Preliminary assessment of connected speech and language as marker for cognitive change in late middle-aged Black/African American adults at risk for Alzheimer's disease

Background: Connected speech-language (CSL) has been a promising measure of assessing cognitive decline in populations at-risk for Alzheimer's disease and related dementias (ADRD) populations. A common way to obtain CSL is through using picture description tasks such as the most frequently used image, "Cookie Theft" (CT). However, questions have been raised about using CT for diverse communities. Little is known about the CSL produced in response to this task in late-middle aged Black/African American (BAA) adults. Goals: The present study's goals were to characterize CSL in BAA adults by sex and APOE-epsilon 4 status from Milwaukee in the Wisconsin Registry for Alzheimer's Prevention (WRAP) study when presented with the CT picture description task, and to identify differences in CSL output between BAAs and non-Hispanic Whites (NHW). Methods and Procedures: We collected CSL samples from the CT picture from 48 BAA participants and 30 NHW participants from the WRAP participants in Milwaukee, WI group. CSL was analyzed using chi-square tests, T-tests, and ANCOVA. Linear mixed effect regression models were used to determine the association between cognitive status and longitudinal CSL in BAA participants with more than 1 timepoint. Outcomes and Results: Declines in CSL of BAA participants were associated with subtle declines in cognition. Among BAA participants, we found no significant differences in speech measures in terms of sex and APOE-epsilon 4 status. Our results showed no significant differences in total words between BAA and NHW groups. Conclusions: CSL analysis provides an inexpensive way to evaluate preclinical changes in cognitive status that may not be as affected by other factors as traditional cognitive tests, such as ethnocultural background. Future studies with larger sample sizes and participants from other geographic locations can clarify these findings.