Emotional–cognitive integration in aging: the role of alexithymia in mild cognitive impairment

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Abstract
Introduction: Aging is accompanied by a range of cognitive and emotional changes. Among these, difficulty in identifying and describing feelings and a tendency toward externally oriented thinking have been associated with frank cognitive decline. This pattern is known as alexithymia and reflects emotional dysregulation. Research Questions– This study aimed to investigate the largely unexplored relationship between alexithymia and cognitive functioning in older adults within the context of mild cognitive impairment (MCI). Methods: Three hundred and twenty adults aged 50–80 years classified as healthy controls, amnestic MCI (aMCI), or non-amnestic MCI (naMCI), completed a comprehensive neuropsychological assessment and the 20-item Toronto Alexithymia Scale (TAS-20). Results and discussion: Participants with aMCI showed significantly higher levels of alexithymia, compared to healthy controls. This pattern suggests that emotional dysregulation is more pronounced in individuals with memory-related cognitive decline. In both the aMCI and naMCI groups, correlations between alexithymia scores and cognitive measures were negative, indicating that higher alexithymia was associated with poorer cognitive performance. In contrast, these associations were weak in healthy controls, implying that the link between emotional processing difficulties and cognitive inefficiency emerges primarily in MCI. Taken together, these findings point to a specific interplay between emotional and cognitive domains in the early stages of neurodegenerative decline. Accordingly, elevated alexithymia in aMCI individuals might represent a socio-emotional marker of prodromal Alzheimer’s disease, highlighting the importance of considering emotional regulation in the assessment of cognitive aging.

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