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Abstract
BackgroundThe Tip-of-the-Tongue (ToTs) state is considered a universal phenomenon and is a frequent cognitive complaint in old age. Previous cross-sectional studies have found that ToT measures successfully discriminate between cognitively unimpaired adults and adults with Mild Cognitive Impairment (MCI). The aim of this study was to identify longitudinal patterns of ToTs in individuals with subjective complaints and with MCI regarding progress of their cognitive status.MethodThe study included 193 participants with subjective cognitive complaints (SCC) and 56 participants with MCI who completed a baseline and two follow-up assessments, with an interval of about 18 months between each assessment. Participants were classified into three groups by considering cognitive stability or deterioration from the baseline diagnosis: SCC-stable, MCI-stable and MCI-worsened. Participants performed a ToT task involving recognition and naming of famous people depicted in 50 photographs. Generalized Linear Mixed Models (GLMM) were used to model longitudinal changes in familiarity, feeling of knowing, semantic access, phonological access and verbal fluency.ResultsPhonological access differentiated MCI patients, stable and worsened, from adults with SCCs at all evaluation times. Phonological access declined over time in the three groups, without significant interactions between groups and time.DiscussionThis study provides the first longitudinal evidence of differences in ToT measures for adults with MCI. The findings indicate that phonological access measures successfully differentiated between the diagnostic groups. However, slopes remain irrespective of the diagnostic group and progression toward more advance stages of cognitive impairment.
Highlights
ToTs occur when the activated semantic representation of a word fails to spread the necessary activation to its corresponding phonological representation, making lexical access impossible
The main aim of this study was to analyze the longitudinal patterns of ToT events in patients with Mild Cognitive Impairment (MCI) according to their changes in diagnostic status, in order to obtain new evidence about the relevance of ToT measures as linguistic markers of MCI
Our findings indicate that ToTs successfully differentiate MCI patients from cognitively unimpaired adults with subjective cognitive complaints (SCC) at all evaluation times
Summary
Cognitive impairment in old adults has been considered a continuum including different stages (Jack et al, 2018): a cognitively unimpaired phase (CU), with performance within the expected range for age and education; presence of subjective cognitive complaints (SCC), without objective cognitive impairment (Jessen et al, 2014; Molinuevo et al, 2017); Mild Cognitive Impairment (MCI), characterized by the presence of cognitive complaints, objective mild cognitive deterioration and relative preservation of instrumental activities of daily living (Petersen, 2004; Petersen et al, 2018); and dementia or major neurocognitive disorder, characterized by cognitive affectation and psychological symptoms that cause dependency (American Psychiatric Association, 2013). Consistent evidence supports the hypothesis that the higher frequency of ToTs in older adults is caused by a decline in transmission of the activation from semantic to phonological representations (Burke et al, 1991; James and Burke, 2000; Shafto et al, 2007; Juncos-Rabadán et al, 2010; White et al, 2013). According to this hypothesis, ToTs occur when the activated semantic representation of a word fails to spread the necessary activation to its corresponding phonological representation, making lexical access impossible. The aim of this study was to identify longitudinal patterns of ToTs in individuals with subjective complaints and with MCI regarding progress of their cognitive status
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