Combining Linguistic, Behavioral and Visuospatial Measures to Characterize Multidomain Impairment in Dementia

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Abstract
Background/Objectives: Visuospatial impairments are among the earliest cognitive symptoms in Alzheimer’s disease (AD) and related dementias (ADRD), yet standard assessments often lack ecological validity and focus on isolated domains. This study examines whether integrating linguistic, behavioral, and eye-tracking measures provides a more comprehensive characterization of cognitive deficits within a multimodal, exploratory framework. Methods: Twenty older adults (10 with mild to moderate dementia, including AD/ADRD, and 10 age-matched controls) completed three tasks: (1) oral narrative production, (2) visuospatial behavioral tasks (manipulation, recognition, reproduction), and (3) free-viewing eye-tracking. Linguistic, behavioral (time, errors), and fixation-based measures were analyzed using non-parametric statistics, with emphasis on effect sizes and cross-domain patterns. Results: The clinical group differed consistently from controls across domains. Linguistic measures showed increased output but reduced quality, including lower syntactic complexity, more grammatical errors, greater pragmatic deviations, and reduced gist comprehension. Behavioral tasks revealed slower performance and more frequent failures. Eye-tracking differences were less pronounced, showing a tendency toward longer fixations and less efficient visual exploration. A composite multimodal index showed clear separation between groups, indicating a consistent pattern of impairment across measures. Conclusions: Cognitive differences in dementia are expressed across multiple domains, with the strongest effects in linguistic and behavioral measures. These findings highlight the value of multimodal profiles for capturing multidimensional impairment. Results should be interpreted as exploratory and require confirmation in larger, confirmatory studies.

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