Writing Indicators in Mild Cognitive Impairment and Early Alzheimer's Disease: A Scoping Review of Study Contexts and Indicator Types
Takahiro Kowari, Atsushi Shinonaga, Shuichiro Takehara, Masahiro IkenoABSTRACT
Introduction
Writing can provide information on both the written product and the production process, but writing‐related indicators in mild cognitive impairment (MCI) and early Alzheimer's disease (AD) have not been systematically synthesized within a unified framework. This study sought to map writing‐related research in MCI and early AD across two complementary dimensions, namely motor process and content/orthographic indicators, and identify evidence gaps that limit clinical translation.
Methods
Following JBI methodological guidance and PRISMA Extension for Scoping Reviews reporting, we searched PubMed, Web of Science, CiNii, and Igaku Chuo Zasshi (Ichushi‐Web) from inception to October 1, 2025. Eligible studies examined writing characteristics in MCI and/or AD, including early‐stage and broader AD samples relevant to early cognitive decline. Extracted indicators were coded as motor process, content/orthographic, or integrated (both domains analyzed within one framework).
Results
From 3355 records, 24 studies were included. The study context groups were MCI (early) ( n = 11), MCI (mixed) ( n = 1), AD (early) ( n = 6), and AD (cross‐stage) ( n = 6). Eight studies primarily used motor process indicators, 14 studies used content/orthographic indicators, and two studies used integrated indicators. Digital measurement studies more frequently emphasized motor process outcomes, whereas paper‐based studies more commonly emphasized content/orthographic outcomes. By study context, motor process indicators were relatively more frequent in MCI (early), whereas content/orthographic indicators predominated in AD (early).
Conclusion
Writing research in MCI and early AD shows context‐dependent outcome selection with limited integration of motor and content/orthographic dimensions. Progress toward clinical use will likely require standardized tasks, shared operational definitions, core indicator sets spanning both domains, and externally validated integrated frameworks to support clinical application.