Cognitive Vulnerability and Multimodal Communicative-Pragmatic Difficulty in Subclinical Aging: A MoCA-Guided Exploration.

Abstract

Background: Pragmatic ability, which encompasses language and other expressive means, is associated with multiple cognitive processes and may be sensitive to subtle cognitive changes in healthy aging. This study investigated its relationship with cognitive vulnerability in older adults without diagnosed neurocognitive disorders.

Methods: 38 community-dwelling older adults were divided into a group scoring below the MoCA cutoff (CIbM) and a control group within the normal range (CTRL). Pragmatic performance and cognitive functions, including language, attention, memory, and executive functions, were assessed.

Results: CIbM participants showed significantly poorer pragmatic performance, particularly in linguistic and contextual domains. Regression and ROC analyses indicated that multimodal pragmatic scores distinguished the groups and predicted MoCA status more effectively than traditional cognitive measures.

Conclusions: Pragmatic ability may represent a complementary, ecologically valid marker of cognitive vulnerability in healthy aging. Since pragmatic processing involves multiple cognitive and neural systems, subtle difficulties may emerge even when impairment in traditional cognitive domains is less evident. Assessing pragmatic performance alongside conventional measures could therefore provide a broader characterization of cognitive functioning and help identify early vulnerability. These findings support including pragmatic assessment in evaluations of cognitive health and inform individualized monitoring of aging trajectories.