Can discourse processing performance serve as an early marker of Alzheimer’s disease and mild cognitive impairment? A systematic review of text comprehension

Abstract

A number of linguistic and cognitive deficits have been reported during the course of Alzheimer’s disease (AD) and its preceding stage of mild cognitive impairment (MCI), with some deficits appearing years before onset of clinical symptoms. It continues to be a critical task to identify tools that may serve as an early marker of pathology that are also reliably able to distinguish AD from normal ageing. Given the limited success of classic psychometric cognitive testing, a novel approach in assessment is warranted. A potentially sensitive assessment paradigm is discourse processing. The aim of this review was to synthesize original research studies investigating comprehension of discourse in AD and MCI, and to evaluate the potential of this paradigm as a promising avenue for further research. A literature search targeting studies with AD or MCI groups over 60 years of age was conducted in PubMed, Web of Science, and PsycINFO databases. Eight articles with good quality were included in the review. Six measures of discourse comprehension—naming latency, summary, lesson, main idea, proportion of inferential clauses, true/false questions—were identified. All eight studies reported significant deficits in discourse comprehension in AD and MCI groups on five of the six measures, when compared to cognitively healthy older adults. Mixed results were observed for associations with commonly used cognitive measures. Given the consistent findings for discourse comprehension measures across all studies, we strongly recommend further research on its early predictive potential, and discuss different avenues for research.

Macro‐event recognition in healthy ageing, Alzheimer’s disease, and mild cognitive impairment

“…Further, previous studies have established that AD patients experience visuospatial disorientation that is not associated with memory deficits, rather with an inability to link and integrate spatial and temporal cues (Duffy et al, 2004). This has also been observed in linguistic narrative comprehension, wherein AD and MCI patients display impairment in macro-level comprehension of textual narratives, which relies largely on inferencing, integration, and abstraction of information (Kokje, Celik, Wahl, & von Stutterheim, 2021). We extend these findings to show impairment in processing visual event scenes in AD and MCI.…”

Automatic Assessment of Connected Speech and Its Relation to Memory in Alzheimer’s Disease in Low Education

“…This study adopts a holistic approach by studying impairment at the discourse level in its interactions with cognitive processes [31]. Among cognitive processes, different types of memory have been linked to performance in discourse production tasks.…”