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

Abstract

Introduction: 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 dementia, language features of MCI are less well understood. Connected speech and language 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 dementia 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. Understanding the breadth of evidence across the continuum of cognitive decline will help to elucidate the areas of strength and need in terms of using this method as an evaluative tool for both cognitive changes and everyday functional communication.

Method: We performed an extensive literature search of peer-reviewed journal articles that focused on the use of picture description tasks for evaluating language in persons with MCI or AD dementia. We selected articles based on inclusion and exclusion criteria and described the measures assessed, the psychometric properties that were reported, the findings, and the limitations of the included studies.

Results: 36 studies were selected and reviewed. Across all 36 studies, there were 1, 127 patients with AD dementia and 274 with MCI or early cognitive decline. Multiple measures were examined, including those describing semantic content, syntactic complexity, speech fluency, vocal parameters, and pragmatic language. Discriminant validity widely reported and distinct differences in language were observable between adults with dementia and controls; fewer studies were able to distinguish language differences between typically aging adults and those with MCI.

Discussion: Our review shows that picture description tasks are useful tools for detecting differences in a wide variety of language and communicative measures. Future research should expand knowledge about subtle changes to language in preclinical AD and Mild Cognitive Impairment (MCI) which may improve the utility of this method as a clinically meaningful screening tool.

Keywords: Alzheimer’s disease; connected speech; dementia; discourse; language; mild cognitive impairment; picture description; spontaneous speech.

Figure 1.

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) search and selection process.

Figure 2.

The “Cookie Theft Picture” from the Boston Diagnostic Aphasia Examination (Goodglass & Kaplan, 1983). Reprinted with permission by PRO-ED Inc.

Figure 3.

The “Picnic Scene” from the Western Aphasia Battery, Revised (WAB-R). Copyright c 2006 NCS Pearson, Inc. Used with permission. All rights reserved.