Language Measures Research Articles

Psychometric properties of parent- and staff-reported measures and observational measures of infant and toddler development in Early Head Start

Using longitudinal data from the Early Head Start Family and Child Experiences Survey 2009 (Baby FACES 2009), this study examines the psychometric properties of infant and toddler measures of language and cognitive development and social-emotional competence collected from multiple sources, including parent and Early Head Start staff reports and direct assessments from trained assessors. We examined the validity and reliability of parent/staff ratings and observational measures derived from adult/child play-based interactions using independently administered standardized measures from direct assessments as the criteria or comparison measures. Participants included 846 children and families with low incomes enrolled in Early Head Start in spring 2009 who were followed from ages 1 to 3, drawn from a nationally representative sample of programs. The results suggest adequate internal consistency reliability for most of the measures. We found stronger rater effects for staff-reported measures compared with assessor effects for direct child assessment and observational measures. Moreover, the rater effects in the staff-reported measures varied by staff characteristics. There was some evidence of validity for the staff- and parent-reported measures at ages 2 and 3, but little evidence of validity for the age 1 measures. We discuss the implications of these findings for research on infants and toddlers from families with low incomes. It is important to consider the purpose of the assessments and their psychometric properties for the particular group of children with whom the assessments will be used when selecting assessment tools.

Universal language development screening: comparative performance of two questionnaires.

Background and objectiveLow language ability in early childhood is a strong predictor of later psychopathology as well as reduced school readiness, lower educational attainment, employment problems and involvement with the criminal justice system. Assessment of early language development is universally offered in many countries, but there has been little evaluation of assessment tools. We planned to compare the screening performance of two commonly used language assessment instruments.MethodsA pragmatic diagnostic accuracy study was carried out in five areas of England comparing the performance of two screening tools (Ages and Stages Questionnaire (ASQ) and Sure Start Language Measure (SSLM)) against a reference test (Preschool Language Scale, 5th edition).ResultsResults were available for 357 children aged 23–30 months. The ASQ Communication Scale using optimal cut-off values had a sensitivity of 0.55, a specificity of 0.95 and positive and negative predictive values of 0.53 and 0.95, respectively. The SSLM had corresponding values of 0.83, 0.81, 0.33 and 0.98, respectively. Both screening tools performed relatively poorly in families not using English exclusively in the home.ConclusionThe very widely used ASQ Communication Scale performs poorly as a language screening tool, missing over one-third of cases of low language ability. The SSLM performed better as a screening tool.

A natural language measure of ideology in the Brazilian Senate

Abstract: We estimate a measure of political ideology using as data a corpus of over two decades of speeches delivered by Brazilian Federal Senators across five legislatures. We employ a computational technique that analyses political speech by extracting the dictionaries that best translate the content of each ideology. Through this supervised learning method, we calculate the classification accuracy over these political texts and show that polarization is increasing across the legislatures. The method also reveals the evolving patterns of political ideologies over a period of deep change in Brazilian society. We further investigate the political dynamic across legislatures by comparing our results with current approaches to ideology in the political science literature.

Impact of Evidence-Based Functional Intervention Approach on an Individual with Wernicke’s Aphasia Based on International Classification of Functioning, Disability and Health Framework: A Case Study

Background Severe comprehension impairments in Wernicke’s aphasia (WA) are often seen to be associated with auditory related impairment and phonological processing, including semantic and executive difficulties. This study investigated whether an intensive functional approach regime underpins the improvement in speech, language and cognitive domains in an individual with WA resulting in a positive impact on functional communication skills and quality of life-based on international classification of functioning (ICF), disability and health framework. Aim To study the impact of evidence-based functional treatment approach on the speech, language, cognitive and quality of life (QoL) domains in a patient diagnosed with WA based on ICF Framework. Objective The purpose of this longitudinal case study was to compare before- and after-scores of speech and language abilities, cognitive abilities and QoL in a patient diagnosed with WA after providing an intensive evidence-based functional communication treatment approach. Material and Methods A case aged 60-years-old male with a one-month history of stroke; was diagnosed as WA. The patient received intensive functional treatment approach focusing on language and cognition for one hour continuously per session, for eight sessions, within 2-months which involved different therapy approaches to improve his communication abilities. The measurement of language, cognitive abilities and QoL was assessed using the English adaptation of the Western Aphasia Battery (WAB), Addenbrooke’s Cognitive Examination-Revised (ACE-R) and World Health Organization Quality of Life Instrument, Short Form ((WHOQoLBREF) respectively. The results obtained were analyzed based upon the scores obtained across the domains of WAB, ACE-R, and QoL in two stages i.e. pre- and post-intensive aphasia functional language intervention program. Results The outcome of the current study revealed improved scores in WAB, ACE-R, and WHOQoL which highlighted the fact that aphasia therapy techniques targeting the language and functional goals must be followed and implemented during the therapeutic sessions based on the client’s type of aphasia. Conclusion The findings of the case study suggests that the impact of functional communication approach targeting the maximum participation of the person with aphasia seems to be one of the most effective and efficient way to rehabilitate aphasics to improve their QoL.

Functional Connectivity and Speech Entrainment Speech Entrainment Improves Connectivity Between Anterior and Posterior Cortical Speech Areas in Non-fluent Aphasia

Background Speech entrainment (SE), the online mimicking of an audio-visual speech model, has been shown to increase speech fluency in individuals with non-fluent aphasia. One theory that may explain why SE improves speech output is that it synchronizes functional connectivity between anterior and posterior language regions to be more similar to that of neurotypical speakers. Objectives The present study tested this by measuring functional connectivity between 2 regions shown to be necessary for speech production, and their right hemisphere homologues, in 24 persons with aphasia compared to 20 controls during both free (spontaneous) speech and SE. Methods Regional functional connectivity in participants with aphasia were normalized to the control data. Two analyses were then carried out: (1) normalized functional connectivity was compared between persons with aphasia and controls during free speech and SE and (2) stepwise linear models with leave-one-out cross-validation including normed functional connectivity during both tasks and proportion damage to the left hemisphere as independent variables were created for each language score. Results Left anterior–posterior functional connectivity and left posterior to right anterior functional connectivity were significantly more similar to connectivity of the control group during SE compared to free speech. Additionally, connectivity during free speech was more associated with language measures than connectivity during SE. Conclusions Overall, these results suggest that SE promotes normalization of functional connectivity (i.e., return to patterns observed in neurotypical controls), which may explain why individuals with non-fluent aphasia produce more fluent speech during SE compared to spontaneous speech.

Promoting Executive Function Skills in Preschoolers Using a Play-Based Program.

In recent years, play has been shown to be a powerful means to enhance learning and brain development. It is also known that through play children enhance their executive function (EF) skills. Furthermore, well-developed EF in preschoolers has been shown to be an important predictor for later academic and life success. Armed with this information a program, Building Brains and Futures (BBF), for developing EF through play was designed for 3–5-year-old. The program consisted of 10 simple, fun, and interactive games selected to enhance various facets of EF. The 10 games included were: dimensional change card sort, lips and ears, block building, musical freeze, opposites, pretend play, red light/green light, shared project, Simon says, and wait for it. The program was implemented with a group of children shown to have challenges with respect to kindergarten readiness. The approach was first, to build adult capability by sharing knowledge of brain development, EF, and the importance of play with educators, caregivers, and parents. Second, to build skills in delivering the program in the school setting. Children engaged with the program of games for a minimum of 6 weeks. Their performance on a battery of direct measures of EF, language, and motor skills, were recorded before and after the program. The results showed improvement in all three domains. In addition, adopters of the BBF program reported it was easily and successfully integrated into their existing preschool curricula. The importance of intentional adult directed play in building developmental learning, including EF, is discussed.

Personality and Socioeconomic Predictors of Midlife Cognitive Functioning in Mexican-Origin Adults

The present study aims to identify personality and socioeconomic (e.g., education, per capita income, economic stress) factors that contribute to midlife cognitive functioning across middle adulthood. Specifically, we examined how the growth trajectories of personality and socioeconomic factors across 12 years predict subsequent cognitive functioning, using data from a large sample of Mexican-origin adults (N=1,110; median age at Time 1=37 years, age range at Time 1=26-65). Personality was assessed using the Big Five Inventory, which assesses the Big Five domains as well as specific facets of each domain; economic stress was assessed using measures of negative economic events (e.g., job loss) and economic hardship (e.g., difficulty paying bills). Cognitive functioning was assessed using the NIH Cognitive Toolbox with measures of memory, language, and executive function. Findings from this work will help identify intervention targets for promoting healthy cognitive aging in midlife and beyond in Mexican-origin adults.

The Bouba-Kiki Effect in Children With Childhood Apraxia of Speech.

The bouba-kiki (BK) effect refers to associations between visual shapes and auditory pseudonames. Thus, when tested, people tend to associate the pseudowords bouba and kiki with round or spiky shapes, respectively. This association requires cross-modal sensory integration. The ability to integrate information from different sensory modalities is crucial for speech development. A clinical population that may be impaired in cross-modal sensory integration is children with childhood apraxia of speech (CAS). The purpose of this study was to examine the involvement of cross-modal sensory integration in children with (CAS). The BK effect was assessed in participants with CAS (n = 18) and two control groups: One control group was composed of children with developmental language disorder (DLD), also termed specific language impairment (n = 15), and a second group included typically developing (TD) children (n = 22). The children were presented with 14 pairs of novel visual displays and nonwords. All the children were asked to state which shape and nonword correspond to one another. In addition, background cognitive (Leiter-3) and language measures (Hebrew PLS-4) were determined for all children. Children in the CAS group were less successful in associating between visual shapes and corresponding auditory pseudonames (e.g., associating the spoken word "bouba" with a round shape; the spoken word "kiki" with a spiky shape). Thus, children with CAS demonstrated a statistically significant reduced BK effect compared with participants with TD and participants with DLD. No significant difference was found between the TD group and the DLD group. The reduced BK effect in children with CAS supports the notion that cross-modal sensory integration may be altered in these children. Cross-modal sensory integration is the basis for speech production. Thus, difficulties in sensory integration may contribute to speech difficulties in CAS.

The relation between drawing and language in preschoolers: The role of working Memory and executive functions

Language and pictures are two major representational systems, but the relation between them in early childhood is under-investigated. This study investigated the association between drawing and language in preschoolers, and examined the role of working memory and executive functions (inhibition, shifting, and updating) in the association between drawing and language. The participants were 125 preschoolers (aged 3;0–6;1). Exploratory and confirmatory factor analyses found that two factors, respectively loading language and drawing measures, were correlated, also controlling for age. Regression analyses indicated that working memory and inhibition tasks predicted language, and inhibition tasks predicted drawing, above and beyond age. Structural equation modeling supported a model, according to which indirect influence of working memory and direct influence of executive functions fully accounted for the correlation between drawing and language. This suggests that the intertwining of language and drawing development in preschoolers depends on the development of domain-general components of the cognitive system.

Language input to infants of different socioeconomic statuses: A quantitative meta-analysis.

For the past 25 years, researchers have investigated language input to children from high- and low-socioeconomic status (SES) families. Hart and Risley first reported a "30 Million Word Gap" between high-SES and low-SES children. More recent studies have challenged the size or even existence of this gap. The present study is a quantitative meta-analysis on socioeconomic differences in language input to young children, which aims to systematically integrate decades of research on this topic. We analyzed 19 studies and found a significant effect of SES on language input quantity. However, this effect was moderated by the type of language included in language quantity measures: studies that include only child-directed speech in their language measures find a large SES difference, while studies that include all speech in a child's environment find no effect of SES. These results support recent work suggesting that methodological decisions can affect researchers' estimates of the "word gap." Overall, we find that young children from low-SES homes heard less child-directed speech than children from mid- to high-SES homes, though this difference was much smaller than Hart & Risley's "30 Million Word Gap." Finally, we underscore the need for more cross-cultural work on language development and the forces that may contribute to it, highlighting the opportunity for better integration of observational, experimental, and intervention-basedapproaches.

Establishing a relationship between semantic clustering and language performance

AbstractBackgroundSemantic clustering (SC) is an implicit learning strategy commonly utilized on verbal list‐learning tasks. While research has examined SC and executive functioning and memory, little has been done relating SC and language. In the present study, we calculated a SC score on a common list‐learning task and explored relationships with language performance. We predicted weaker SC in individuals with MCI compared cognitively normal individuals, which could potentially be used as an additional measure to help identify MCI and Alzheimer’s disease.MethodArchival test data from an outpatient neurology clinic were extracted (N=355), including the Hopkins Verbal Learning Test – Revised, Boston Naming Test, WAIS‐IV Similarities, D‐KEFS Verbal Fluency Letter Fluency (FAS) and Category Fluency (CF) tests, and Wide Range Achievement Test‐Reading (WRAT). Diagnostic subgroups of MCI and CN were created using actuarial diagnostic criteria. SC was calculated as the sum of novel consecutive recalls belonging to the same category, without repeats or semantically‐related intrusions. A chi‐square test was conducted to assess differences between demographic factors. ANCOVA was used to compare performance of SC and selected language measures between the MCI and CN groups using age and WRAT‐Reading as covariates; SC and language measure raw scores were treated as dependent variables and diagnostic grouping as the independent variable.ResultDifferences in age(X2 =36.39,p<0.01), education(X2 =21.44,p<0.05), and WRAT‐Reading SS(X2 =45.43,p<0.01) were found. ANOVA found significant differences between the groups’ SC scores, as well as performance on language measures (p<0.05). The CN group showed a trend of being stronger than the MCI group across all measures, including SC. Generally, language measures were significantly positively correlated with SC scores for both groups (p<0.05), including BNT and CF, and FAS for the CN group.ConclusionOverall, findings support our hypothesis that both SC and language scores vary as a function of clinical diagnosis with the CN group having stronger abilities than those with MCI. As such, SC scores derived from verbal learning tests may be able to contribute to knowledge of one’s language skills. Further research should aim to help establish this relationship. SC scores could assist in screening for MCI or cognitive deficiencies resulting from AD.

Remote neuropsychological assessment using the UDS v3.0 T‐Cog: Preliminary data among participants at the Penn ADRC

AbstractBackgroundDue to the COVID‐19 pandemic, collection of the Uniform Data Set (UDS) at Alzheimer’s Disease Research Centers (ADRCs) transitioned to remote administration via the T‐Cog. Feasibility of data collection and dissemination of normative data in individuals across the cognitive spectrum will be necessary for accurate utilization of remotely‐captured neurocognitive performance and classification of cognitive function.MethodData was included from individuals who completed a remote T‐Cog protocol during their annual NACC evaluation. Additional data included demographics, informant‐reported functioning, self‐reported depression and consensus diagnosis. Descriptive and general linear model (GLM) statistics were used to characterize the overall sample and test for differences in performance across diagnostic groups.ResultA total of 151 participants with normal cognition (NC; N=103), mild cognitive impairment (MCI; N=32) and Alzheimer’s disease (AD; N=16) were administered the T‐Cog (Age = 75.2+7.2, Education=16.3+3.1; 62% Female; 75% White). Data were collected via telephone (68%), video‐conference (29%), or a combination (3%). Time to completion ranged from 38‐120 minutes (M=58+14 minutes), with NCs showing a significantly lower (p<0.05) mean completion time (54 minutes) than those with MCI (65 minutes) and AD (69 minutes). Across the battery, 80% of responses were deemed “extremely valid”, 19% were “questionably valid” and <1% were “invalid”. Contributors to poor validity included hearing impairment (34%), distractions (16%), interruptions (6%), lack of effort/disinterest (9%), fatigue (3%), emotional issues (6%), or other reasons (25%). Diagnostic groups varied on tests of global cognition and functioning, as measured by the MoCA‐Blind and Global CDR, with the highest performance among NC, followed by MCI, and AD (p‐values<0.01). Nearly all T‐Cog measures of language, memory, and executive functioning abilities showed expected differences across diagnostic categories (covarying for age, sex and education; p<0.05). Comparisons to prior in‐person UDS neurocognitive testing across all diagnostic groups will also be presented.ConclusionPreliminary feasibility and performance data on the T‐Cog reveals expected differences in T‐Cog performance. Comparisons to within‐subject in‐person testing and deviations from in‐person norms will be presented to further explore the validity of remote cognitive testing and identify tests that show particular promise in discriminating between diagnostic groups.

The development and validation of a new cross‐cultural naming test

AbstractBackgroundTraditional naming tests such as the Boston Naming Test are unsuitable to assess naming impairment in diverse populations, given the large influence of culture, language, and education on performance. A more fair naming test is urgently needed. The goal of this study was therefore to develop and validate a new cross‐cultural naming test to diagnose naming impairment in Alzheimer’s disease in diverse populations.MethodWe carried out a multistage pilot study. First, we generated a list of 149 potentially cross‐cultural items, and selected the items with a homogeneous age of acquisition and word frequency across multiple languages. For the 74 items that remained, we selected several colored photographs (examples provided in Figure 1), out of which 194 controls selected the best matching photograph. The 74‐item test was piloted in 15 diverse healthy controls, after which 14 items were removed. The final 60‐item test was validated in 39 controls and 61 culturally, educationally, and linguistically diverse patients – mainly with dementia (30%), psychiatric illness (20%), MCI (16%), or subjective memory impairment (15%). Participants were mostly from North Africa, Suriname, Eastern Europe, and the Middle East, and the majority of participants had an education level of primary school or lower (51%).ResultThe new cross‐cultural naming test was well able to discriminate between patients with Alzheimer’s/mixed dementia (n=11, median score: 48/60) and the rest of the sample (median: 58/60, AUC=0.87). Preliminary item analyses indicated that colors, as well as animals (ant, worm, snake) and occupations with a later age of acquisition/lower word frequency were the most sensitive. There were robust correlations with other measures of language (Recall of Pictures Test naming ρ=0.26, p=.04, animal fluency ρ=0.66, p<.001, foods fluency ρ=0.57, p<.001), as well as a culture‐sensitive cognitive screener (ρ=0.69, p<.001). The scores were not correlated with education level, age, or number of years of residence in the Netherlands (analysis in controls).ConclusionThis new naming test is an important step towards a more fair neuropsychological assessment and more accurate dementia diagnosis in culturally, linguistically, and educationally diverse individuals.

Amyloid status is associated with deficits in connected speech language

AbstractBackgroundSubtle changes in connected speech language (CSL) comprising fluency disruptions and limited semantic content are present in preclinical stages of Alzheimer’s disease (AD) and dementia. Our prior research suggests that individuals identified by PET imaging as amyloid‐positive experience more rapid decline of semantic content than those without amyloid. Here we expand our analyses to additional CSL measures sensitive to nascent deficits in communication.MethodStudy participants were enrolled in Wisconsin Alzheimer’s Disease Research Center (n= 103) or the Wisconsin Registry for Alzheimer’s Prevention (n= 223), had available cerebrospinal fluid (CSF) measurements, and 1‐4 CSL samples. CSF biomarkers were measured using the exploratory Roche NeuroToolKit assays, a panel of automated robust prototype immunoassays (Roche Diagnostics International Ltd). Speech samples (N=740) were recorded while describing the “Cookie Theft” picture from the Boston Diagnostic Aphasia Examination. The majority of participants (65%) provided ≥ 2 language samples across biennial visits. Moving average types‐tokens ratio (MATTR), content information unit (CIU) density, CIUs per minute, words per minute, and filled pauses were extracted from speech samples. Linear mixed effects models were used to test moderation of age related changes CSL samples by amyloid status (Aβ42/Aβ40 ≥ .046), where age at study visit is the measure of time. ovariates gender, years of education, and number of CSL visits (i.e., practice effects) were included as fixed effects.ResultBaseline demographics and study variables stratified by amyloid status are shown in Table 1. CSF amyloid status did not moderate longitudinal changes in any of the CSL outcomes (Figure 1). After dropping these non‐significant interactions, amyloid‐positive individuals expressed fewer CIUs total and per minute and slightly more filled pauses (Table 2). We also found a significant decline with age in CSL outcomes MATTR, CIUs per minute, and words per minutes. The pattern of results was unchanged after excluding nineteen individuals with cognitive impairment from analyses.ConclusionWe found that amyloid burden associated with connected speech measures reflecting semantic content and word retrieval. CSL is a ‘digital biomarker’ that shows promise as a measure of language; future work will continue to explore longitudinal relationships between CSL and AD biomarkers.

Change in communication‐related participation in primary progressive apraxia of speech and aphasia

AbstractBackgroundIndividuals with Primary Progressive Apraxia of Speech (PPAOS) have AOS as the initial and predominant symptom. Many develop aphasia and/or dysarthria later in the disease course. Past research has shown that patients with neurodegenerative AOS experience reduced participation in communication that is further exacerbated by co‐occurring language deficits. Previous studies suggest measures of disease severity do not necessarily correlate with measures of participation restrictions. The aim of this study was to describe changes in communication limitations in these patients over a one‐year interval, measured by 1) the patient via the Communicative Participation Item Bank (CPIB) and 2) the speech‐language pathologist via ASHA's Functional Communication Measures (FCMs) and an adapted Motor Speech Disorder (MSD) severity rating and determine if there are significant changes in these and other objective speech and language measures (e.g. Western Aphasia Battery‐Revised Aphasia Quotient, Apraxia of Speech Rating Scale‐3).MethodSeventeen patients (10 male) with progressive AOS were seen for a second visit approximately one year following the first visit. The measures collected at each visit were statistically compared. Correlations were calculated between the participation ratings and other clinical assessment measures at each visit and qualitatively compared.ResultThere were statistically significant differences in AOS and aphasia severity between visits. There were significant changes in clinical assessments, MSD severity rating, and all ASHA FCMs between visits, but not the CPIB. Comparison of correlations suggest the relationships among clinical and participation measures may change over time.ConclusionThe findings of this study support the use of patient reported outcome measures, like the CPIB, as they may better reflect the patient experience and associated changes in day‐to‐day functioning when other measures may simply index the progression of the disease.

Lateralized tau deposition and speech, language, and cognition: A descriptive case report

AbstractBackgroundAsymmetric binding patterns in tau PET imaging are sometimes observed, but less is known about how this asymmetry might explain clinical phenotypes and AD variants, especially in a longitudinal context. Previous work has demonstrated that unilateral tau deposition in left frontal and temporal regions is common in logopenic progressive aphasia (lvPPA), an atypical AD variant. This work presents two descriptive case studies of participants with opposing laterality of [18F]MK‐6240, a PET radioligand for AD neurofibrillary tangles.MethodTwo participants from the Wisconsin Registry for Alzheimer’s Prevention (WRAP), an ongoing, longitudinal cohort study of late middle‐aged adults enriched for AD risk, were identified based on unilateral MK‐6240 deposition. Topographic amyloid and tau burden was assessed with [11C]PiB and [18F]MK‐6240 PET imaging, respectively. Demographic data, cognitive diagnoses, health histories, and APOE status are described. Longitudinal neuropsychological assessments and digitally recorded connected speech samples were analyzed to create a descriptive profile of cognition and connected speech‐language (CSL). Cognitive test scores and language measures were then compared against the scores of the full WRAP sample, using a robust normative approach previously described by our group.ResultMK‐6240 tau‐PET imaging revealed right‐lateralized tau in Participant A and left‐lateralized tau in Participant B (Figure 1). Participants were identical on all demographics except age and APOE risk of developing AD (though both participants were ApoE‐4 allele carriers) (Table 1). Cognitive assessment Z‐scores (0=mean of demographically similar cognitively stable WRAP participants; Figs 2‐4) depict considerable between visit variability for Participant A on all measures, including language and CSL, with decline from baseline on all but letter fluency. Participant B showed isolated baseline deficits on memory tests (AVLT and story recall) at two standard deviations below the mean, which declined further across visits, whereas performances on Trails, naming, category fluency, and all measures of CSL remained stable and within normal expectations.ConclusionIn this case study, right>left tau PET signal was associated with greater decline in language, particularly connected speech and naming. Future work will examine associations between volumetric MRI and asymmetric regional tau deposition, as well as additional relationships to language and cognition.

Domain specific cognitive functions predict neuropathological traits in the Framingham Heart Study.

Clinical diagnosis of Alzheimer's disease depends on assessing cognition using domain specific neuropsychological (NP) tests. However, relationships between ante-mortem NP tests and detailed post-mortem neuropathological traits from the same participants are understudied. We analyzed 25 NP and 24 neuropathological traits measured in 159 brain donors from the Framingham Heart Study (FHS). Collectively, the NP tests assessed performance in memory, language, executive, and visual-spatial domains. We normalized NP tests after adjusting for sex and age at NP exam, while neuropathological traits for sex and age at death. We tested the association of NP test scores with neuropathological diagnosis of Alzheimer's disease (AD) as a binary outcome adjusting for sex, age at death, and interval age (age at death minus age at NP exam) in a logistic regression. Associations with covariate-adjusted neuropathological traits were performed under linear regression models. We also evaluated a model predicting AD including terms for domain-specific NP tests, age at death, sex, and APOE ɛ4 status RESULT: AD was significantly associated (P<0.05) with measures of memory, language, and executive function (best with executive function: P=0.0016). Braak stages and plaque scores showed a strong association with all cognitive domains (P<0.02). Neurofibrillary tangle (NFT) with memory domain (P=7.4x10-5 ) and amyloid beta plaque density with executive function (P=0.01) showed significant associations. Total tau level was strongly associated with executive function (P=5.3x10-6 ). Significant associations were also observed between pTau231 and language (P=0.001), as well as between pTau396 and visual-spatial domain (P=0.03). PTau181 (P=0.02), pTau202 (P=0.0089), and amyloid-β40 (P=5.9x10-4 ) were significantly associated with memory domains. For complement component proteins, the C4A level was nominally significant with language (P=0.03) and the C4B level with executive function (P=0.02). AD was predicted as area under the ROC (receiver operating characteristic) curve is 0.75 (confidence interval: 0.59-0.91), where memory and language domains were the top-ranked predictors with importance value>0.63. We confirmed association of memory and executive function with AD-related neuropathological traits. This study demonstrated for the first time associations of ante-mortem language and executive function with post-mortem complement component protein levels. AD in this study was largely predicted by language and memory performance.

Characterising spoken interactions of healthy ageing adults with CognoSpeak, a web‐based cognitive assessment tool

AbstractBackgroundAutomatic conversation analysis presents a useful aid for diagnosis and management of people with cognitive impairments, having already successfully differentiated between people with Alzheimer’s disease (AD) and healthy controls. Current clinical brief cognitive tests such as Addenbrooke’s Cognitive Examination are influenced by age, education and practice effects but it is unknown how these factors influence automated analysis of speech. This study characterised the effects of age, education and repetition on measures of speech and language of cognitively healthy ageing adults.MethodAudio recordings of memory related questions and verbal fluency tasks from 37 cognitively healthy adults’ conversations with CognoSpeak were analysed (mean age 73.11 ± 7.97). Linguistic analysis comprised of pause to speech ratio (pause length/speech length), age of acquisition of words, phonemes per minute, words per minute and total word count. Spearman’s correlations assessed relationships with age and education. 6 participants repeated testing at an average of 4.05 and 12.25 months later. Friedman’s ANOVA and post‐hoc related‐samples Wilcoxon signed ranks tests assessed longitudinal changes.ResultPause to speech ratio was significantly higher for recent memory questions than remote memory. Age of acquisition was significantly higher for phonemic fluency than semantic fluency. A moderate negative correlation was found for age with ACE‐R score and phonemic fluency. A strong positive correlation was found with education and ACE‐R score, and a moderate positive correlation with education and words per minute. No further relationships for age or education were found. Semantic fluency showed practice effects, whereas linguistic measures did not. Further follow‐up data will be available by July 2021.ConclusionThese results support the theory of semantic memory preservation with age. It is indicated that age, education and time do not have large effects on linguistic measures, giving conversation analysis a practical advantage over the ACE‐R for longitudinal monitoring of people with Mild Cognitive Impairment or Subjective Cognitive Impairment.

Early‐onset APOE‐ε4 carriers show greater decline in memory, language and executive function than late‐onset carriers

AbstractBackgroundApolipoprotein‐ε4 (APOE‐ε4) is the strongest genetic risk factor for sporadic Alzheimer’s disease (AD). However, whether APOE‐ε4 accelerates cognitive decline in AD has not been firmly established. We studied the rate of cognitive decline among early‐ (EOAD) and late‐onset (LOAD) APOE‐ε4 carriers vs non‐carriers on measures of memory, attention, language, and executive function.MethodEOAD and LOAD (onset‐age &lt; or ≥65) subjects were selected from the National Alzheimer’s Coordinating Center (NACC) database. Mixed‐effects models were run separately for EOAD and LOAD with longitudinal neuropsychological measures as dependent variables. APOE‐ε4 carrier status, follow‐up time, and an APOE*time interaction were included as independent variables adjusting for age, sex, education, and disease severity (CDR‐SB) at baseline. For measures where ε4‐carriers had significantly more decline in both groups, mixed‐effects models in the combined samples were used with a three‐way interaction among APOE status, follow‐up time and onset‐age variables to determine whether APOE‐ε4 associated decline was similar between EOAD and LOAD.ResultSubject demographics are shown in Table 1. The estimated differences in annual cognitive change between ε4‐carriers and non‐carriers are shown in Table 2. Both EOAD and LOAD APOE‐ε4 carriers showed significant decline in Craft Immediate (p=0.0065 and p=0.0134, respectively), semantic fluency (p=0.0001 and p&lt;0.0001, respectively), and Trail‐Making B scores (p=0.0028 and 0.0206, respectively) than non‐ε4 carriers. Only EOAD APOE‐ε4 carriers showed significantly greater decline in Craft Delayed recall than non‐ε4 carriers (p=0.0189). Only LOAD APOE‐ε4 carriers showed significantly greater decline on MoCA (p&lt;0.0001), MINT (p&lt;0.0001), and Trail‐Making A (p&lt;0.0001) than non‐carriers. The accelerated rate of decline in two of the three cognitive tests that showed faster decline in APOE‐ε4 carriers in both EOAD and LOAD was significantly greater in EOAD, while one was trending (Craft Immediate, p=0.0042; semantic fluency, p&lt;0.0001; Trail‐Making B, p=0.0942).ConclusionThese results suggest that APOE‐ε4 is associated with accelerated rate of decline in both LOAD and EOAD; however, the magnitude of the rate of decline is more pronounced in EOAD. Investigation in other large research consortia such as LEADS and ADNI can further characterize the genetic influences of APOE‐ε4 and other genetic risk factors on AD.

Neuropsychological assessment of diverse populations in Europe: The European Consortium for Cross‐Cultural Neuropsychology (ECCroN)

AbstractBackgroundPopulations living in European countries are becoming increasingly diverse. As performance on traditional neuropsychological tests is heavily influenced by culture, language, (level and quality of) education, literacy, and other factors, neuropsychological assessment practices need to be adapted to account for this diversity.MethodThe European Consortium for Cross‐Cultural Neuropsychology (ECCroN) aims to improve assessment of culturally, educationally, and linguistically diverse individuals across Europe by 1) collaborating on the validation and implementation of cross‐cultural neuropsychological tests and 2) working on initiatives geared at improving interpreter use and training programs for neuropsychologists.ResultThe consortium was founded in late 2019 and currently consists of 16 experts based in 9 countries – some of whom work in multinational contexts. The first meetings of the network stressed several points. First, ECCroN aims to develop and/or validate cross‐culturally applicable tests, as opposed to race‐based norms for existing tests; for example, current projects aim to validate measures of social cognition and language (naming) in patients with migration backgrounds. Second, ECCroN emphasizes the importance of taking into account diversity across the entire spectrum, both in populations traditionally considered to be ‘majority’ and ‘minority’ groups, e.g. best practices should be developed for those with little education regardless of native‐born or migrant status. Third, ECCroN aims to identify and share suitable instruments to measure factors potentially influencing the assessment, such as bilingualism, acculturation and educational quality.ConclusionJoint efforts should be undertaken to develop, validate, publish, and implement cross‐cultural tests across European countries to reduce misdiagnoses in diverse patient populations.