Evidence for the role of semantic cueing and executive functioning tools in early and differential diagnosis of Neurocognitive Disorder (NCD): A neuropsychological approach

Background: Recent advances in the diagnosis of Mild Cognitive Impairment (MCI) and Neurocognitive Disorders (NCDs) build on neuropsychological models (Dodich et al., 2018; Possin et al., 2018). Despitethe lack of harmonized protocols (Costa et al., 2017), tools such as the Free and Cued Selective Reminding Test (FCSRT) yield specific scores (e.g., ISC for cue sensitivity) for the early detection of hippocampal syndromes involved in Alzheimer’s Disease (AD), and for the prediction of MCI-to-AD conversion (Brugnolo et al., 2021). Accordingly, the study aims to investigate the correlation between neuropsychological profiles and cognitive patterns through an extensive assessment procedure accounting for the heterogeneity of MCI and NCDs.
Methods: N=150 outpatients (mean age=72.29±5.42 SD) were administered a battery meeting both MCI(Petersen et al., 2014) and NCD criteria (APA, 2013) including: two screening tools; ten domain-specific cognitive tests; psychodiagnostic-functional assessment. Analyses through paired-sample tests and multivariate models focused on: (1) episodic memory and executive deficits; (2) predictive indices for MCI/NCD diagnosis.
Results: 70.7% of the clinical sample obtained scores consistent with MCI or mildNCD profiles, and 75% showed episodic memory impairment on cut-off basis (FCSRT-ISC<0.9). Wilcox on signed-rank test revealed poorer performance in FCSRT-ISC compared to Babcock Story-IR (p-value<0,001<α=0,05),notably in MCI/mild NCDs but not in major NCDs. The full sample and MCI/mild NCD subset also obtained lower scores in Digit Span Backward (DS-B) than in the Clock Drawing Test (CDT), whereas major NCD performed worse in CDT. Logistic regression showed three predictive indices for major NCD: the lower the scores on FCSRT-IFR, DS-B and CDT, the greater the chances of fitting major NCD profile.
Conclusion: Driven by the need for early and differential diagnosis of NCDs, our findings showed episodic memory impairment within the total sample and the MCI/mild NCD subsets, indicating: (1) a high prevalence of AD-type MCI/mild NCDs; (2) the possible key role of FCSRT-ISC in detecting early or mild conditions of impairment; (3) the good predictive values (86%) of some memory (i.e. FCSRT-IFR) and executive tasks(i.e. DS-B and CDT) contributing to a major NCD diagnosis, potentially enhancing NCD nosography and differential diagnosis.