Participation and Autonomy-Older persons (IPA-O). Cognition was measured using the Mini Mental State Examination (MMSE), where decreased cognition was broadly defined as a score below 25 points. Fisher's exact test was used to test differences in proportions of perceiving self-determination in relation to cognition. The Relative Risk (RR) with a 95% Confidence Interval (CI) was used to explore the risk of perceiving reduced self-determination in relation to cognitive functioning.

RESULTS

Nearly the entire study population, regardless of cognitive functioning, perceived self-determination in Financial situation. For people with decreased cognition, the relative risk for perceiving reduced self-determination was statistically significant higher in activities related to Self-care and in Social relationships when comparing with the participants with intact cognition.

CONCLUSION

Perceiving self-determination when being old, frail and having decreased cognition is possible but is dependent upon which activities that are involved. Organizing healthcare needs according to the older people's wants and wishes is crucial regardless of people having a cognitive decline or not when the effort is to enable the people to be as self-determined as they want. The frail older people with decreased cognition should be treated as being experts in their own lives, and healthcare professionals should navigate the older people to get to their desired direction.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT02773914. Retrospectively registered 16 May 2016.

Natural language processing techniques for studying language in pathological ageing: A scoping review

BACKGROUND

In the past few years there has been a growing interest in the employment of verbal productions as digital biomarkers, namely objective, quantifiable behavioural data that can be collected and measured by means of digital devices, allowing for a low-cost pathology detection, classification and monitoring. Numerous research papers have been published on the automatic detection of subtle verbal alteration, starting from written texts, raw speech recordings and transcripts, and such linguistic analysis has been singled out as a cost-effective method for diagnosing dementia and other medical conditions common among elderly patients (e.g., cognitive dysfunctions associated with metabolic disorders, dysarthria).

AIMS

To provide a critical appraisal and synthesis of evidence concerning the application of natural language processing (NLP) techniques for clinical purposes in the geriatric population. In particular, we discuss the state of the art on studying language in healthy and pathological ageing, focusing on the latest research efforts to build non-intrusive language-based tools for the early identification of cognitive frailty due to dementia. We also discuss some challenges and open problems raised by this approach.

METHODS & PROCEDURES

We performed a scoping review to examine emerging evidence about this novel domain. Potentially relevant studies published up to November 2021 were identified from the databases of MEDLINE, Cochrane and Web of Science. We also browsed the proceedings of leading international conferences (e.g., ACL, COLING, Interspeech, LREC) from 2017 to 2021, and checked the reference lists of relevant studies and reviews.

MAIN CONTRIBUTION

The paper provides an introductory, but complete, overview of the application of NLP techniques for studying language disruption due to dementia. We also suggest that this technique can be fruitfully applied to other medical conditions (e.g., cognitive dysfunctions associated with dysarthria, cerebrovascular disease and mood disorders).

CONCLUSIONS & IMPLICATIONS

Despite several critical points need to be addressed by the scientific community, a growing body of empirical evidence shows that NLP techniques can represent a promising tool for studying language changes in pathological aging, with a high potential to lead a significant shift in clinical practice.

WHAT THIS PAPER ADDS

What is already known on this subject Speech and languages abilities change due to non-pathological neurocognitive ageing and neurodegenerative processes. These subtle verbal modifications can be measured through NLP techniques and used as biomarkers for screening/diagnostic purposes in the geriatric population (i.e., digital linguistic biomarkers-DLBs). What this paper adds to existing knowledge The review shows that DLBs can represent a promising clinical tool, with a high potential to spark a major shift to dementia assessment in the elderly. Some challenges and open problems are also discussed. What are the potential or actual clinical implications of this work? This methodological review represents a starting point for clinicians approaching the DLB research field for studying language in healthy and pathological ageing. It summarizes the state of the art and future research directions of this novel approach.

AI-based assessments of speech and language impairments in dementia

Recent advancements in the artificial intelligence (AI) domain have revolutionized the early detection of cognitive impairments associated with dementia. This has motivated clinicians to use AI-powered dementia detection systems, particularly systems developed based on individuals' and patients' speech and language, for a quick and accurate identification of patients with dementia. This paper reviews articles about developing assessment tools using machine learning and deep learning algorithms trained by vocal and textual datasets.

Language Differences Among Individuals with Normal Cognition, Amnestic and Non-Amnestic MCI, and Alzheimer's Disease

OBJECTIVE

To investigate differences in language performance among older adults with normal cognition (CN), mild cognitive impairment (MCI), and Alzheimer's disease (ad). Owing to the conflicting literature concerning MCI, discrepancies between amnestic (aMCI) and non-amnestic MCI (naMCI) were explored in greater detail.

METHOD

The study sample was drawn from the older (>64 years) HELIAD cohort. Language performance was assessed via semantic and phonemic fluency, confrontation naming, verbal comprehension, verbal repetition as well as a composite language index. Age, sex, and education adjusted general linear models were used to quantify potential pairwise differences in language performance.

RESULTS

The present analysis involved 1607 participants with CN, 146 with aMCI [46 single and 100 multi-domain aMCI], 92 with naMCI [41 single and 51 multi-domain naMCI], and 79 with ad. The mean age and education of our predominantly female (60%) participants were 73.82 (±5.43) and 7.98 (±4.93) years, respectively. MCI individuals performed between those with CN and ad, whereas participants with aMCI performed worse compared to those with naMCI, especially in the semantic fluency and verbal comprehension tasks. Discrepancies between the aMCI and naMCI groups were driven by the exquisitely poor performance of multi-domain aMCI subgroup.

CONCLUSIONS

Overall, individuals could be hierarchically arranged in a continuum of language impairment with the CN individuals constituting the healthy reference and naMCI, aMCI, ad patients representing gradually declining classes in terms of language performance. Exploration of language performance via separation of single from multi-domain naMCI provided a potential explanation for the conflicting evidence of previous research.

Automatic Detection of Putative Mild Cognitive Impairment from Speech Acoustic Features in Mandarin-Speaking Elders

BACKGROUND

To date, the reliable detection of mild cognitive impairment (MCI) remains a significant challenge for clinicians. Very few studies investigated the sensitivity of acoustic features in detecting Mandarin-speaking elders at risk for MCI, defined as "putative MCI" (pMCI).

OBJECTIVE

This study sought to investigate the possibility of using automatically extracted speech acoustic features to detect elderly people with pMCI and reveal the potential acoustic markers of cognitive decline at an early stage.

METHODS

Forty-one older adults with pMCI and 41 healthy elderly controls completed four reading tasks (syllable utterance, tongue twister, diadochokinesis, and short sentence reading), from which acoustic features were extracted automatically to train machine learning classifiers. Correlation analysis was employed to evaluate the relationship between classifier predictions and participants' cognitive ability measured by Mini-Mental State Examination 2.

RESULTS

Classification results revealed that some temporal features (e.g., speech rate, utterance duration, and the number of silent pauses), spectral features (e.g., variability of F1 and F2), and energy features (e.g., SD of peak intensity and SD of intensity range) were effective predictors of pMCI. The best classification result was achieved in the Random Forest classifier (accuracy = 0.81, AUC = 0.81). Correlation analysis uncovered a strong negative correlation between participants' cognitive test scores and the probability estimates of pMCI in the Random Forest classifier, and a modest negative correlation in the Support Vector Machine classifier.

CONCLUSIONS

The automatic acoustic analysis of speech could provide a promising non-invasive way to assess and monitor the early cognitive decline in Mandarin-speaking elders.

Language performance as a prognostic factor for developing Alzheimer's clinical syndrome and mild cognitive impairment: Results from the population-based HELIAD cohort

OBJECTIVES

There is limited research on the prognostic value of language tasks regarding mild cognitive impairment (MCI) and Alzheimer's clinical syndrome (ACS) development in the cognitively normal (CN) elderly, as well as MCI to ACS conversion.

METHODS

Participants were drawn from the population-based Hellenic Longitudinal Investigation of Aging and Diet (HELIAD) cohort. Language performance was evaluated via verbal fluency [semantic (SVF) and phonemic (PVF)], confrontation naming [Boston Naming Test short form (BNTsf)], verbal comprehension, and repetition tasks. An additional language index was estimated using both verbal fluency tasks: SVF-PVF discrepancy. Cox proportional hazards analyses adjusted for important sociodemographic parameters (age, sex, education, main occupation, and socioeconomic status) and global cognitive status [Mini Mental State Examination score (MMSE)] were performed.

RESULTS

A total of 959 CN and 118 MCI older (>64 years) individuals had follow-up investigations after a mean of ∼3 years. Regarding the CN group, each standard deviation increase in the composite language score reduced the risk of ACS and MCI by 49% (8-72%) and 32% (8-50%), respectively; better SVF and BNTsf performance were also independently associated with reduced risk of ACS and MCI. On the other hand, using the smaller MCI participant set, no language measurement was related to the risk of MCI to ACS conversion.

CONCLUSIONS

Impaired language performance is associated with elevated risk of ACS and MCI development. Better SVF and BNTsf performance are associated with reduced risk of ACS and MCI in CN individuals, independent of age, sex, education, main occupation, socioeconomic status, and MMSE scores at baseline.

Predicting Scores on the Mini-Mental State Examination (MMSE) from Spontaneous Speech

The aim of this study was to examine the relationship between language components, such as lexical density, length, and content in terms of “Time, Space and Action”, with MMSE scores. For this reason, a group of 33 older participants, without a diagnosis of dementia, was examined, providing information regarding recent and future events. Participants with higher MMSE scores showed higher lexical density, speech length, as well as number of tokens related to Time, Place and Action in their speech. However, these differences only reach the statistical level for lexical density when participants were divided into two groups (MCI and healthy controls). Word frequency was lower for participants with MCI but this difference was not statistically significant. Lastly, lexical density was positively correlated with MMSE scores and predicted MMSE scores. These results could be of interest at the applied level in the screening of MCI.

Painting for a Purpose: A Visual Arts Program as a Method to Promote Engagement, Communication, Cognition, and Quality of Life for Individuals With Dementia

PURPOSE

The arts (e.g., music and painting) have received considerable theoretical and observational support as a cognitive stimulation technique for persons living with dementia (PLWD). However, particularly for visual arts, limited empirical support exists. Therefore, the purpose of this study was to pilot a free-form arts program for PLWD in the context of a cognitive stimulation paradigm and measure subsequent engagement, communication, cognitive-linguistic function, and quality of life.

METHOD

Three PLWD (one each in mild-to-moderate, moderate, and moderate-to-severe stages) were referred for study participation by a local long-term care facility. A single subject across subjects, ABA reversal design was used to assess intervention effects over a period of 8 weeks, in comparison to an active control condition (cooking activity). Cognitive-linguistic function and quality of life were assessed using standardized measures at baseline and follow-up. Engagement and communication were probed regularly across each study phase.

RESULTS

Significant changes were seen in participants' engagement and communication during painting sessions compared to the control activity. A nonsignificant positive trend was noted for self-rated quality of life from baseline to follow-up. Pre-post testing revealed nominal change in cognitive-linguistic functions.

CONCLUSIONS

An arts program led to significant increases in constructive engagement and communication and a trend toward increased self-rated quality of life for the three PLWD. The fact that these changes were not sustained outside intervention sessions (i.e., pre-post testing) is consistent with the need for a larger paradigm shift in which rehabilitation specialists-including speech-language pathologists-better integrate creative, meaningful activities into the everyday lives of PLWD to maximize ongoing engagement, communication, and quality of life.

Decision-Making Profiles and Their Associations with Cognitive Performance in Mild Cognitive Impairment

Background: It is crucial for older adults, especially those with mild cognitive impairment (MCI), to make profitable decisions routinely. However, the results regarding decision-making (DM) remain inconsistent. Objective: The present study assessed DM profiles under uncertainty conditions in individuals with MCI and their associations with multi-domain cognitive performance. Method: Fifty-three patients with MCI and forty-two age-, gender-, and education level-matched healthy controls (HCs) were administered a comprehensive neuropsychological battery test. The Iowa Gambling Task (IGT) and Game of Dice Task (GDT) were used to assess DM competence in conditions involving ambiguity and risk, respectively. In addition, Spearman’s correlations were used to examine relationships between GDT and multi-domain cognitive performance. Result: The final capital (FC) and frequency of utilization of negative feedback (FUNF) and positive feedback (FUPF) in the GDT were lower in MCI patients than in HCs. In addition, the number of shifts between safe and risky alternatives was significantly different across groups. However, IGT performance was comparable across groups. In the MCI patients, risky DM performance was associated with language, whereas in HCs was correlated with memory and executive functions. Besides, in MCI, performance on IGT was significantly correlated with social cognition. Conclusion: Individuals with mild cognitive impairment have difficulty utilizing feedback to make optimal decisions under risky situations. The association between decision-making performance and cognitive function is divergent regarding situational uncertainty and individuals’ cognitive status. In mild cognitive impairment and normal aging, decision-making under ambiguity needs further investigation.

Evaluating Voice-Assistant Commands for Dementia Detection

Early detection of cognitive decline involved in Alzheimer's Disease and Related Dementias (ADRD) in older adults living alone is essential for developing, planning, and initiating interventions and support systems to improve users' everyday function and quality of life. In this paper, we explore the voice commands using a Voice-Assistant System (VAS), i.e., Amazon Alexa, from 40 older adults who were either Healthy Control (HC) participants or Mild Cognitive Impairment (MCI) participants, age 65 or older. We evaluated the data collected from voice commands, cognitive assessments, and interviews and surveys using a structured protocol. We extracted 163 unique command-relevant features from each participant's use of the VAS. We then built machine-learning models including 1-layer/2-layer neural networks, support vector machines, decision tree, and random forest, for classification and comparison with standard cognitive assessment scores, e.g., Montreal Cognitive Assessment (MoCA). Our classification models using fusion features achieved an accuracy of 68%, and our regression model resulted in a Root-Mean-Square Error (RMSE) score of 3.53. Our Decision Tree (DT) and Random Forest (RF) models using selected features achieved higher classification accuracy 80-90%. Finally, we analyzed the contribution of each feature set to the model output, thus revealing the commands and features most useful in inferring the participants' cognitive status. We found that features of overall performance, features of music-related commands, features of call-related commands, and features from Automatic Speech Recognition (ASR) were the top-four feature sets most impactful on inference accuracy. The results from this controlled study demonstrate the promise of future home-based cognitive assessments using Voice-Assistant Systems.

Detecting Alzheimer's Disease Using Natural Language Processing of Referential Communication Task Transcripts

BACKGROUND

People with Alzheimer's disease (AD) often demonstrate difficulties in discourse production. Referential communication tasks (RCTs) are used to examine a speaker's capability to select and verbally code the characteristics of an object in interactive conversation.

OBJECTIVE

In this study, we used contextualized word representations from Natural language processing (NLP) to evaluate how well RCTs are able to distinguish between people with AD and cognitively healthy older adults.

METHODS

We adapted machine learning techniques to analyze manually transcribed speech transcripts in an RCT from 28 older adults, including 12 with AD and 16 cognitively healthy older adults. Two approaches were applied to classify these speech transcript samples: 1) using clinically relevant linguistic features, 2) using machine learned representations derived by a state-of-art pretrained NLP transfer learning model, Bidirectional Encoder Representation from Transformer (BERT) based classification model.

RESULTS

The results demonstrated the superior performance of AD detection using a designed transfer learning NLP algorithm. Moreover, the analysis showed that transcripts of a single image yielded high accuracies in AD detection.

CONCLUSION

The results indicated that RCT may be useful as a diagnostic tool for AD, and that the task can be simplified to a subset of images without significant sacrifice to diagnostic accuracy, which can make RCT an easier and more practical tool for AD diagnosis. The results also demonstrate the potential of RCT as a tool to better understand cognitive deficits from the perspective of discourse production in people with AD.

Electrophysiological abnormalities as indicators of early-stage pathology in Primary Progressive Aphasia (PPA): A case study in semantic variant PPA

Language induced and spontaneous oscillatory activity was measured using MEG in a patient with the semantic variant of Primary Progressive Aphasia (svPPA) and 15 healthy controls.The patient showed oscillatory slowing in the left anterior temporal lobe (ATL) that extended into non-atrophied brain tissue in left and right frontal areas. The white matter connections were reduced to the left and right ATL and left frontal regions, exhibiting electrophysiological abnormalities. Altered diffusion metrics in all four language tracts, indicted compromised white matter integrity. Task-related and spontaneous oscillatory abnormalities can indicate early neurodegeneration in svPPA, providing promising targets for intervention.

Family history of FXTAS is associated with age-related cognitive-linguistic decline among mothers with the FMR1 premutation

BACKGROUND

Women who carry a premutation allele of the FMR1 gene are at increased vulnerability to an array of age-related symptoms and disorders, including age-related decline in select cognitive skills. However, the risk factors for age-related decline are poorly understood, including the potential role of family history and genetic factors. In other forms of pathological aging, early decline in syntactic complexity is observed and predicts the later onset of neurodegenerative disease. To shed light on the earliest signs of degeneration, the present study characterized longitudinal changes in the syntactic complexity of women with the FMR1 premutation across midlife, and associations with family history of fragile X-associated tremor/ataxia syndrome (FXTAS) and CGG repeat length.

METHODS

Forty-five women with the FMR1 premutation aged 35-64 years at study entry participated in 1-5 longitudinal assessments spaced approximately a year apart (130 observations total). All participants were mothers of children with confirmed fragile X syndrome. Language samples were analyzed for syntactic complexity and participants provided information on family history of FXTAS. CGG repeat length was determined via molecular genetic testing.

RESULTS

Hierarchical linear models indicated that women who reported a family history of FXTAS exhibited faster age-related decline in syntactic complexity than those without a family history, with that difference emerging as the women reached their mid-50 s. CGG repeat length was not a significant predictor of age-related change.

CONCLUSIONS

Results suggest that women with the FMR1 premutation who have a family history of FXTAS may be at increased risk for neurodegenerative disease, as indicated by age-related loss of syntactic complexity. Thus, family history of FXTAS may represent a personalized risk factor for age-related disease. Follow-up study is needed to determine whether syntactic decline is an early indicator of FXTAS specifically, as opposed to being a more general age-related cognitive decline associated with the FMR1 premutation.

Rates of Cognitive and Functional Impairments in Older Adults Residing in a Continuing Care Senior Housing Community

OBJECTIVE

The current cross-sectional study examined cognition and performance-based functional abilities in a continuing care senior housing community (CCSHC) that is comparable to other CCSHCs in the US with respect to residents' demographic characteristics.

METHOD

Participants were 110 older adult residents of the independent living unit. We assessed sociodemographics, mental health, neurocognitive functioning, and functional capacity.

RESULTS

Compared to normative samples, participants performed at or above expectations in terms of premorbid functioning, attention span and working memory, processing speed, timed set-shifting, inhibitory control, and confrontation naming. They performed below expectation in verbal fluency and verbal and visual learning and memory, with impairment rates [31.4% (>1 SD below the mean) and 18.49% (>1.5 SD below the mean)] well above the general population (16% and 7%, respectively). Within the cognitive test battery, two tests of delayed memory were most predictive of a global deficit score. Most cognitive test scores correlated with performance-based functional capacity.

CONCLUSIONS

Overall, results suggest that a subset of older adults in the independent living sector of CCSHCs are cognitively and functionally impaired and are at risk for future dementia. Results also argue for the inclusion of memory tests in abbreviated screening batteries in this population. We suggest that CCSHCs implement regular cognitive screening procedures to identify and triage those older adults who could benefit from interventions and, potentially, a transition to a higher level of care.

Language Decline Characterizes Amnestic Mild Cognitive Impairment Independent of Cognitive Decline

Purpose This research investigated the nature of cognitive decline in prodromal Alzheimer's disease (AD), particularly in mild cognitive impairment, amnestic type (aMCI). We assessed language in aMCI as compared with healthy aging (HA) and healthy young (HY) with new psycholinguistic assessment of complex sentences, and we tested the degree to which deficits on this language measure relate to performance in other general cognitive domains such as memory. Method Sixty-one individuals with aMCI were compared with 24 HA and 10 HY adults on a psycholinguistic measure of complex sentence production (relative clauses). In addition, HA, HY, and a subset of the aMCI participants (n = 22) were also tested on a multidomain cognitive screen, the Addenbrooke's Cognitive Examination-Revised (ACE-R), and on a verbal working memory Brown-Peterson (BP) test. General and generalized linear mixed models were used to test psycholinguistic results and to test whether ACE-R and BP performance predicted performance on the psycholinguistic test similarly in the aMCI and HA groups. Results On the psycholinguistic measure, sentence imitation was significantly deficited in aMCI in comparison with that in HA and HY. Experimental factorial designs revealed that individuals with aMCI had particular difficulty repeating sentences that especially challenged syntax-semantics integration. As expected, the aMCI group also performed significantly below the HY and HA groups on the ACE-R. Neither the ACE-R Memory subtest nor the BP total scores predicted performance on the psycholinguistic task for either the aMCI or the HA group. However, the ACE-R total score significantly predicted psycholinguistic task performance, with increased ACE-R performance predicting increased psycholinguistic task performance only for the HA group, not for the aMCI group. Conclusions Results suggest a selective deterioration in language in aMCI, specifically a weakening of syntax-semantics integration in complex sentence processing, and a general independence of this language deficit and memory decline. Results cohere with previous assessments of the nature of difficulty in complex sentence formation in aMCI. We argue that clinical screening for prodromal AD can be strengthened by supplementary testing of language, as well as memory, and extended evaluation of strength of their relation.

Textual Inference Comprehension in Mild Cognitive Impairment: The Influence of Semantic Processing and Verbal Episodic Memory

Language complaints, especially in complex tasks, may occur in mild cognitive impairment (MCI). Various language measures have been studied as cognitive predictors of MCI conversion to Alzheimer's type dementia. Understanding textual inferences is considered a high-demanding task that recruits multiple cognitive functions and, therefore, could be sensitive to detect decline in the early stages of MCI. Thus, we aimed to compare the performance of subjects with MCI to healthy elderly in a textual inference comprehension task and to determine the best predictors of performance in this ability considering one verbal episodic memory and two semantic tasks. We studied 99 individuals divided into three groups: (1) 23 individuals with amnestic mild cognitive impairment (aMCI), (2) 42 individuals with non-amnestic mild cognitive impairment (naMCI), (3), and (4) 34 cognitively healthy individuals for the control group (CG). A reduced version of The Implicit Management Test was used to assess different types of inferential reasoning in text reading. MCI patients performed poorer than healthy elderly, and there were no differences between MCI subgroups (amnestic and non-amnestic). The best predictors for inference-making were verbal memory in the aMCI and semantic tasks in the naMCI group. The results confirmed that the failure to understand textual inferences can be present in MCI and showed that different cognitive skills like semantic knowledge and verbal episodic memory are necessary for inference-making.

Emotional Processing in Healthy Ageing, Mild Cognitive Impairment, and Alzheimer's Disease

Emotional processing, particularly facial expression recognition, is essential for social cognition, and dysfunction may be associated with poor cognitive health. In pathological ageing conditions, such as mild cognitive impairment (MCI) and Alzheimer’s disease (AD), in which cognitive impairments are present, disturbed emotional processing and difficulty with social interactions have been documented. However, it is unclear how pathological ageing affects emotional processing and human social behaviour. The aim of this study is to provide insight into how emotional processing is affected in MCI and AD and whether this capacity can constitute a differentiating factor allowing the preclinical diagnosis of both diseases. For this purpose, an ecological emotional battery adapted from five subsets of the Florida Affect Battery was used. Given that emotion may not be separated from cognition, the affect battery was divided into subtests according to cognitive demand, resulting in three blocks. Our results showed that individuals with MCI or AD had poorer performance on the emotional processing tasks, although with different patterns, than that of controls. Cognitive demand may be responsible for the execution patterns of different emotional processing tests. Tasks with moderate cognitive demand are the most sensitive for discriminating between two cognitive impairment entities. In summary, emotional processing tasks may aid in characterising the neurocognitive deficits in MCI or AD. Additionally, identifying these deficits may be useful for developing interventions that specifically target these emotional processing problems.

Using a Discourse Task to Explore Semantic Ability in Persons With Cognitive Impairment

This paper uses a discourse task to explore aspects of semantic production in persons with various degree of cognitive impairment and healthy controls. The purpose of the study was to test if an in-depth semantic analysis of a cognitive-linguistic challenging discourse task could differentiate persons with a cognitive decline from those with a stable cognitive impairment. Both quantitative measures of semantic ability, using tests of oral lexical retrieval, and qualitative analysis of a narrative were used to detect semantic difficulties. Besides group comparisons a classification experiment was performed to investigate if the discourse features could be used to improve classification of the participants who had a stable cognitive impairment from those who had cognitively declined. In sum, both types of assessment methods captured difficulties between the groups, but tests of oral lexical retrieval most successfully differentiated between the cognitively stable and the cognitively declined group. Discourse features improved classification accuracy and the best combination of features discriminated between participants with a stable cognitive impairment and those who had cognitively declined with an area under the curve (AUC) of 0.93.

Effects of language stimulation on cognition of institutionalized aged people: a preliminary case series study

Cognitive stimulation programs for institutionalized elderly people show positive results, however few studies have investigated the effectiveness of language stimulation programs for the health of this population.

OBJECTIVES

To characterize the cognitive-linguistic profile of institutionalized elderly and to compare their performance before and after a language stimulation program (LSP).

METHODS

An exploratory case series study was conducted with nine residents of a Home for the Aged. Elderly people aged 60 or over, of both sexes, without neurological or neuropsychiatric diseases, communication disorders, intellectual impairment or severe visual or hearing impairment were included. The participants were submitted to an initial assessment through the Montreal Cognitive Assessment (MoCA) and Montreal Toulouse Battery Language Assessment - Brazil to characterize the cognitive-linguistic profile of the studied group. Five elderly were selected to participate in the LSP, of wich only two participated effectively in the program, but all were reassessed after the program was completed.

RESULTS

on the initial assessment, of the nine participants, only one had adequate cognitive performance and all presented changes in macro and/or microlinguistics aspects of oral discourse, with oral comprehension preserved. On the reassessment carried out with five participants, only two participants who adhered effectively to the program obtained improvements in MoCa scores. In regarding language, three participants performed better in the oral emission measures. The performance of the participants in oral comprehension remained or declined.

CONCLUSION

The speech-language therapy intervention through a LSP contributes to improving the cognitive-linguistic performance of institutionalized elderly.

Development and validation of language and visuospatial composite scores in ADNI

INTRODUCTION

Composite scores may be useful to summarize overall language or visuospatial functioning in studies of older adults.

METHODS

We used item response theory to derive composite measures for language (ADNI-Lan) and visuospatial functioning (ADNI-VS) from the cognitive battery administered in the Alzheimer's Disease Neuroimaging Initiative (ADNI). We evaluated the scores among groups of people with normal cognition, mild cognitive impairment (MCI), and Alzheimer's disease (AD) in terms of responsiveness to change, association with imaging findings, and ability to differentiate between MCI participants who progressed to AD dementia and those who did not progress.

RESULTS

ADNI-Lan and ADNI-VS were able to detect change over time and predict conversion from MCI to AD. They were associated with most of the pre-specified magnetic resonance imaging measures. ADNI-Lan had strong associations with a cerebrospinal fluid biomarker pattern.

DISCUSSION

ADNI-Lan and ADNI-VS may be useful composites for language and visuospatial functioning in ADNI.

Diagnostic accuracy of early cognitive indicators in mild cognitive impairment

The aging of the population leads to an increase in the prevalence of dementia and mild cognitive impairment (MCI). Alzheimer's disease (AD) is the most common cause of dementia. Recent studies highlight the early non-amnestic deficits in AD and MCI. The European Union report shows the importance of thoroughly assessing cognitive aspects that have been poorly evaluated, such as processing speed (PS), which could represent early indicators of cognitive decline.

Objective

To analyze the diagnostic accuracy of PS measures in older adults with MCI, AD, and those who are cognitively-healthy.

Methods

A cross-sectional study was conducted by performing an extensive neuropsychological assessment in three samples: 26 control participants, 22 individuals with MCI, and 21 individuals with AD. Analysis of variance (ANOVA) was employed to test the relationship between dependent variables and the clinical group. Post hoc tests (Bonferroni test) were used when a significant ANOVA result was found. Finally, the Receiver Operating Characteristic (ROC) curve for PS measures was performed in older adults with MCI and AD compared with cognitively-healthy older adults.

Results

The results showed that deficits in PS measures can be early indicators of cognitive decline in cases of MCI, even when executive functions (EFs) and functionality are preserved. Conversely, AD versus MCI presented differences in PS, EFs, and functionality.

Conclusions

The ROC analyses showed that PS measures had discriminative capacities to differentiate individuals with MCI, AD, and cognitively-healthy older adults.

Aluminum-Induced Cognitive Impairment and PI3K/Akt/mTOR Signaling Pathway Involvement in Occupational Aluminum Workers

Epidemiological studies indicate that long-term occupational exposure to aluminum (Al) causes neurotoxicity and cognitive impairment. While the molecular underpinnings associated with workers' cognitive impairment is unclear, one mechanism may involve Al-induced PI3K/Akt/mTOR activation and neuronal cell death, which impairs learning and memory in rats. Here, we sought to determine whether PI3K/Akt/mTOR is also associated with cognitive impairment in Al-exposed occupational workers. Cognitive function was screened by Mini-Mental State Examination (MMSE) and Clock-Drawing Test (CDT), and serum Al and PI3K/Akt/mTOR-associated gene expression was quantified. A negative correlation between serum Al and scores of MMSE and CDT was found, which might relate with downregulation of PI3K/Akt/mTOR. To determine the role of the PI3K/Akt/mTOR pathway cognitive function, we treated zebrafish with Al and observed a profound impairment in learning and memory. Increased brain Al levels was associated with decreased expression of PI3K/Akt/mTOR in Al-exposed zebrafish. Finally, rapamycin, an mTOR inhibitor, was added to isolate the role of mTOR specifically in the Al exposed zebrafish. The results suggested that Al induces learning and memory deficits by downregulating PI3K, Akt, and mTOR1 expression and inducing neuronal cell death like rapamycin group. This study indicates that aluminum exposure can cause cognitive impairment through PI3K/Akt/mTOR pathway, with mTOR activity being a critical player involved in this mechanism. Future studies are necessary to further characterize the role of PI3K/Akt/mTOR1 signaling in Al-induced neurocognitive decline among Al occupational workers. These findings draw attention to Al risk exposure among occupational workers and the need to implement novel safety and protective measures to mitigate neurocognitive health risks in the Al industrial workspace.

Comorbid Conditions Differentiate Rehabilitation Profiles in Traumatic Versus Nontraumatic Brain Injury: A Retrospective Analysis Using a Medical Database

PURPOSE

We examined the relationship between comorbid medical conditions and changes in cognition over the course of rehabilitation following acquired brain injury. In particular, we compared outcomes between traumatic brain injury (TBI) and non-TBI using a retrospective inpatient rehabilitation dataset. We hypothesized that differences by diagnosis would be minimized among subgroups of patients with common comorbid medical conditions.

MATERIALS AND METHODS

We used the Functional Independence Measure (FIM)-cognition subscale to index changes in cognition over rehabilitation. A decision tree classifier determined the top 10 comorbid conditions that maximally differentiated TBI and non-TBI. Ten subsets of patients were identified by matching on these conditions, in rank order. Data from these subsets were submitted to repeated-measures logistic regression to establish the minimum degree of commonality in comorbid conditions that would produce similar cognitive rehabilitation, regardless of etiology.

RESULTS

The TBI group demonstrated a greater increase in ordinal scores over time relative to non-TBI, across all subscales of the FIM-cognition. When both groups were matched on the top 3 symptoms, there were no significant group differences in rehabilitation trajectory in problem-solving and memory domains (Cohen's d range: 0.2-0.4).

CONCLUSION

Comorbid medical conditions explain differences in cognitive rehabilitation trajectories following acquired brain injury beyond etiology.

Visuospatial performance in patients with statistically-defined mild cognitive impairment

Introduction: The Oblique Effect denotes superior performance for perceiving horizontal or vertical rather than diagonal or oblique stimuli. The current research investigated responding to oblique test stimuli in patients with mild cognitive impairment (MCI).Method: Four statistically-determined groups (n = 112) were studied; patients with little to no cognitive impairment (non-MCI, n = 39); subtle cognitive impairment (SCI, n = 15); amnestic MCI (aMCI, n = 28); and a combined mixed/dysexecutive MCI (mixed/dys MCI, n = 30). The ability to respond to oblique versus non-oblique test stimuli was assessed using the Judgment of Line Orientation Test (JOLO). Comprehensive neuropsychological assessment was also obtained. Between-group differences for JOLO oblique and non-oblique test stimuli were analyzed. Hierarchical linear regression models were constructed to identify relations between accuracy for oblique and non-oblique test items and neurocognitive domains.Results: The mixed/dys MCI group demonstrated lower accuracy for oblique test items compared to non-MCI patients. Accurate responding to oblique test items was associated with better performance on tests measuring executive control, processing speed, naming/lexical retrieval, and verbal concept formation. No between-group differences were seen for non-oblique items and these items were not associated with cognition.Conclusions:Significant impairment on oblique test items distinguished patients with multi-domain/dysexecutive MCI from non-MCI patients. Accurate responding to oblique test items was associated with a complex array of neuropsychological tests suggesting that multidimensional neuropsychological skills underlie the visuospatial reasoning abilities necessary for successful oblique line identification. Research associating responding to oblique versus non-oblique test stimuli using additional neuropsychological test paradigms, and MRI-defined neuroanatomical regions of interest may provide additional information about the brain-behavior relations that underlie MCI subtypes.