Altered Frontal Lateralization Underlies the Category Fluency Deficits in Older Adults with Mild Cognitive Impairment: A Near-Infrared Spectroscopy Study

Michael K. Yeung, Sophia L. Sze, Jean Woo, Timothy Kwok, David H. K. Shum, Ruby Yu, Agnes S. Chan

Individuals with mild cognitive impairment (MCI) have been consistently found to have category fluency deficits. However, little is known about the neural basis of these deficits. A diversity of neuroimaging studies has revealed left-lateralized prefrontal activations due to verbal processing and control functions during the performance of category fluency tasks. Given the reports of structural and functional abnormalities in the prefrontal cortices in individuals with MCI, it is conceivable that these individuals would also exhibit altered prefrontal activation patterns during a category fluency task. The present study aimed to investigate the prefrontal dynamics during the category fluency task in older adults with MCI by using near-infrared spectroscopy (NIRS). Twenty-six older adults with MCI were compared with 26 older adults with normal cognition (NC) who were matched in age, gender, handedness, and educational level. All participants performed a category fluency task while the prefrontal dynamics were recorded. The results showed that the MCI group generated fewer unique words, made fewer switches between subcategories, and generated fewer new subcategories than did the NC group. Importantly, the NIRS results showed that the NC group exhibited a left lateralization of frontal activations during the category fluency task, while the MCI group did not exhibit such a lateralization. Furthermore, there was a significant positive correlation between the category fluency performance and the extent of lateralization, suggesting that the category fluency deficits in the MCI group could be related to frontal dysfunction. That is, the rightward shift of frontal activations in the MCI group may reflect the presence of cortical reorganization in which the contralateral regions (i.e., the right hemisphere) are recruited to take over the function that is declining in the specialized regions (i.e., the left hemisphere). Our lateralization finding may serve as an objective neural marker for distinguishing between normal aging and MCI. Our study highlights that an alteration of neural functioning is already present at the prodromal stage of dementia.