Doença de alzheimer: cognição e discurso narrativo com apoio em figuras

The Generalizability of Longitudinal Changes in Speech Before Alzheimer's Disease Diagnosis

BACKGROUND

Language impairment in Alzheimer's disease (AD) has been widely studied but due to limited data availability, relatively few studies have focused on the longitudinal change in language in the individuals who later develop AD. Significant differences in speech have previously been found by comparing the press conference transcripts of President Bush and President Reagan, who was later diagnosed with AD.

OBJECTIVE

In the current study, we explored whether the patterns previously established in the single AD-healthy control (HC) participant pair apply to a larger group of individuals who later receive AD diagnosis.

METHODS

We replicated previous methods on two larger corpora of longitudinal spontaneous speech samples of public figures, consisting of 10 and 9 AD-HC participant pairs. As we failed to find generalizable patterns of language change using previous methodology, we proposed alternative methods for data analysis, investigating the benefits of using different language features and their change with age, and compiling the single features into aggregate scores.

RESULTS

The single features that showed the strongest results were moving average type:token ratio (MATTR) and pronoun-related features. The aggregate scores performed better than the single features, with lexical diversity capturing a similar change in two-thirds of the participants.

CONCLUSION

Capturing universal patterns of language change prior to AD can be challenging, but the decline in lexical diversity and changes in MATTR and pronoun-related features act as promising measures that reflect the cognitive changes in many participants.

The Discourse Profile in Corticobasal Syndrome: A Comprehensive Clinical and Biomarker Approach

The aim of this study was to characterize the oral discourse of CBS patients and to verify whether measures obtained during a semi-spontaneous speech production could differentiate CBS patients from controls. A second goal was to compare the performance of patients with CBS probably due to Alzheimer's disease (CBS-AD) pathology and CBS not related to AD (CBS-non-AD) in the same measures, based on the brain metabolic status (FDG-PET) and in the presence of amyloid deposition (amyloid-PET). Results showed that CBS patients were significantly different from controls in speech rate, lexical level, informativeness, and syntactic complexity. Discursive measures did not differentiate CBS-AD from CBS-non-AD. However, CBS-AD displayed more lexical-semantic impairments than controls, a profile that is frequently reported in patients with clinical AD and the logopenic variant of primary progressive aphasia (lvPPA). CBS-non-AD presented mainly with impairments related to motor speech disorders and syntactic complexity, as seen in the non-fluent variant of PPA.

Lower Education and Reading and Writing Habits Are Associated With Poorer Oral Discourse Production in Typical Adults and Older Adults

During normal aging there is a decline in cognitive functions that includes deficits in oral discourse production. A higher level of education and more frequent reading and writing habits (RWH) might delay the onset of the cognitive decline during aging. This study aimed at investigating the effect of education and RWH on oral discourse production in older adults. Picture-based narratives were collected from 117 healthy adults, aged between 51 and 82 years (68.6 ± 6.38) with 0-20 years of formal education (10.1 ± 5.69). Measures of macro, microlinguistic and modalizations were computed and entered as dependent variables in hierarchical regression analyses that included age, education and RWH as regressors. Results revealed that higher education explained a better performance at the macrostructure and microstructure dimensions. Higher frequency of RWH explained the production of fewer modalizations. These results demonstrate the positive effect of education and RWH in oral discourse production in older adults. Therefore, higher attention should be given to these social factors.

Low Speech Connectedness in Alzheimer's Disease is Associated with Poorer Semantic Memory Performance

Connected speech is an everyday activity. We aimed to investigate whether connected speech can differentiate oral narrative production between adults with Alzheimer's disease (AD; n = 24) and cognitively healthy older adults (n = 48). We used graph attributes analysis to represent connected speech. Participants produced oral narratives and performed semantic, episodic, and working memory tasks. AD patients produced less connected narratives than cognitively healthy older adults. Connectedness was associated with semantic memory in AD and with episodic memory in controls. Word-graphs connectedness represents a practical tool to assess cognitive impairment in AD patients.

Cognitive Stimulation Therapy (CST) for older adults with mild-to-moderate dementia in Italy: effects on cognitive functioning and on emotional and neuropsychiatric symptoms

OBJECTIVES

Cognitive Stimulation Therapy (CST) is one of the most popular evidence-based interventions for people with dementia. The aim of the present study was to assess the effectiveness in the short and long term (on completing the treatment and 3 months later) of an Italian adaptation of the CST protocol (CST-IT).

METHOD

Older adults with mild-to-moderate dementia at 16 residential care homes were randomly assigned to a CST-IT group (N=123), or an active control group (N=102). The following domains were examined for potential benefits: general cognitive functioning (Mini-Mental State Examination [MMSE] and the Alzheimer's Disease Assessment Scale - Cognitive subscale [ADAS-Cog]), and language (Narrative Language Test); mood and behavior (Cornell scale and Neuropsychiatric Inventory); everyday life functioning (Disability Assessment for Dementia), and quality of life (Quality of Life - Alzheimer's Disease scale).

RESULTS

At both the short- and long-term assessments, the CST-IT group's MMSE scores remained stable, while the control group's scores decreased slightly from pre-test to post-test and follow-up. The CST-IT group also had short-term benefits in other cognitive measures (ADAS-Cog and Narrative Language Test), and mood and behavior measures, which were generally maintained at follow-up. No other differences were observed.

DISCUSSION

The effectiveness of CST in sustaining cognitive and emotional functioning, and counteracting the progression of behavioral/neuropsychiatric symptoms in people with dementia was confirmed, and a long-term benefit was demonstrated. CST is a promising option for the treatment of people with dementia in clinical practice.

Discourse macrolinguistic impairment as a marker of linguistic and extralinguistic functions decline in early Alzheimer's disease

BACKGROUND

Alzheimer's disease is characterized by macrolinguistic changes. This decline is often analyzed with quantitative scales.

AIMS

To analyze discourse production in early Alzheimer's disease (AD) and to identify qualitative markers of macrolinguistic decline.

METHODS & PROCEDURES

We analyzed macrolinguistic features of a clinical narrative task along with patients' cognitive changes. To do so, 17 early AD participants and 17 healthy controls were recruited and given a full neuropsychological and language assessment. Narrative discourses produced during the language assessment were transcribed and macrolinguistic features were qualitatively analyzed (i.e., local and global coherence marks and discourse informativeness). Inter-group comparison was complemented by intra-group correlation. As some inter-group comparisons revealed the existence of subgroups of patients, permutation tests were used to investigate how these subgroups differed vis-à-vis cognitive measures.

OUTCOMES & RESULTS

Overall, the results indicate that AD participants presented declines in informativeness and global coherence, correlated with declines in memory and executive functions. Permutation tests showed that participants with AD producing referential errors or misinterpretations had a deeper lexical-executive decline and a lower Mini-Mental State Evaluation (MMSE).

CONCLUSIONS & IMPLICATIONS

This study shows that two clinically relevant, qualitative signs differ in discourse production between typical ageing and early AD, namely information units and modalizing discourse. It also shows that macrolinguistic assessment is a useful tool for revealing impaired communication and cognition in early AD. Although lexical processing decline probably contributes to patients' macrolinguistic impairment, implications of extralinguistic functioning should be further investigated.

Linguagem em idosos com doença de Alzheimer: uma revisão sistemática

Resumo: Com o aumento da expectativa de vida, as demências vêm acometendo a população, sendo a doença de Alzheimer a mais comum. Essa se define por um desaparecimento gradativo de memória e de outras funções cognitivas, entre elas, a linguagem. A linguagem humana é importante para estabelecer as ligações interpessoais e promover a inclusão social do indivíduo. O presente artigo teve por objetivo realizar uma revisão sistemática a respeito de trabalhos científicos sobre a associação entre a Doença de Alzheimer e a Linguagem. Os artigos foram pesquisados em três bases de dados: Scielo, Lilacs e Bireme, sendo utilizados como principais descritores de busca bibliográfica: Doença de Alzheimer, Linguagem e Comunicação, no período de outubro a dezembro de 2013. A amostra final formou-se por 07 artigos, sendo incluídos aqueles que caracterizavam a linguagem na Doença Alzheimer em seus diferentes estágios. Através dos resultados desse estudo, foi possível verificar a existência de alterações da linguagem em todos os estágios da Doença e a importância da identificação precoce de tais alterações. Essa identificação pode proporcionar tempo ao paciente e seus familiares de programarem e organizarem seu futuro, buscando serviços de assistência ao paciente, bem como auxílio no processo de comunicação do indivíduo e na qualidade de vida. Esses achados apontam para a importância do conhecimento das principais alterações apresentadas pelos indivíduos com a doença de Alzheimer, sejam elas de linguagem, cognitivas ou de comportamento. É fundamental o desenvolvimento de estudos que contemplem a relação entre testes utilizados para identificarem as principais alterações de linguagem em indivíduos com Doença de Alzheimer.