Background: Effective screening and cohort enrichment remain major challenges in clinical trials for Alzheimer’s disease (AD), where traditional diagnostic pathways rely on costly, invasive, and time-consuming procedures. Speech and language analysis has emerged as a scalable, low-burden approach for detecting subtle cognitive-linguistic and motor-speech changes that may appear early in the disease course. Summary: This review synthesizes current evidence on acoustic, prosodic, lexical, semantic, and syntactic speech features associated with AD and mild cognitive impairment (MCI) and evaluates their reported utility across a range of elicitation tasks including picture description, verbal fluency, narrative recall, spontaneous speech, and reading. Across studies, machine-learning models trained on speech and language features have reported consistent performance, although results vary substantially depending on task design, feature sets, and cohort characteristics. Task-dependent variability is evident, with picture description and verbal fluency tasks capturing lexical-semantic and timing markers, while narrative and spontaneous speech tasks capture impairments in coherence, information content, and prosody. Hybrid approaches integrating hand-crafted and machine-extracted features have also been explored to improve interpretability and model performance. Speech and language analytics may support digital pre-screening, cohort enrichment, and quality-assurance monitoring within clinical trials; however, their application depends on methodological considerations and validation across diverse settings. Key Messages: Despite encouraging findings, several methodological challenges persist, including inter-individual variability, limited dataset sizes, differences in recording conditions, and limitations in automatic speech recognition performance in cognitively impaired populations. Continued development of standardized protocols, disorder-adapted speech models, and multimodal analytic pipelines is needed to support clinical translation. Collectively, current evidence suggests that speech and language features represent candidate digital markers that may improve screening efficiency and support clinical trial enrichment in AD, although further validation is required to establish their reliability and generalizability.
Siddiqui et al. (Mon,) studied this question.