Filler words, rambling, repetition, and vague word choices could signal a future diagnosis of Alzheimer’s, according to new research presented at the Alzheimer’s Association in July 2017.
During the London conference, Professor Kimberly Mueller from University of Wisconsin-Madison outlined these indicators found in an on-going study of children of Alzheimer’s patients.
The study is an attempt to trace back the steps of Alzheimer’s development, up to 10 years before diagnosis, to the early indicators of cognitive impairment. The subtle indicators of language decline, like filler words, could be the earliest indicators. Between 15 to 20 percent of adults with mild cognitive impairment eventually develop Alzheimer’s.
Mueller and her team believe identifying these earliest indictors may help stem the progress of Alzheimer’s; the disease has often progressed too far for effective treatment at the time of diagnosis.
Studying Language in Alzheimer’s Descendants
Loss of language skills can be detected in as little as two years for people with mild cognitive impairment (MCI) if speech patterns are carefully scrutinized, according to Mueller.
Mueller’s team studied 264 adults at-risk for dementia. Speech patterns and word recovery were analyzed from a one-minute verbal sample where participants described a picture. Participants who later developed MCI—a precursor to dementia—saw a sharper decline in scores just two to three years on, compared to their peers with stable cognitive health. At the 10-year mark, the difference was notable for those with MCI.
Mueller pulled the participants from a larger University of Wisconsin study: The Wisconsin Registry for Alzheimer’s Prevention (WRAP). Started in 2001, it’s believed to be the largest longitudinal study its kind. The goal is to identify the impact of modifiable risks, like exercise and diet, and to find early indicators of the onset of Alzheimer’s disease.
WRAP includes both children of parents with and without Alzheimer’s and children of parents who did not develop the disease. As people with a family member who suffered from Alzheimer’s are at a higher risk for developing the disease themselves, the two groups form a natural comparison point.
To date, WRAP has 1,550 participants who are tested every two years on cognition, lifestyle, physical activity, biomarkers, genetics, and metabolomics (studying the physiology of cells). Included in the study is a memory test focused on language.
Signs of Speech Deterioration
Speech deterioration is often subtle. The WRAP study recorded conversations and performed in-depth analysis to spot difference; those drops in speech ability would likely not have been noticed in casual conversations. Indeed, people with speech decline often cleverly mask the issue in social settings by changing the subject or finding funny alternate words, decreasing the likelihood of detection.
Analysis from WRAP and other groups points to at least four signs that speech may be deterioration, with the potential for a future Alzheimer’s diagnosis.
Sign one: More filler words
While we all grasp for the correct word, a large increase in filler words, such as “uh” and “well”, should be noted. Long pauses also work as a type of filler as the speaker attempts to recall the correct word.
Sign two: Rambling
A sudden balloon in story telling was identified as a sign of decline in research from Janet Sherman at Massachusetts General Hospital. In Sherman’s test, participants were asked to create a sentence from related words, like “ink”, “pen”, and “paper”. Those with mental decline were less concise, had longer sentences, and tended to ramble off topic, according to Sherman.
Sign three: Repetition
Sherman studied the speech patterns of President Ronald Reagan up to 10 years before his Alzheimer’s diagnosis. "Ronald Reagan started to have a decline in the number of unique words with repetitions of statements over time," said Sherman. Repetition could include the same phrases used in diverse situations as those are easier for the brain to recall rather than construct new syntax patterns.
Sign four: Vague speech
Vague speech may include pronouns like “it” and “they” instead of specific names for items. For example, saying “We went to the store” instead of “Julie and I went to the store” is an easier load on the brain’s recall function.
The WRAP study also showed MCI patients struggled to repeat vague phrases, such as “Bill and Tom went to the store.” There was no known association with Bill and Tom—both were random names the participant was unfamiliar with—and so memory recall was harder.
Speech Decline in Alzheimer’s
The subtle speech decline signs noted for MCI patients become more pronounced if Alzheimer’s develops. As the disease progresses, language changes accelerate and are easier to detect.
Phase one is often anomia, or difficulty recalling words. Patients with this form of aphasia could describe in detail what an object is and how it’s used but are unable to recall the word. The person might talk around the word or offer hand gestures until someone else jumps in with the word. Anomia could also cause use of incorrect but related words, like substituting “aunt” for “sister.” In this phase, speech is fluent and grammar is intact.
The next phase is paraphasia, or using incorrect or jumbled words; “rhinoceros” becomes “rhinosus.” A person with this level of decline may be unaware of their mistakes or have trouble understanding others’ speech. In this phase, speech is effortful and hesitant. Reading and writing may decline and less frequently-used word are labored.
As the disease progresses, neologism and stuttering are common. At this stage, words are often made-up—a “hammer” becomes a “nail banger”—or nonsense words. The person may only be able to mutter incomprehensible sounds. There may be no response to questions or sentences could stop mid-way.
What to Do with Speech Decline
Mueller recommends speaking to a doctor as soon as speech pattern differences are detected. "If it is noticeable and interfering with socializing or with getting needs met, then it would be worth going to your doctor and talking about that," Mueller said.
Given the potential for early dementia detection, Mueller also advocates for doctors to add audio recorders to their diagnosis tool belts. If doctors could record patients and upload the recordings into simple language analysis software, detection of subtle changes could lead to earlier diagnosis and potentially treatment.
Final Note: Some Speech Decline is Expected
As a final note, it’s important to remember not all speech decline indicates cognition issues or dementia. Age reduces the brain’s ability to recall the sounds of words, increasing the burden of language recall. Spelling ability also declines because of weakened connections in the brain. Some senior become more reclusive, limiting use of language and causing a bigger drop in ability.
To stave off the impact of aging on language ability, try learning a second language or musical instrument, memorizing poetry, practicing spelling of common words, or finding a weekly outing that requires extended conversation.