Sentence Writing ” in the Mini Mental State Examination : A Possible Marker for Progression of Mild Cognitive Impairment to Dementia

thinking (that can be expressed in writing’s tasks) might have different functional outcomes depending on neuropsychological deficits [12-14]. In this work, we analyzed if there is a correlation among: (a) the Sentence Writing of MMSE and global outcome score at the same test; (b) the length of the sentence (n° of words) and disability’s degree (healthy, MCI, Dementia); (c) the semantic meaning (ex: “today it’s a beautiful day” which has an abstract meaning versus “I have got three daughter” that has a concrete meaning) and different disease such are probable/possible Alzheimer’s Disease (AD), Parkinson Disease (PD), FrontoTemporal dementia (FTD)and Vascular dementia (VD). Participants and Methods This observational study enrolled 396 subjects from IRCCS Centro Neurolesi “BoninoPulejo” of Messina, from 2016 to 2018. An interdisciplinary team included neurologist, psychologist and neuropsychologist. Neuroimaging (Computer axial tomography CT or Magnetic Resonance Imaging MRI) and laboratory examinations were obtained for all participants. Subjects were randomly selected following these inclusion criteria: the MMSE test score>10; absence of substance abuse (including alcohol abuse); absence of serious psychiatric disorders such as major depression. Participants were randomly selected on basis of their global MMSE test’s score due to the cognitive impairment level, age, gender and divided into three groups: Control Group (CG; MMSE score>26/30), MCI Group (MCI; MMSE score<26/30 but>22/30) and Dementia Group (DG; MMSE score<22/20) (Figure 1). For this purpose, authors adopted as cut-off scores the education-adjusted means reported by Trabucchi. Moreover, to better define if it could be possible to discriminate though different type of Dementia, authors sub-divided this group in four categories: AD (subjects with Alzheimer Disease; n°=49), PD (Parkinson’s; n°=51), FTD (Fronto-Temporal Dementia; n°=43) and VD (Vascular Dementia; n°=53) (Table 1). The diagnoses of dementia were based on clinical findings according to the DSM5 [15,16] and the National Institute of Neurological and Communicative disorders and stroke (NINCDS) and the Alzheimer’s disease and Related Disorders Association (ADRDA) workgroup. The diagnosis of MCI was based Introduction The written word and language have always revealed many aspects of human intellectual functions and behavior. Hand-writing activity, most of times, shows in words what people think, feel and behave [1,2]. In normal aging, syntactic complexity of written production decreases, usually associated with deficits in working memory, reduced speed of information processing and changes in the effectiveness of inhibitory control, although vocabulary level is preserved [3-5]. On the other side, a neurodegenerative condition, such as dementia, can lead to agraphia; defined as a partial or total loss of the ability to produce written language. When severity of disease increases, deterioration in spelling, poor narrative organization, content word errors and perseverations, reduced syntactic complexity and shorter sentences were present [6]. The Mini Mental State Examination (MMSE) [7] is the most frequently brief cognitive screening test used for cognitive impairment, diagnosis of dementia and related disorders. It assesses various cognitive domains, namely orientation, registration, concentration, short-term memory, language and visual spatial function. The MMSE includes a request to “write a sentence” of own choice, with a subject and a verb, that has a sense. It can be used to evaluate the textual production of patient and may help to assess the impact of global cognitive status over textual production. Press et al. [8] found out a significant association between the number of words per sentence and the cognitive diagnosis: the shortest sentences were written by patients with dementia, Mild Cognitive Impairment (MCI) subjects wrote slightly longer sentences, and the longest sentences were written by patients without cognitive impairment. Moreover, a previous study found a correlation between the degree of cognitive impairment and a decline in the ability for sentence writing: while 85% of nondemented elderly wrote a correct spontaneous sentence, only 67% of those with dementia, 41% of those with moderate dementia and none with severe dementia were able to write a sentence [9]. In addition, in younger people, the use of words in their positive sense within a written sentence predicted better health and a functional outcome [10]. In normal aging, are more often used words with positive significance and future tenses, instead of fewer self-references [11]. Moreover, various authors reported that, the develop of