Abstract
Purpose Evidence exists that changes in language performance may be an early indicator of mild cognitive impairment (MCI), often a harbinger of dementing disease. The purpose of this study was the evaluation of language performance in individuals at risk for MCI by virtue of age and self-concern and its relation to performance on tests of memory, visuospatial function, and mental status. Method Eighty-three individuals 55 years or older were administered the Arizona Battery for Communication Disorders of Dementia ( Bayles & Tomoeda, 1993 ), a standardized battery with normative data from 86 healthy older adults (HOAs) and 86 individuals with Alzheimer's dementia, the most common dementing disease. A performance criterion of 1-1.5 SDs below the mean of HOAs defined MCI, as recommended in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. We hypothesized that (a) the majority of at-risk participants would score 1 SD or more below the mean of HOAs on 1 or more subtests and (b) language performance tests would present a greater challenge than memory, mental status, and visuospatial construction tests. Results Both hypotheses were confirmed. Sixty-two participants (74.6%) met the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, criteria on at least 1 subtest. Moreover, language subtests were those most likely to elicit a performance 1 SD or more below the mean of HOAs. Conclusions Language performance deficits can appear early before impairment in episodic memory, visuospatial construction ability, or mental status in individuals at risk for MCI. Speech-language pathologists are uniquely qualified to identify subtle changes in language, and standardized language tests with normative data should be used when testing for MCI.
Highlights
Evidence exists that changes in language performance may be an early indicator of mild cognitive impairment (MCI), often a harbinger of dementing disease
When we changed the criterion for MCI to 1.5 SDs below the mean of healthy older adults (HOAs), the majority of study participants (N = 48, 57.8%) still had at least one subtest score that was lower than HOAs in the Arizona Battery for Communication Disorders of Dementia (ABCD) standardization study
Of the study participants who scored at least 1 SD below the mean of HOAs on at least one ABCD subtest, 79% did so on a linguistic comprehension subtest, 62.9% on a linguistic expression subtest, 38.7% on an episodic memory subtest, 27.4% on the mental status subtest, and 14.5% on a visuospatial construction subtest
Summary
Evidence exists that changes in language performance may be an early indicator of mild cognitive impairment (MCI), often a harbinger of dementing disease. Language subtests were those most likely to elicit a performance 1 SD or more below the mean of HOAs. Language performance deficits can appear early before impairment in episodic memory, visuospatial construction ability, or mental status in individuals at risk for MCI. We hypothesized that (a) the majority of at-risk participants would score 1 SD or more below the mean of HOAs on 1 or more subtests and (b) language performance tests would present a greater challenge than memory, mental status, and visuospatial construction tests. Language subtests were those most likely to elicit a performance 1 SD or more below the mean of HOAs. Conclusions: Language performance deficits can appear early before impairment in episodic memory, visuospatial construction ability, or mental status in individuals at risk for MCI. Delaying dementia onset decreases the incalculable personal and emotional costs to patients and families (Sperling, Karlawish, & Johnson, 2013)
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