Connected speech and language in mild cognitive impairment and Alzheimer’s disease: A review of picture description tasks

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Abstract

<p class="first" id="P1">The neuropsychological profile of people with Mild Cognitive Impairment (MCI) and Alzheimer’s Disease (AD) dementia includes a history of decline in memory and other cognitive domains, including language. While language impairments have been well described in AD, language features of MCI are less well understood. A potentially sensitive measure of language in MCI is analysis of connected speech. Connected speech analysis is the study of an individual’s spoken discourse, usually elicited by a target stimulus, the results of which can facilitate understanding of how language deficits typical of MCI and AD manifest in everyday communication. Among discourse genres, picture description is a constrained task that relies less on episodic memory and more on semantic knowledge and retrieval, within the cognitive demands of a communication context. Here we review picture description task data from adults with MCI and AD, identify speech and language parameters assessed, discuss the potential value of this task for MCI diagnosis, and provide recommendations for future research. </p>

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Sex differences in the clinical manifestations of Alzheimer disease pathology.

Tom Schneider, R. Wilson, Benjamin Evans … (2005)

Sex differences in risk of clinically diagnosed Alzheimer disease (AD) have been studied extensively, but little is known about the relation of the pathologic indices of AD to the clinical manifestations of the disease in men compared with women. To test whether the relation of AD pathology to the clinical manifestations of the disease differs in men and women. Longitudinal, clinicopathologic cohort study. Analyses were conducted on 141 older Catholic clergy members who underwent detailed annual clinical evaluations and brain autopsy at death. The number of neuritic plaques, diffuse plaques, and neurofibrillary tangles in a 1-mm2 area sampled from 4 cortical regions was counted, and a global measure of AD pathology (range, 0-2.98 U) and specific measures of each pathology were derived. Clinical diagnosis of probable AD and level of global cognitive function at the last evaluation before death. Women had more global AD pathology than did men (P = .04), due primarily to more neurofibrillary tangles (P = .02). At the last evaluation before death, 57 persons met clinical criteria for probable AD (34 [60%] of them women). In logistic regression models, sex was not related to odds of clinical AD (odds ratio [OR], 1.35; 95% confidence interval [CI], 0.56-3.25), but the relation of global AD pathology to clinical diagnosis differed for men and women. Each additional unit of AD pathology was associated with a nearly 3-fold increase in the odds of clinical AD in men (OR, 2.82; 95% CI, 1.03-7.65) compared with a more than 20-fold increase in the odds of clinical AD in women (OR, 22.67; 95% CI, 5.11-100.53). Results were unchanged after controlling for potential confounders or using level of cognition as the outcome. These data suggest that AD pathology is more likely to be clinically expressed as dementia in women than in men.

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Functional alterations in memory networks in early Alzheimer's disease.

Reisa Sperling, Bradford Dickerson, Maija Pihlajamäki … (2010)

The hallmark clinical symptom of early Alzheimer's disease (AD) is episodic memory impairment. Recent functional imaging studies suggest that memory function is subserved by a set of distributed networks, which include both the medial temporal lobe (MTL) system and the set of cortical regions collectively referred to as the default network. Specific regions of the default network, in particular, the posteromedial cortices, including the precuneus and posterior cingulate, are selectively vulnerable to early amyloid deposition in AD. These regions are also thought to play a key role in both memory encoding and retrieval, and are strongly functionally connected to the MTL. Multiple functional magnetic resonance imaging (fMRI) studies during memory tasks have revealed alterations in these networks in patients with clinical AD. Similar functional abnormalities have been detected in subjects at-risk for AD, including those with genetic risk and older individuals with mild cognitive impairment. Recently, we and other groups have found evidence of functional alterations in these memory networks even among cognitively intact older individuals with occult amyloid pathology, detected by PET amyloid imaging. Taken together, these findings suggest that the pathophysiological process of AD exerts specific deleterious effects on these distributed memory circuits, even prior to clinical manifestations of significant memory impairment. Interestingly, some of the functional alterations seen in prodromal AD subjects have taken the form of increases in activity relative to baseline, rather than a loss of activity. It remains unclear whether these increases in fMRI activity may be compensatory to maintain memory performance in the setting of early AD pathology or instead, represent evidence of excitotoxicity and impending neuronal failure. Recent studies have also revealed disruption of the intrinsic connectivity of these networks observable even during the resting state in early AD and asymptomatic individuals with high amyloid burden. Research is ongoing to determine if these early network alterations will serve as sensitive predictors of clinical decline, and eventually, as markers of pharmacological response to potential disease-modifying treatments for AD.

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Language performance in Alzheimer's disease and mild cognitive impairment: a comparative review.

Vanessa Taler, Natalie A Phillips (2008)

Mild cognitive impairment (MCI) manifests as memory impairment in the absence of dementia and progresses to Alzheimer's disease (AD) at a rate of around 15% per annum, versus 1-2% in the general population. It thus constitutes a primary target for investigation of early markers of AD. Language deficits occur early in AD, and performance on verbal tasks is an important diagnostic criterion for both AD and MCI. We review language performance in MCI, compare these findings to those seen in AD, and identify the primary issues in understanding language performance in MCI and selecting tasks with diagnostic and prognostic value.

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Author and article information

Journal

Title: Journal of Clinical and Experimental Neuropsychology

Abbreviated Title: Journal of Clinical and Experimental Neuropsychology

Publisher: Informa UK Limited

ISSN (Print): 1380-3395

ISSN (Electronic): 1744-411X

Publication date Created: March 06 2018

Publication date Created: October 21 2018

Publication date (Electronic): April 19 2018

Publication date (Print): October 21 2018

Volume: 40

Issue: 9

Pages: 917-939

Affiliations

[1 ] Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Madison, WI, USA

[2 ] Wisconsin Alzheimer’s Institute, University of Wisconsin-Madison, Madison, WI, USA

[3 ] Department of Neurology, University of Wisconsin-Madison, Madison, WI, USA

[4 ] School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada

Article

DOI: 10.1080/13803395.2018.1446513

PMC ID: 6198327

PubMed ID: 29669461

SO-VID: 5fe9e367-6a46-4d2b-b8ee-307964e6f926

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