Detection Test for Language Impairments in Adults and the Aged-A New Screening Test for Language Impairment Associated With Neurodegenerative Diseases: Validation and Normative Data

Are subjective language complaints in memory clinic patients informative?

To diagnose mild cognitive impairment, it is crucial to understand whether subjective cognitive complaints reflect objective cognitive deficits. This question has mostly been investigated in the memory domain, with mixed results. Our study was one of the first to address it for language. Participants were 55-to-93-year-old memory clinic patients (n = 163). They filled in a questionnaire about subjective language and memory complaints and performed two language tasks (naming-by-definition and sentence comprehension). Greater language complaints were associated with two language measures, thus showing a moderate value in predicting language performance. Greater relative severity of language versus memory complaints was a better predictor, associated with three language performance measures. Surprisingly, greater memory complaints were associated with better naming, probably due to anosognosia in further disease progression or personality-related factors. Our findings highlight the importance of relative complaint severity across domains and, clinically, call for developing self-assessment questionnaires asking specific questions about multiple cognitive functions.

The impact of phonological short-term memory impairment on verbal repetition in the logopenic variant of primary progressive aphasia

The logopenic variant of primary progressive aphasia (lvPPA) is characterized mainly by anomia, production of phonological errors, and impairment in repetition of sentences. The functional origin of these language impairments is mainly attributed to the breakdown of phonological short-term memory. The present study examined the effects of phonological short-term memory impairment on language processing in lvPPA. In two studies, 11 participants with lvPPA and 11 healthy control participants were presented with repetition tasks in which the type and length of stimuli and the mode of administration were manipulated. Study 1 aimed to examine the influence of length and lexicality (words vs. pseudowords) on immediate and delayed repetition, whereas Study 2 aimed to examine the influence of length, syntactic complexity (nominalized vs. pronominalized sentences), and serial position on immediate sentence repetition. Study 1 showed that participants' performance with lvPPA was impaired only on immediate repetition of five-syllable pseudowords and on delayed repetition of words and pseudowords. Study 2 showed that participants' performance with lvPPA was impaired in the repetition of nominalized sentences where a recency effect was observed. Repetition of pronominalized sentences was also impaired in the lvPPA group. This study provides additional support for arguments regarding phonological short-term memory as a cause of language impairment in lvPPA. Clinically, the results of the study suggest that instruments for assessing repetition ability in lvPPA should include not only lists of short or long nominalized sentences, but also delayed repetition of words and pseudowords and pronominalized sentences.

The Quebec Semantic Memory Battery: Development, Standardization, and Psychometric Assessment of a Semantic Memory Battery in French

OBJECTIVE

People with aphasia often experience semantic memory (SM) impairment. To improve diagnostic outcomes, SM tasks should recruit various sensory input channels (oral, written, and pictographic), permitting accessible, complete evaluation. There is a need for SM batteries for French-speaking Quebecers that use multiple input channels. The present study, therefore, describes the development of a novel French-language semantic battery: la Batterie québécoise de la mémoire sémantique (BQMS), the assessment of the BQMS's psychometric properties, and the establishment of normative data for the BQMS.

METHOD

We first developed eight SM tasks. Following a pilot validation study, we determined the BQMS's reliability and validity, to ensure consistent, accurate detection of SM impairment. Among French-speaking Quebecers with cerebrovascular aphasia (n = 10), people with the semantic variant of Primary Progressive Aphasia (n = 4), and healthy controls (n = 14), we examined its convergent validity, concurrent validity, test-retest reliability, and internal consistency. Finally, we established normative data for the BQMS by calculating cut-off scores per task that indicate SM impairment (in 93 cognitively healthy French-speaking Quebecers), stratified by sociodemographic variables associated with performance.

RESULTS

The BQMS shows high concurrent, discriminant, and convergent validity, as well as good test-retest reliability and internal consistency. The cut-off score indicating SM impairment ranged from the 2nd to 25th percentiles (stratified by task, age, and sex).

CONCLUSIONS

The BQMS's psychometric properties indicate that it could be a valuable clinical tool for detecting SM impairment. Our normative data will help clinicians detect such impairments.

Turkish adaptation, reliability, and validity of the detection test for language impairments in adults and the aged

There is no quick, valid, and reliable screening tool in Turkish that can be used for screening language disorders associated with major neurocognitive disorders (MND). To fill this gap, we designed three distinct studies. In the first study, we adapted the Detection Test for Language Impairments in Adults and the Aged into the Turkish language (DTLA-Tr). In the second study, we collected data from 175 Turkish individuals to determine the normative data of the DTLA-Tr. In the last study, we investigated the psychometric properties of the DLTA-Tr by comparing 17 healthy individuals with 17 patients with Alzheimer's disease and determining its test-retest reliability. As a result of Study 1, the DTLA was adapted to the Turkish adult population. In Study 2, the normative data of the DTLA-Tr were provided. The results of this study indicated a positive correlation between educational level and DTLA-Tr total score. The results of Study 3 showed that the DTLA-Tr has high predictive validity and good test-retest reliability. The DTLA-Tr is a valid and reliable tool for assessing language abilities in both adults and the elderly. The findings of this study have significant implications for the evaluation of language in Turkish-speaking patients with MND.

Exploring Cognitive-Pragmatic Heterogeneity Following Acquired Brain Injury: A Cluster Analysis of Hint Comprehension

PURPOSE

Difficulties understanding nonliteral language (especially hints) are frequently reported following acquired brain injury (ABI). Several cognitive mechanisms, such as context processing, executive functions, and theory of mind (ToM), may underlie these disorders. However, their role remains controversial, mainly because of the characteristic heterogeneity of this population. Therefore, our study aimed to identify cognitive-pragmatic profiles in individuals with ABI.

METHOD

A new task of hint comprehension, manipulating executive demand, markers of hints, and ToM and neuropsychological tests were administered to 33 participants with frontal ABI and 33 control participants. Cluster analysis, a method sensitive to profile heterogeneity, was applied and coupled with error analysis.

RESULTS

We highlighted two cognitive-pragmatic profiles. One subgroup of participants with ABI exhibited contextual insensitivity, leading them to infer the utterance meaning based on linguistic decoding alone-literal meaning. This difficulty in understanding hints was associated with deficits in working memory, inhibition, and ToM. The second subgroup of participants with ABI showed difficulty with literal statements, associated with impaired inhibition and ToM. In addition, the two subgroups differed only on the ToM task. This result suggests that various types of ToM deficit (misunderstanding vs. incorrect attribution of mental states) could contribute to the variability of the pragmatic profiles observed (difficulties in interpreting hints vs. literal statements).

CONCLUSION

The experimental design adopted in this study provides valuable insight into the explanatory hypotheses of nonliteral language comprehension disorders and has important clinical implications.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.24069516.

Brief instrument for direct complex functionality assessment: a new ecological tool

Background

The Direct Assessment of Functional Status (DAFS) is the only instrument validated in Brazil that assesses functionality directly with the patient. However, this clinical tool takes a long time to be administered. This limits its use in hospitals and outpatient clinics that require brief assessment instruments. Additionally, we need to count with a direct assessment because the number of older adults living alone is increasing and we thus lack reliable informants.

Objective

This study aimed to present the development and content validity evidence of a direct complex functionality test for older adults, the Brief Instrument for Direct Functionality Assessment (BIDFA).

Method

A total sample of 30 older adults and eight expert judges took part in the study stages. The BIDFA construction stages were: (1) literature review of functionality instruments; (2) development of seven ecological tasks to evaluate the performance of daily complex activities with the older adults; (3) content analysis by eight expert judges; (4) pilot study with 30 older adults; (5) the ecological analysis of items; (6) focus group analysis; and (7) final version of the BIDFA.

Results

The BIDFA had evidence of content validity with an agreement index of 96.5%. The final version of BIDFA was left with six domains of complex functionality divided into semantic memory and time orientation; shopping skills; executive attention, math and finance skills; organization; planning and procedural memory; and problem-solving. The complex functionality score by BIDFA ranges from 0 to 100 points.

Conclusion

The BIDFA was found to have good content validity by the expert judges and by the ecological analysis of the items by the older adults. The new instrument is expected to help assess the functional status of older adults, in an abbreviated context including complex functionality demands, with a wider range of total and subdomain scores.

Assessing Lexical and Syntactic Comprehension in Deaf Signing Adults

Among the existing sign language assessment tools, only a small number can be used in clinical settings. This contribution aims at presenting three comprehension assessment tests (two lexical and one syntactic) that offer a solid basis to build tools to assess language impairments in deaf signing adults. We provide the material and guidelines, based on psychometric analyses of the items, to make these tests suitable for clinical assessment. They are available for French Sign Language and Italian Sign Language. So far, the three tests were administered to three groups of deaf participants based on age of exposure (AoE) to sign language: native (AoE from birth), early (AoE = from 1 to 5 years), and late (AoE = from 6 to 15 years) signers. The results showed that the three tests are easy for the typical deaf signing population, and therefore, they can be adapted into tests that assess a deaf signing population with language impairments. Moreover, the results of the syntactic test reveal a categorial difference between native and non-native signers and therefore show the need for baselines that mirror the effect of AoE to sign language when assessing language competence, in particular in clinical assessment.

Decision-Making in Alzheimer's Disease: The Role of Working Memory and Executive Functions in the Iowa Gambling Task and in Tasks Inspired by Everyday Situations

BACKGROUND

Alzheimer's disease (AD) negatively impacts patients' ability to make advantageous decisions, i.e., a core ability contributing to the preservation of autonomy.

OBJECTIVE

The present study aims to analyze the changes that occur in the decision-making competence (DMC) in AD patients and to determine if these changes are related to the deterioration of executive functions and working memory.

METHOD

To this end, 20 patients with AD and 20 elderly control adults were assessed using executive, working memory, and DMC tasks. The latter comprised the Iowa Gambling Task (IGT) and a scenarios task based on situations inspired by everyday life and performed under conditions of risk and ambiguity.

RESULTS

Results revealed lower performances in AD patients than in elderly control adults for all the tasks assessing cognitive functions. The AD patients also made more strategy changes during the IGT. In the scenarios tasks, the two groups took as many ambiguous or risky decisions, but AD patients tended to take more risks in the context of gain than elderly control adults did. Switching and updating ability, as well as working memory, appeared to be involved in decisions in tasks inspired by everyday life, while inhibition was more related to the IGT performances.

CONCLUSION

Working memory and executive functions seem to be involved in decision-making, but in different ways in gambling and daily-life situations.

The Use of Executive Fluency Tasks to Detect Cognitive Impairment in Individuals with Subjective Cognitive Decline

OBJECTIVE

Although evidence has indicated that subjective cognitive decline (SCD) may be an early sign of Alzheimer's disease (AD), the objectification of cognitive impairment in SCD is challenging, mainly due to the lack of sensitivity in assessment tools. The present study investigated the potential contribution of two verbal fluency tasks with high executive processing loads to the identification of cognitive impairment in SCD.

METHODS

A total of 60 adults with SCD and 60 healthy controls (HCs) performed one free action (verb) fluency task and two fluency tasks with more executive processing load-an alternating fluency task and an orthographic constraint fluency task-and the results were compared.

RESULT

In the free action fluency task, the performance of the participants with SCD and the HCs was similar. However, HCs performed significantly better than SCD in the alternating fluency task, which required mental flexibility, and the orthographic constraint fluency task, which required inhibition.

DISCUSSION

The study findings suggest that verbal fluency tasks with high executive processing load could be useful in detecting cognitive deficits at the preclinical stage of AD. The inclusion of such tests in assessment batteries should be considered in order to improve the detection of subtle cognitive impairment in preclinical major neurocognitive disorder populations.

[Revue systématique des tests cognitifs validés et/ou ayant des normes de référence pour la population canadienne francophone âgée]

Il est essentiel d'utiliser des tests cognitifs ayant été validés et détenant des normes de référence auprès de la population cible, puisque les réalités culturelles et linguistiques différentes entre l'échantillon de validation ou auprès duquel les normes ont été créées et la population cible peuvent affecter les résultats. Cette revue systématique vise à recenser et décrire les tests cognitifs (incluant tests, questionnaires et grilles d'observation) validés et/ou présentant des normes sur la population âgée canadienne francophone. Au total, 46 articles ont été sélectionnés. Cette revue recense 9 tests validés, 20 tests avec normes de référence et 18 tests validés et avec normes, couvrant la majorité des domaines cognitifs (fonctions mnésiques, attentionnelles, exécutives, perceptivo-motrices et langagières), excepté la cognition sociale. La quasi-totalité des échantillons ont été recrutés au Québec. Les tests relevés présentent majoritairement des indices psychométriques satisfaisants et généralement des normes considérant l'âge, le sexe et l'éducation. Cette revue systématique permettra aux cliniciens et chercheurs canadiens en vieillissement d'orienter optimalement leurs choix de tests cognitifs.

Logogenic Primary Progressive Aphasia or Alzheimer Disease: Contribution of Acoustic Markers in Early Differential Diagnosis

The logopenic variant of Primary Progressive Aphasia (lvPPA), a syndromic disorder centered on language impairment, often presents variable underlying neurodegenerative pathologies such as Alzheimer Disease (AD). Actual language assessment tests and lumbar puncture, focused on AD diagnosis, cannot precisely distinguish the symptoms, or predict their progression at onset time. We analyzed acoustic markers, aiming to discriminate lvPPA and AD as well as the influence of AD biomarkers on acoustic profiles at the beginning of the disease. We recruited people with AD (n = 8) and with lvPPA (n = 8), with cerebrospinal fluid biomarker profiles determined by lumbar puncture. The participants performed a sentence repetition task that allows assessing potential lvPPA phonological loop deficits. We found that temporal and prosodic markers significantly differentiate the lvPPA and AD group at an early stage of the disease. Biomarker and acoustic profile comparisons discriminated the two lvPPA subgroups according to their biomarkers. For lvPPA with AD biomarkers, acoustic profile equivalent to an atypical AD form with a specific alteration of the phonological loop is shown. However, lvPPA without AD biomarkers has an acoustic profile approximating the one for DLFT. Therefore, these results allow us to classify lvPPA differentially from AD based on acoustic markers from a sentence repetition task. Furthermore, our results suggest that acoustic analysis would constitute a clinically efficient alternative to refused lumbar punctures. It offers the possibility to facilitate early, specific, and accessible neurodegenerative diagnosis and may ease early care with speech therapy, preventing the progression of symptoms.

The course of primary progressive aphasia diagnosis: a cross-sectional study

Background

The primary progressive aphasia (PPA) diagnosis trajectory is debated, as several changes in diagnosis occur during PPA course, due to phenotype evolution from isolated language alterations to global cognitive impairment.

The goal of the present study, based on a French cohort, was to describe the demographics and the evolution of subjects with (PPA) in comparison with Alzheimer’s disease (AD) on a period of 7 years.

Methods

We conducted a repeated cross-sectional study. The study population comprised individuals with PPA and AD diagnosis (N=167,191) from 2010 to 2016 in the French National data Bank (BNA). Demographic variables, MMSE scores, diagnosis status at each visit and prescribed treatments were considered.

Results

From 2010 to 2016, 5186 patients were initially diagnosed with PPA, 162,005 with AD. Compared to AD subjects, significant differences were found concerning age (younger at first diagnosis for PPA), gender (more balanced in PPA), education level (higher in PPA) and MMSE score (higher of 1 point in PPA).

Percentage of pending diagnosis, delay between first consultation and first diagnosis and the number of different diagnoses before the diagnosis of interest were significantly higher in PPA group compared to AD group. Pharmacological and non-pharmacological treatments were significatively more recommended following PPA than AD diagnosis.

Conclusion

This study improves the knowledge of PPA epidemiology and has the potential to help adopting appropriate public health service policies. It supports the hypothesis that PPA is diagnosed later than AD. The PPA diagnosis increases the prescription of non-pharmacological treatments, especially speech and language therapy (SLT) that is the main treatment available and most effective when at the initial stage.

Trial registration

ClinicalTrials.gov identifier NCT03687112

Supplementary Information

The online version contains supplementary material available at 10.1186/s13195-022-01007-6.

Presupposition processing declines with age

The present study investigates the processing of presuppositions across the life span and extends the findings of the only available study on presupposition processing and typical aging by Domaneschi and Di Paola (J Pragmat 140:70-87, 2019). In an online and offline task, we investigate the impact of cognitive load during the processing and recovery of two presupposition triggers-definite descriptions and change-of-state verbs-comparing a group of younger adults with a group of older adults. The collected experimental data show that (1) presupposition recovery declines during normal aging, (2) presupposition recovery of change-of-state verbs is more cognitively demanding for older adults than the recovery of definite descriptions, and lastly (3) presupposition recovery for the change-of-state verb begin is more demanding than the change-of-state verb stop. As of today, few works have directly investigated presupposition processing across the life span. To the best of our knowledge, this is the first work revealing that cognitive load directly impacts the recovery of presuppositions across the life span, which in turn suggests an involvement of verbal working memory.

Heterogeneity of repetition abilities in logopenic variant primary progressive aphasia

The differential diagnosis of primary progressive aphasia (PPA) is challenging due to overlapping clinical manifestations of the different variants of the disease. This is particularly true for the logopenic variant of PPA (lvPPA), in which such overlap was reported with regard to impairments in repetition abilities. In this study, four individuals with lvPPA underwent standard neuropsychological and language assessments. The influence of psycholinguistic variables on their performance of in word, nonword and sentence repetition tasks was also specifically explored. Some level of heterogeneity was found in cognitive functions and in language. The four participants showed impairment in sentence repetition in which their performance was negatively affected by semantic reversibility and syntactic complexity. This study supports the heterogeneity of lvPPA with respect to the cognitive and linguistic status of participants. It also shows that sentence repetition is influenced not only by length, but also by semantic reversibility and syntactic complexity, two psycholinguistic variables known to place additional demands on phonological working memory.

Primary Progressive Aphasia: Use of Graphical Markers for an Early and Differential Diagnosis

Primary progressive aphasia (PPA) brings together neurodegenerative pathologies whose main characteristic is to start with a progressive language disorder. PPA diagnosis is often delayed in non-specialised clinical settings. With the technologies' development, new writing parameters can be extracted, such as the writing pressure on a touch pad. Despite some studies having highlighted differences between patients with typical Alzheimer's disease (AD) and healthy controls, writing parameters in PPAs are understudied. The objective was to verify if the writing pressure in different linguistic and non-linguistic tasks can differentiate patients with PPA from patients with AD and healthy subjects. Patients with PPA (n = 32), patients with AD (n = 22) and healthy controls (n = 26) were included in this study. They performed a set of handwriting tasks on an iPad® digital tablet, including linguistic, cognitive non-linguistic, and non-cognitive non-linguistic tasks. Average and maximum writing pressures were extracted for each task. We found significant differences in writing pressure, between healthy controls and patients with PPA, and between patients with PPA and AD. However, the classification of performances was dependent on the nature of the tasks. These results suggest that measuring writing pressure in graphical tasks may improve the early diagnosis of PPA, and the differential diagnosis between PPA and AD.

Language impairment in the moderate stage of dementia due to Alzheimer's disease

BACKGROUND

During the moderate stage of dementia due to Alzheimer's disease (AD), language disorder is more evident and it impacts on communication. An overview of language impairment could be helpful to find compensatory communication strategies for these patients.

OBJECTIVE

To identify all language impairments among patients with moderate-stage of AD.

METHODS

20 patients diagnosed with probable AD based on the criteria of the NINCDS-ARDRA, with a MMSE score of 13-23 points and CDR=2, who were undergoing treatment for AD with therapeutic doses of acetyl cholinesterase inhibitors, were assessed using the Boston Diagnostic Aphasia Examination (BDAE), a test that provides a broad assessment of language. The results were compared with the performance of a normal population.

RESULTS

The patients assessed in this study presented normal scores for oral and written word recognition, repetition, mechanics of writing, primer-level dictation and spelling to dictation but also had impairment at most levels of linguistic processing, in oral and written comprehension and production. In general, as expected, the tasks relying on access to the mental lexicon were most significantly affected. However, they performed well in the naming task, in which semantic cues were presented. Moreover, the patients assessed in this study had better performance in written comprehension tasks than in oral ones.

CONCLUSION

The severity of the language impairments was not homogenous, with some linguistic abilities more impaired than others. The abilities that were found to be preserved can help to guide strategies for aiding in communication at this stage of AD.

A New Test of Irony and Indirect Requests Comprehension-The IRRI Test: Validation and Normative Data in French-Speaking Adults

OBJECTIVE

Nonliteral language comprehension disorders in individuals with acquired brain injuries (ABI) are frequently reported in the literature but rarely assessed in clinical settings. A major reason is the lack of tools available to clinicians. Therefore, the present study aimed to further promote the pragmatic assessment routine by creating a new nonliteral language comprehension tool for ABI individuals: the IRRI test. This tool is intended to be standardized and capable of directing clinicians to cognitive deficits underlying a poor understanding of nonliteral language-context processing, executive functions, and theory of mind.

METHOD

Three studies were conducted. The first study aimed at constructing the two IRRI test tasks: the irony and indirect requests comprehension tasks. These tasks integrate the cognitive processes within them. The second study aimed at analyzing the tasks' psychometric qualities in a sample of 33 ABI participants and 33 healthy participants (HC). Preliminary normative data obtained from 102 healthy French-speaking subjects were collected in the third study.

RESULTS

Significant differences in the IRRI test's performances were observed between the ABI and HC individuals. The indirect requests task demonstrated robust convergent validity and good sensibility to discriminate altered participants among ABI participants. Both IRRI test's tasks also showed excellent test-retest and inter-rater reliability. The preliminary norms were stratified according to the conditions of interest in relation to the cognitive mechanisms underlying the understanding of nonliteral language.

CONCLUSIONS

The IRRI test is a promising new standardized test of nonliteral language comprehension, which contributes to identifying cognitive-pragmatic profiles to guide therapy.

TDQ-30-A New Color Picture-Naming Test for the Diagnostic of Mild Anomia: Validation and Normative Data in Quebec French Adults and Elderly

OBJECTIVE

A reduction in lexical access is observed in normal aging and a few studies also showed that this ability is affected in individuals with subjective cognitive decline. Lexical access is also affected very early in mild cognitive impairment as well as in major neurocognitive disorders. The detection of word-finding difficulties in the earliest stages of pathological aging is particularly difficult because symptoms are often subtle or mild. Therefore, mild anomia is underdiagnosed, mainly due to the lack of sensitivity of naming tests. In this article, we present the TDQ-30, a new picture-naming test designed to detect mild word-finding deficits in adults and elderly people.

METHOD

The article comprises three studies aiming at the development of the test (Study 1), the establishment of its validity and reliability (Study 2), and finally, the production of normative data for French-speaking adults and elderly people from Quebec (Study 3).

RESULTS

The results showed that the TDQ-30 has good convergent validity. Also, the TDQ-30 distinguished the performance of healthy controls from those of participants with mild cognitive impairment, Alzheimer's disease, and post-stroke aphasia. This suggests good discriminant validity. Finally, this study provides normative data computed from a study sample composed of 227 participants aged 50 years and over.

CONCLUSIONS

The TDQ-30 has the potential to become a valuable picture-naming test for the diagnosis of mild anomia associated with pathological aging.

Development of a new tool for the early identification of communication-support needs in people living with dementia: An Australian face-validation study

Language and communication difficulties are common in dementia but limited tools are available for a timely assessment of those individuals who experience these difficulties. The Communication-Support Needs Assessment Tool in Dementia (CoSNAT-D) was developed to assist in (a) the early identification of communication difficulties among people with dementia in the community context; and (b) determining the level of their communication support needs to guide appropriate service access. The CoSNAT-D was developed based on a literature review. The face validity was tested with end-users (people with dementia and support persons of people with dementia) regarding relevance, wording, syntax, appropriateness and comprehensiveness of the items of the tool. Data were collected using semi-structured phone interviews. Seven people with dementia and 15 carers participated in the study. Feedback regarding items' appropriateness was largely positive and minor changes were made to improve comprehensiveness. A new item was added to the original item pool. The interviews highlighted the importance of including people with dementia in the assessment processes and person-centered approaches in this context. The CoSNAT-D presents a first step for the early identification of individual support needs of people living with dementia and communication difficulties who live in the community. Items of the CoSNAT-D have been determined face-valid by end-users. The face-validated version of the tool is currently undergoing further testing to determine additional relevant psychometric properties.

The Dépistage Cognitif de Québec: A New Clinician's Tool for Early Recognition of Atypical Dementia

INTRODUCTION

Early recognition of atypical dementia remains challenging partly because of lack of cognitive screening instruments precisely tailored for this purpose.

METHODS

We assessed the validity and reliability of the Dépistage Cognitif de Québec (DCQ; www.dcqtest.org), a newly developed cognitive screening test, to detect atypical dementia using a multicenter cohort of 628 participants. Sensitivity and specificity were compared to the Montreal Cognitive Assessment (MoCA). A predictive diagnostic algorithm for atypical dementia was determined using classification tree analysis.

RESULTS

The DCQ showed excellent psychometric properties. It was significantly more accurate than the MoCA to detect atypical dementia. All correlations between DCQ indexes and standard neuropsychological measures were significant. A statistical model distinguished typical from atypical dementia with a predictive power of 79%.

DISCUSSION

The DCQ is a better tool to detect atypical dementia than standard cognitive screening tests. Expanding the clinician's tool kit with the DCQ could reduce missed/delayed identification of atypical dementia and accelerate therapeutic intervention.

The Assessment of Language and Communication in Dementia: A Synthesis of Evidence

OBJECTIVE

Without the current option of a dementia cure, there is an existing need to focus on rehabilitation intervention. This includes interventions that address language and communication impairment (LCI), found to be present early in most types of dementia. Assessment of LCI can occur in many contexts (e.g., speech pathology, neuropsychology, occupational therapy) and is a vital initial step in providing adequate support to people living with dementia and their families. However, no previous research has compared the psychometric properties and utility of currently available and suitable tools for this purpose.

METHODS

Eighteen tools with the potential to assess language and communication in dementia were identified through a two-stage process, and a synthesis of evidence is provided.

RESULTS

Three tools satisfied all selection criteria: the Arizona Battery for Communication Disorders of Dementia, the Sydney Language Battery, and the Addenbrooke's Cognitive Examination III. Main limitations of the 18 tools reviewed concern a lack of standardization, normative data, and criterion validity, as well as poor evidence of reliability of tools originally developed for non-neurodegenerative LCI (e.g., aphasia in the context of cerebrovascular accidents). Furthermore, no tool considers the perspectives of people with dementia regarding the impact of LCI on their daily lives.

CONCLUSION

Further research is needed to improve reliability and validity of currently available tools for the linguistic assessment of people living with dementia. Importantly, a tool to assess early identification of language and communication difficulties and associated needs among people with dementia is warranted to facilitate timely management and support.