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Sentence Comprehension and Action Fluency: Utility as Markers of Mild Cognitive Impairment in Parkinson’s Disease

Noémie Auclair-Ouellet1, 2*, Alexandru Hanganu3, Mekale Kibreab3, Tazrina Alrazi3, Mehrafarin Ramezani3, Justyna Sarna3 and Oury Monchi3
  • 1 McGill University, School of Communication Sciences and Disorders, Faculty of Medicine, Canada
  • 2 Centre for Research on Brain Language and Music, Canada
  • 3 Hotchkiss Brain Institute, University of Calgary, Canada

Recommendations for the identification of Mild Cognitive Impairment (MCI) in Parkinson’s disease (PD) have been published by a Movement Disorder Society task force in 2012 [1]. When using a full neuropsychological battery instead of a screening tool, the assessment should cover five domains of cognition, including language, and the presence of MCI should be determined based on impairment in at least two tests. For language, the recommendations suggest using the Boston Naming Test (BNT) [2] and the Vocabulary subtest from the WAIS [3]. However, language-focused research in PD suggests that sentence comprehension and semantic processing of action words would target the specific difficulties of PD patients more accurately [4]. 50 PD participants and 34 controls completed a comprehensive neuropsychological and language battery. MCI was determined based on impairment (performance 1.5 standard deviation (SD) below norms or lower) in two measures in the remaining four domains of cognition (executive functions, memory, attention, visuo-spatial processing). 22 out of the 50 PD participants met the criteria for PD-MCI. None of the control participants had cognitive impairments. The language battery included a short sentence comprehension test (TROG-2 [5]) and semantic fluency for actions. It also included semantic fluency for animals, which has been related with semantic impairment and cognitive decline in PD [6], and the BNT. One-way ANOVAs were used to test the difference between PD, PD-MCI and control participants on the four language tests. The performance was significantly different between groups on the TROG-2 (F(2,81) = 7.025, p = .002, ηp2 = .148) and action fluency test (F(2,81) = 4.362, p = .016, ηp2 = .097), but not on the animal fluency test (F(2,81) = 2.525, p = .086, ηp2 = .059) and the BNT (F(2,81) = 1.480, p = .234, ηp2 = .035). Post-hoc comparisons with Bonferroni correction showed that PD-MCI participants had significantly more difficulties than control participants on the TROG-2 and action fluency tests, and more difficulties than PD participants on the TROG-2 (p < .05). The difference between PD-MCI and PD participants on the action fluency test was not significant. Sentences that caused the most difficulties in the PD-MCI group assessed the comprehension of singular and plural inflection, sentence-final object-relative clauses (ORC) and center-embedded ORC. Sentences with a center-embedded ORC caused difficulties in a majority of participants from all groups. However, more PD-MCI participants than PD participants had difficulties with the sentence-final ORC structure (45% vs. 7%, p =.003, Fisher’s Exact Test). 73% of PD-MCI participants had a below-average score on the TROG-2, but none reached the threshold of -1.5 SD. Performance on the TROG-2 differentiated PD participants with normal cognition from those with MCI, while action fluency did not differentiate those groups. Tests that were developed for other populations, such as the TROG-2, are often used to assess the difficulties of patients with neurodegenerative diseases. However, ceiling effect and available norms limit their clinical utility. Well-normed sentence comprehension tests developed for patients with neurodegenerative diseases may provide accurate and clinically useful markers of cognitive decline in PD.

References

1. Litvan, I., Goldman, J. G., Tröster, A. I., Schmand, B. A., Weintraub, D., Petersen, R. C., ... Emre, M. (2012). Diagnostic criteria for mild cognitive impairment in Parkinson's disease: Movement Disorder Society Task Force guidelines. Movement Disorders, 27, 349-356.
2. Kaplan, E., Goodglass, H., Weintraub, S. (1983). Boston Naming Test. Philadelphia: Lea & Febiger.
3. Wechsler, D. (2008). Wechsler Adult Intelligence Scale WAIS-IV: Technical and Interpretive Manual. San Antonio: Pearson.
4. Auclair-Ouellet, N., Lieberman, P., & Monchi, O. (2017). Contribution of language studies to the understanding of cognitive impairment and its progression over time in Parkinson's disease. Neuroscience & Biobehavioral Reviews, 80, 657-672.
5. Bishop, D.V.M. (2003). Test for Reception of Grammar Version 2 - TROG-2 Manual. 2003, London: Pearson.
6. Williams-Gray, C. H., Evans, J. R., Goris, A., Foltynie, T., Ban, M., Robbins, T. W., … Barker, R. A. (2009). The distinct cognitive syndromes of Parkinson's disease: 5 year follow-up of the CamPaIGN cohort. Brain, 132, 2958-2969.

Keywords: sentence comprehension, action word, semantics, Mild Cognitive Impairment, Parkinson's disease

Conference: Academy of Aphasia 56th Annual Meeting, Montreal, Canada, 21 Oct - 23 Oct, 2018.

Presentation Type: poster presentation

Topic: not eligible for a student prize

Citation: Auclair-Ouellet N, Hanganu A, Kibreab M, Alrazi T, Ramezani M, Sarna J and Monchi O (2019). Sentence Comprehension and Action Fluency: Utility as Markers of Mild Cognitive Impairment in Parkinson’s Disease. Conference Abstract: Academy of Aphasia 56th Annual Meeting. doi: 10.3389/conf.fnhum.2018.228.00068

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Received: 10 Apr 2018; Published Online: 22 Jan 2019.

* Correspondence: Dr. Noémie Auclair-Ouellet, McGill University, School of Communication Sciences and Disorders, Faculty of Medicine, Montreal, Canada, noemie.auclairouellet@mcgill.ca