The effect of lifelong bilingualism on regional grey and white matter volume

Examining the relation between bilingualism and age of symptom onset in frontotemporal dementia

Bilingualism is thought to confer advantages in executive functioning, thereby contributing to cognitive reserve and a later age of dementia symptom onset. While the relation between bilingualism and age of onset has been explored in Alzheimer's dementia, there are few studies examining bilingualism as a contributor to cognitive reserve in frontotemporal dementia (FTD). In line with previous findings, we hypothesized that bilinguals with behavioral variant FTD would be older at symptom onset compared to monolinguals, but that no such effect would be found in patients with nonfluent/agrammatic variant primary progressive aphasia (PPA) or semantic variant PPA. Contrary to our hypothesis, we found no significant difference in age at symptom onset between monolingual and bilingual speakers within any of the FTD variants, and there were no notable differences on neuropsychological measures. Overall, our results do not support a protective effect of bilingualism in patients with FTD-spectrum disease in a U.S. based cohort.

A neural mechanism of cognitive reserve: The case of bilingualism

Cognitive Reserve (CR) refers to the preservation of cognitive function in the face of age- or disease-related neuroanatomical decline. While bilingualism has been shown to contribute to CR, the extent to which, and what particular aspect of, second language experience contributes to CR are debated, and the underlying neural mechanism(s) unknown. Intrinsic functional connectivity reflects experience-dependent neuroplasticity that occurs across timescales ranging from minutes to decades, and may be a neural mechanism underlying CR. To test this hypothesis, we used voxel-based morphometry and resting-state functional connectivity analyses of MRI data to compare structural and functional brain integrity between monolingual and bilingual older adults, matched on cognitive performance, and across levels of second language proficiency measured as a continuous variable. Bilingualism, and degree of second language proficiency specifically, were associated with lower gray matter integrity in a hub of the default mode network - a region that is particularly vulnerable to decline in aging and dementia - but preserved intrinsic functional network organization. Bilingualism moderated the association between neuroanatomical differences and cognitive decline, such that lower gray matter integrity was associated with lower executive function in monolinguals, but not bilinguals. Intrinsic functional network integrity predicted executive function when controlling for group differences in gray matter integrity and language status. Our findings confirm that lifelong bilingualism is a CR factor, as bilingual older adults performed just as well as their monolingual peers on tasks of executive function, despite showing signs of more advanced neuroanatomical aging, and that this is a consequence of preserved intrinsic functional network organization.

Linking early-life bilingualism and cognitive advantage in older adulthood

Previous studies have identified bilingualism as a protective factor against dementia. Here we aimed to test whether being bilingual at different life stages impacts cognition and brain structure in older adulthood. We included 746 participants from the DZNE-Longitudinal Cognitive Impairment and Dementia Study (DELCODE). Assessment of bilingualism at 3 life stages (early: 13-30, middle: 30-65 and late: over 65 years old) was determined with the Lifetime of Experiences Questionnaire. Individuals reporting bilingualism (i.e., daily use of L2) in the early life stage outperformed monolinguals on learning & memory, working-memory, executive functions and language. Bilingualism in middle life stage showed a significant advantage on learning & memory, while no effect of bilingualism in old life stage was identified. Brain gray matter volume was not associated with L2 use and did not differ between groups. However, stronger correlations between brain gray matter volume in selected brain regions and cognitive performance were found in bilingual participants in the early and middle life stages. Our results indicate that bilingualism in early life might provide a long-lasting protective effect on cognition and shape the brain to sustain cognitive performance in older adulthood.

Subcortical lesions impact confrontation naming in bilinguals with later age of acquisition: An exploratory study

The bilingual experience is believed to impact brain development and, possibly, cognitive performance. Subcortical structures, including the striatum and white matter, are believed related to confrontation naming performance among bilingual individuals with later age of acquisition (AoA) and lower proficiency of a second language (L2). However, these findings are primarily derived from healthy adult samples, although there is clinical significance for the interpretation of naming performance. The present study examined whether striatal and white matter lesions were associated with naming tasks in clinic-referred bilingual veterans (n = 29) and whether L2 AoA moderated this relationship. Clinically rated lesions, without regard for AoA, were not consistently correlated with naming performance. Moderation models (lesion × AoA) were significant across naming tasks (i.e., naming scores were negatively correlated with striatal lesions with increasing AoA). Effect sizes were higher among striatal models as compared to white matter models. Results extend prior neuroimaging findings with healthy bilinguals that AoA moderates the relationship between subcortical lesions and naming performance in bilingual patients, and suggests that clinicians should consider specifics of bilingual experience when interpreting test scores.

Can Speaking More Than One Language Help Prevent Alzheimer's Disease?

Alzheimer's disease (AD) is an age-related neurocognitive disorder that is epidemic in the elderly population. Currently, there are limited pharmacological interventions, and this has heightened the urgency to identify potential preventable or modifiable risk factors that promote resilience to the neuropathological effects of AD. The regular use of two or more languages is one such factor that may increases cognitive reserve through the long-standing executive control involved in managing multiple languages in the brain. There is also evidence that bilingualism is associated with increased brain reserve or maintenance, particularly in frontal-executive structures and networks. This review examines the current, sometimes conflicting literature on bi/multilingualism and AD. These studies have confounding variations in the assessment of age of second language onset, language proficiency, language usage, and whether determining incidence of AD or age of symptom onset. Despite these limitations, most publications support the presence of increased frontal-executive reserve that compensates for the development of AD neuropathology and, thereby, delays the emergence of clinical symptoms of dementia by about 4-5 years. Although regularly speaking more than one language does not protect against AD neuropathology, the delay in its clinical expression has a potentially significant impact on the lifelong morbidity from this age-related disease. Learning other languages may be an important modifiable factor for delaying the clinical expression of AD in later life.

Does bilingualism come with linguistic costs? A meta-analytic review of the bilingual lexical deficit

A series of recent studies have shown that the once-assumed cognitive advantage of bilingualism finds little support in the evidence available to date. Surprisingly, however, the view that bilingualism incurs linguistic costs (the so-called lexical deficit) has not yet been subjected to the same degree of scrutiny, despite its centrality for our understanding of the human capacity for language. The current study implemented a comprehensive meta-analysis to address this gap. By analyzing 478 effect sizes from 130 studies on expressive vocabulary, we found that observed lexical deficits could not be attributed to bilingualism: Simultaneous bilinguals (who acquired both languages from birth) did not exhibit any lexical deficit, nor did sequential bilinguals (who acquired one language from birth and a second language after that) when tested in their mother tongue. Instead, systematic evidence for a lexical deficit was found among sequential bilinguals when tested in their second language, and more so for late than for early second language learners. This result suggests that a lexical deficit may be a phenomenon of second language acquisition rather than bilingualism per se.

Multifactorial approaches to study bilingualism in the aging population: Past, present, future

A better understanding and more reliable classification of bilinguals has been progressively achieved through the fine-tuning methodology and simultaneously optimizing the measurement tools. However, the current understanding is far from generalization to a larger population varying in different measures of bilingualism-L2 Age of acquisition (L2 AOA), L2 usage and exposure, and L2 proficiency. More recent studies have highlighted the importance of modeling bilingualism as a continuous variable. An in-depth look at the role of bilingualism, comparing groups, may be considered a reductionist approach, i.e., grouping based on one measure of bilingualism (e.g., L2 AOA) may not account for variability in other measures of bilingualism (L2 exposure, L2 use or L2 proficiency, amongst others) within and between groups. Similarly, a multifactorial dimension is associated with cognitive performance, where not all domains of cognition and subcomponents are equally influenced by bilingualism. In addition, socio-cultural and demographical factors may add another dimension to the impact of bilingualism on cognitive performance, especially in older adults. Nevertheless, not many studies have controlled or used the multiple socio-cultural and demographical factors as a covariate to understand the role of different aspects of bilingualism that may influence cognitive performance differently. Such an approach would fail to generalize the research findings to a larger group of bilinguals. In the present review paper, we illustrate that considering a multifactorial approach to different dimensions of bilingual study may lead to a better understanding of the role of bilingualism on cognitive performance. With the evolution of various fine-tuned methodological approaches, there is a greater need to study variability in bilingual profiles that can help generalize the result universally.

The Nuance of Bilingualism as a Reserve Contributor: Conveying Research to the Broader Neuroscience Community

The neurological notion of “reserve” arises from an individually observable dissociation between brain health and cognitive status. According to the cognitive reserve hypothesis, high-reserve individuals experience functional compensation for neural atrophy and, thus, are able to maintain relatively stable cognitive functioning with no or smaller-than-expected impairment. Several lifestyle factors such as regular physical exercise, adequate and balanced nutrition, and educational attainment have been widely reported to contribute to reserve and, thus, lead to more successful trajectories of cognitive aging (CA). In recent years, it has become clear that bilingualism is also a potential reserve contributor. Yet, there is little communication between the neuroscience of bilingualism research community and researchers working in the field of CA more generally, despite compelling reasons for it. In fact, bilingualism tends to be overlooked as a contributory factor in the CA literature, or reduced to a dichotomous trait, despite it being a complex experience. Herein, we discuss issues that are preventing recognition of bilingualism as a reserve contributor across all literatures, highlight the benefits of including language experiences as a factor of interest across research disciplines, and suggest a roadmap to better integrate bilingualism and aging moving forward. We close with calls toward a model of aging that examines the contributions across lifestyle factors, including that of bilingual experience.

Cultural factors related to neuropsychological performance and brain atrophy among Hispanic older adults with amnestic Mild Cognitive Impairment (aMCI): A pilot study

OBJECTIVES

This study examined the association of cultural factors and literacy to neuropsychological performance and measures of regional brain atrophy among Hispanic elders diagnosed with amnestic Mild Cognitive Impairment (aMCI).

METHOD

Acculturation and literacy levels were measured among 45 subjects tested in Spanish; their primary language. Scores for measures of memory, executive functioning, and verbal fluency, as well as volumetric analysis of MRI scans of left hemisphere structures commonly affected by Alzheimer's disease (AD) were examined. Linear regression models were employed to examine the association of acculturation and literacy to neuropsychological performance and MRI measures.

RESULTS

After controlling for age, higher literacy levels were associated with better performance on phonemic verbal fluency (r = 0.300, p < .05), while higher levels of acculturation to the U.S. was associated with poorer performance on category verbal fluency (r = 0.300, p < .05). There was a significant inverse relationship after controlling for age between literacy and the left entorhinal cortex (r = -0.455, p < .05), left precuneus (r = -0.457, p < .05), and left posterior cingulate (r = -0.415, p < .05).

CONCLUSIONS

Results of the current pilot study indicate that high acculturation to the U.S. among aMCI immigrants from Latin-American countries may hinder performance on verbal learning measures when they are administered in one's primary language. Moreover, in this cohort, a higher literacy level, which is indicative of greater cognitive reserve, was associated with better performance in language measures, but with greater atrophy in brain regions susceptible to neurodegenerative disease. These preliminary findings should be further examined among larger cohorts and using more diverse measures, which capture other cultural constructs.

Foreign Language Learning in Older Adults: Anatomical and Cognitive Markers of Vocabulary Learning Success

In recent years, foreign language learning (FLL) has been proposed as a possible cognitive intervention for older adults. However, the brain network and cognitive functions underlying FLL has remained largely unconfirmed in older adults. In particular, older and younger adults have markedly different cognitive profile—while older adults tend to exhibit decline in most cognitive domains, their semantic memory usually remains intact. As such, older adults may engage the semantic functions to a larger extent than the other cognitive functions traditionally considered the most important (e.g., working memory capacity and phonological awareness). Using anatomical measurements and a cognitive test battery, the present study examined this hypothesis in twenty cognitively normal older adults (58–69 years old), who participated in a two-month Italian learning programme. Results showed that the immediate learning success and long-term retention of Italian vocabularies were most consistently predicted by the anatomical measures of the left pars orbitalis and left caudal middle frontal cortex, which are implicated in semantic and episodic memory functions. Convergent evidence was also found based on the pattern of cognitive associations. Our results are consistent with a prominent role of semantic and episodic memory functions in vocabulary learning in older learners.

Bilingualism and Aging: Implications for (Delaying) Neurocognitive Decline

As a result of advances in healthcare, the worldwide average life expectancy is steadily increasing. However, this positive trend has societal and individual costs, not least because greater life expectancy is linked to higher incidence of age-related diseases, such as dementia. Over the past few decades, research has isolated various protective "healthy lifestyle" factors argued to contribute positively to cognitive aging, e.g., healthy diet, physical exercise and occupational attainment. The present article critically reviews neuroscientific evidence for another such factor, i.e., speaking multiple languages. Moreover, with multiple societal stakeholders in mind, we contextualize and stress the importance of the research program that seeks to uncover and understand potential connections between bilingual language experience and cognitive aging trajectories, inclusive of the socio-economic impact it can have. If on the right track, this is an important line of research because bilingualism has the potential to cross-over socio-economic divides to a degree other healthy lifestyle factors currently do not and likely cannot.

The neuroanatomical consequences and pathological implications of bilingualism

In recent years, there has been a rise in the number of people who are able to speak two or more languages. This has been paralleled by an increase in research related to bilingualism. Despite this, much of the neuroanatomical consequences and pathological implications of bilingualism are still subject to discussion. This review aims to evaluate the neuroanatomical structures related to language and to the acquisition of a second language as well as exploring how learning a second language can alter one's susceptibility to and the progression of certain cerebral pathologies. A literature search was conducted on the Medline, Embase, and Web of Science databases. A total of 137 articles regarding the neuroanatomical or pathological implications of bilingualism were included for review. Following analysis of the included papers, this review finds that bilingualism induces significant gray and white matter cerebral changes, particularly in the frontal lobes, anterior cingulate cortex, left inferior parietal lobule and subcortical areas, and that native language and acquired language largely recruit the same neuroanatomical structures with however, subtle functional and anatomical differences dependent on proficiency and age of language acquisition. There is adequate evidence to suggest that bilingualism offsets the symptoms and diagnosis of dementia, and that it is protective against both pathological and age-related cognitive decline. While many of the neuroanatomical changes are known, more remains to be elucidated and the relationship between bilingualism and other neurological pathologies remains unclear.

Lifelong bilingualism and mechanisms of neuroprotection in Alzheimer dementia

Lifelong bilingualism is associated with delayed dementia onset, suggesting a protective effect on the brain. Here, we aim to study the effects of lifelong bilingualism as a dichotomous and continuous phenomenon, on brain metabolism and connectivity in individuals with Alzheimer's dementia. Ninety-eight patients with Alzheimer's dementia (56 monolinguals; 42 bilinguals) from three centers entered the study. All underwent an [18F]-fluorodeoxyglucose positron emission tomography (PET) imaging session. A language background questionnaire measured the level of language use for conversation and reading. Severity of brain hypometabolism and strength of connectivity of the major neurocognitive networks was compared across monolingual and bilingual individuals, and tested against the frequency of second language life-long usage. Age, years of education, and MMSE score were included in all above mentioned analyses as nuisance covariates. Cerebral hypometabolism was more severe in bilingual compared to monolingual patients; severity of hypometabolism positively correlated with the degree of second language use. The metabolic connectivity analyses showed increased connectivity in the executive, language, and anterior default mode networks in bilingual compared to monolingual patients. The change in neuronal connectivity was stronger in subjects with higher second language use. All effects were most pronounced in the left cerebral hemisphere. The neuroprotective effects of lifelong bilingualism act both against neurodegenerative processes and through the modulation of brain networks connectivity. These findings highlight the relevance of lifelong bilingualism in brain reserve and compensation, supporting bilingual education and social interventions aimed at usage, and maintenance of two or more languages, including dialects, especially crucial in the elderly people.

The effects of bilingualism on hippocampal volume in ageing bilinguals

Long-term management of more than one language has been argued to contribute to changes in brain and cognition. This has been particularly well documented in older age, where bilingualism has been linked to protective effects against neurocognitive decline. Since memory difficulties are key aspects of this decline, herein we examine potential effects of bilingualism on the hippocampus, a brain structure related to memory that is particularly vulnerable to cognitive ageing. Hippocampal volume has been shown to increase as a result of second language learning and use in younger adults. However, it is unknown if this is maintained throughout the lifespan. We examine hippocampal volume and episodic memory performance in a participant sample consisting of healthy older individuals with a wide range of experiences in exposure and using a second language. Results reveal greater hippocampal volume calibrated to degree of quantified dual language use. Our results mirror those of immersive active bilingualism in younger populations, suggesting that long-term active bilingualism leads to neuroprotective effects in the hippocampus. We discuss this in the context of literature proposing bilingualism-induced brain reserve in the older age.

Does Second Language Learning Promote Neuroplasticity in Aging? A Systematic Review of Cognitive and Neuroimaging Studies

As the population ages, understanding how to maintain older adults' cognitive abilities is essential. Bilingualism has been linked to higher cognitive reserve, better performance in executive control, changes in brain structure and function relative to monolinguals, and delay in dementia onset. Learning a second language thus seems a promising avenue for cognitive enhancement in older adults. Our review aims to determine whether learning a foreign language in later life improves cognition and promotes neuroplasticity. We screened articles from the Pubmed, Scopus, and Science Direct databases to identify interventional studies using second language training in senior participants, including either cognition or neuroimaging as outcome measures. A total of nine articles were found, with only one neuroimaging study. Results from these studies are inconsistent, but tend to suggest that second language learning is associated with improvement in attentional switching, inhibition, working memory, and increased functional connectivity. We discuss the implications of these results, and suggest new directions and methodological recommendations for future research.

Evidence for cognitive and brain reserve supporting executive control of memory in lifelong bilinguals

Recent bilingualism research attempts to understand whether continually controlling multiple languages provides domain-general benefits to other aspects of cognition. Yet little attention has been given to whether this extends to resistance to proactive interference (PI), which involves the filtering of irrelevant memory traces in order to focus attention on relevant to-be-remembered information. The present study sought to determine whether bilingualism provides benefits to resistance to PI performance and brain structure in regions supporting executive control of memory. Eighty-two younger and older adult participants, half English monolinguals and half highly proficient Spanish-English bilinguals, completed directed forgetting and release from PI tasks and underwent an MRI scan that measured cortical volume, thickness, and white matter integrity. While behavioral performance between bilinguals and monolinguals did not differ, bilinguals displayed thinner cortex in brain regions related to resistance to PI, providing evidence for cognitive reserve, and showed positive relationships between white matter integrity and resistance to PI performance, indicative of brain reserve. This study is the first to demonstrate cognitive reserve and brain reserve in different brain structure indices within the same healthy participants and suggests that bilingualism supports important structural relationships between regions necessary for executive control of memory.

Mitigating the negative impacts of aging on cognitive function; modifiable factors associated with increasing cognitive reserve

Research suggests that social, physical, and cognitively challenging activities during lifetime, could mitigate the negative effects of aging on cognitive function. This effect is explained by the increased cognitive reserve (CR) resulting from such factors; in fact, such activities, by altering structural and functional properties of the human brain, equip one with more effective compensatory mechanisms to resist brain damage before the presentation of severe clinical symptoms. Therefore, applying appropriate modifications in one's lifestyle and activities may be effective in lowering the risk of developing dementia and cognitive dysfunction in old age, especially in brain areas that are susceptible to aging. In this paper, we are going to review relevant studies discussing the association between important modifiable factors, known as CR proxies (i.e., educational attainment, occupational complexity, physical activity, social engagement, bilingualism, leisure activities, and Mediterranean diet), and different domains of cognitive function, which are affected either in the process of healthy aging or neurodegenerative diseases.

Bilingualism: Pathway to Cognitive Reserve

Cognitive reserve is characterized by a dissociation between cognitive level and brain structure, thereby reducing the impact of deteriorating brain structure on cognitive function. Cognitive reserve is therefore a promising approach to maintaining cognitive function and protecting against symptoms of dementia. The present paper evaluates evidence supporting the claim that bilingualism contributes to cognitive reserve. Four types of evidence are presented: (i) brain and cognitive function in healthy aging, (ii) age of onset of symptoms of dementia, (iii) relation between clinical level and neuropathology for patients, and (iv) rate of cognitive decline in later stages of dementia. In all cases, bilinguals revealed patterns that were consistent with the interpretation of protection from cognitive reserve when compared with monolinguals.

Bilinguals who stutter: A cognitive perspective

PURPOSE

Brain differences, both in structure and executive functioning, have been found in both developmental stuttering and bilingualism. However, the etiology of stuttering remains unknown. The early suggestion that stuttering is a result of brain dysfunction has since received support from various behavioral and neuroimaging studies that have revealed functional and structural brain changes in monolinguals who stutter (MWS). In addition, MWS appear to show deficits in executive control. However, there is a lack of data on bilinguals who stutter (BWS). This literature review is intended to provide an overview of both stuttering and bilingualism as well as synthesize areas of overlap among both lines of research and highlight knowledge gaps in the current literature.

METHODS

A systematic literature review on both stuttering and bilingualism studies was conducted, searching for articles containing "stuttering" and/or "bilingualism" and either "brain", "executive functions", "executive control", "motor control", "cognitive reserve", or "brain reserve" in the PubMed database. Additional studies were found by examining the reference list of studies that met the inclusion criteria.

RESULTS

A total of 148 references that met the criteria for inclusion in this paper were used in the review. A comparison of the impact of stuttering or bilingualism on the brain are discussed.

CONCLUSION

Previous research examining a potential bilingual advantage for BWS is mixed. However, if such an advantage does exist, it appears to offset potential deficits in executive functioning that may be associated with stuttering.

Bilingualism and domain-general cognitive functions from a neural perspective: A systematic review

A large body of research has indicated that bilingualism - through continual practice in language control - may impact cognitive functions, as well as relevant aspects of brain function and structure. The present review aimed to bring together findings on the relationship between bilingualism and domain-general cognitive functions from a neural perspective. The final sample included 210 studies, covering findings regarding neural responses to bilingual language control and/or domain-general cognitive tasks, as well as findings regarding effects of bilingualism on non-task-related brain function and brain structure. The evidence indicates that a) bilingual language control likely entails neural mechanisms responsible for domain-general cognitive functions; b) bilingual experiences impact neural responses to domain-general cognitive functions; and c) bilingual experiences impact non-task-related brain function (both resting-state and metabolic function) as well as aspects of brain structure (both macrostructure and microstructure), each of which may in turn impact mental processes, including domain-general cognitive functions. Such functional and structural neuroplasticity associated with bilingualism may contribute to both cognitive and neural reserves, producing benefits across the lifespan.

Characterizing Bilingual Effects on Cognition: The Search for Meaningful Individual Differences

A debate over the past decade has focused on the so-called bilingual advantage-the idea that bilingual and multilingual individuals have enhanced domain-general executive functions, relative to monolinguals, due to competition-induced monitoring of both processing and representation from the task-irrelevant language(s). In this commentary, we consider a recent study by Pot, Keijzer, and de Bot (2018), which focused on the relationship between individual differences in language usage and performance on an executive function task among multilingual older adults. We discuss their approach and findings in light of a more general movement towards embracing complexity in this domain of research, including individuals' sociocultural context and position in the lifespan. The field increasingly considers interactions between bilingualism/multilingualism and cognition, employing measures of language use well beyond the early dichotomous perspectives on language background. Moreover, new measures of bilingualism and analytical approaches are helping researchers interrogate the complexities of specific processing issues. Indeed, our review of the bilingualism/multilingualism literature confirms the increased appreciation researchers have for the range of factors-beyond whether someone speaks one, two, or more languages-that impact specific cognitive processes. Here, we highlight some of the most salient of these, and incorporate suggestions for a way forward that likewise encompasses neural perspectives on the topic.

Cognitive-communication performance following mild traumatic brain injury: Influence of sex, age, education, site of lesion and bilingualism

BACKGROUND

Although previous research studies have defined several prognostic factors that affect cognitive-communication performance in patients with all traumatic brain injury (TBI) severity, little is known about what variables are associated with cognitive-communication impairment in complicated mild TBI (mTBI) specifically.

AIMS

To determine which demographic and trauma-related factors are associated with cognitive-communication performance in the early recovery phase of acute care following a complicated mTBI.

METHODS & PROCEDURES

Demographic and accident-related data as well as the scores on cognitive-communication skill measures in the areas of auditory comprehension (complex ideational material subtest of the Boston Diagnostic Aphasia Examination), verbal reasoning (verbal absurdities subtest of the Detroit Test of Learning Aptitude), confrontation naming (short form of the Boston Naming Test), verbal fluency (semantic category and letter category naming), and conversational discourse (conversational checklist of the Protocole Montréal d'évaluation de la communication) were retrospectively collected from the medical records of 128 patients with complicated mTBI admitted to a tertiary care trauma hospital. Multiple linear regressions analyses were carried out on the variables sex, age, education level, Glasgow Coma Scale (GCS) score, lesion site and bilingualism.

OUTCOMES & RESULTS

Females performed better than males on letter-category naming, while those more advanced in age performed worse on most cognitive-communication measures. Patients with higher education achieved better confrontation and letter-category naming, whereas reading comprehension results were worse with a lower GCS score. Bilingual individuals presented more difficulty in conversational discourse skills than those who spoke only one language. In terms of site of lesion, the presence of a right frontal injury was associated with worse auditory and reading comprehension and an occipital lesion was related to worse confrontation naming.

CONCLUSIONS & IMPLICATIONS

Cognitive-communication skills should be evaluated early in all patients with complicated mTBI, but especially in those who are advanced in age, those with fewer years of education and those who present with lower GCS scores, in order to determine rehabilitation needs. The findings of this study will allow acute care clinicians to better understand how various demographic and injury-related factors affect cognitive-communication skills after complicated mTBI and to better nuance the interpretation of their evaluation results in order to improve clinical care. Further study is required regarding the influence of lesion location, sex and bilingualism following complicated mTBI. What this paper adds What is already known on the subject In early acute recovery studies including all severity of TBI, cognitive-communication performance was poorer in individuals with more advanced age, those with fewer years of education and with more severe TBI. It is not yet known which demographic and injury-related variables predict cognitive-communication performance after a complicated mTBI specifically. What this paper adds to existing knowledge We confirmed that age, level of education and TBI severity, as measured with the GCS score, were associated with some areas of cognitive-communication performance for a group of patients in the acute stage of recovery from a complicated mTBI. We also identified that sex, bilingualism and site of lesion were new variables that show an influence on aspects of cognitive-communication skills in this group of patients. What are the potential or actual clinical implications of this work? The findings of this study on prognostic factors in the case of complicated mTBI will help acute care clinicians to better understand evaluation results knowing the variables that can influence cognitive-communication performance and to nuance the interpretation of these results with the goal of determining rehabilitation needs and enhancing clinical care.

Lifelong Bilingualism Functions as an Alternative Intervention for Cognitive Reserve Against Alzheimer's Disease

Bilingualism has been reported to significantly delay the onset of dementia and plays an important role in the management of Alzheimer's disease (AD), a condition inducing impairment in the brain network and cognitive decline. Cognitive reserve is associated with the adaptive maintenance of neural functions by protecting against neuropathology. Bilingualism acts as a beneficial environmental factor contributing to cognitive reserve, although some potential confounding variables still need further elucidation. In this article, the relationship between bilingualism and cognitive reserve is discussed, interpreting the advantage of bilingualism in protecting against cognitive decline. In addition, the possible brain and biochemical mechanisms, supporting the advantageous effects of bilingualism in delaying the onset of dementia, involved in bilingualism are reviewed. Effectively, bilingualism can be considered as a pharmacological intervention with no side effects. However, the investigation of the pharmacological parameters of bilingualism is still at an early stage.

Meta-Analysis Reveals a Bilingual Advantage That Is Dependent on Task and Age

Debate continues on whether a bilingual advantage exists with respect to executive functioning. This report synthesized the results of 170 studies to test whether the bilingual advantage is dependent on the task used to assess executive functioning and the age of the participants. The results of the meta-analyses indicated that the bilingual advantage was both task- and age-specific. Bilinguals were significantly faster than monolinguals (Hedges' g values ranged from 0.23 to 0.34), and significantly more accurate than monolinguals (Hedges' g values ranged between 0.18 and 0.49) on four out of seven tasks. Also, an effect of age was found whereby the bilingual advantage was larger for studies comprising samples aged 50-years and over (Hedges' g = 0.49), compared to those undertaken with participants aged between 18 and 29 years (Hedges' g = 0.12). The extent to which the bilingual advantage might be due to publication bias was assessed using multiple methods. These were Egger's Test of Asymmetry, Duval and Tweedie's Trim and Fill, Classic Fail-Safe N, and PET-PEESE. Publication bias was only found when using Egger's Test of Asymmetry and PET-PEESE method, but not when using the other methods. This review indicates that if bilingualism does enhance executive functioning, the effects are modulated by task and age. This may arise because using multiple languages has a highly specific effect on executive functioning which is only observable in older, relative to younger, adults. The finding that publication bias was not uniformly detected across the different methods raises questions about the impact that unpublished (or undetected) studies have on meta-analyses of this literature.

The effect of bilingualism on brain development from early childhood to young adulthood

Bilingualism affects the structure of the brain in adults, as evidenced by experience-dependent grey and white matter changes in brain structures implicated in language learning, processing, and control. However, limited evidence exists on how bilingualism may influence brain development. We examined the developmental patterns of both grey and white matter structures in a cross-sectional study of a large sample (n = 711 for grey matter, n = 637 for white matter) of bilingual and monolingual participants, aged 3–21 years. Metrics of grey matter (thickness, volume, and surface area) and white matter (fractional anisotropy and mean diffusivity) were examined across 41 cortical and subcortical brain structures and 20 tracts, respectively. We used generalized additive modelling to analyze whether, how, and where the developmental trajectories of bilinguals and monolinguals might differ. Bilingual and monolingual participants manifested distinct developmental trajectories in both grey and white matter structures. As compared to monolinguals, bilinguals showed: (a) more grey matter (less developmental loss) starting during late childhood and adolescence, mainly in frontal and parietal regions (particularly in the inferior frontal gyrus pars opercularis, superior frontal cortex, inferior and superior parietal cortex, and precuneus); and (b) higher white matter integrity (greater developmental increase) starting during mid-late adolescence, specifically in striatal–inferior frontal fibers. The data suggest that there may be a developmental basis to the well-documented structural differences in the brain between bilingual and monolingual adults.

Bilingualism, Demographics, and Cognitive Control: A Within-Group Approach

Previous studies have suggested a bilingual advantage in cognitive control as a result of the bilinguals’ language experience. However, the results are controversial as there are various factors (language proficiency, SES, culture, and intelligence, etc.) affecting cognitive control. In the current study, after between-group comparisons, we adopted a within-group approach by multiple regressions to investigate whether the performance by 10-to-75-year-old participants (N = 91) of tasks measuring inhibition, monitoring, and mental set shifting could be predicted by bilingualism, or demographic factors, or both. The results of multiple stepwise regression analyses showed that L2 proficiency was a significant predictor for conflict monitoring and inhibition, education and age were significant predictors for mental set shifting, and SES was a minor predictor for inhibition. These findings provide evidence that cognitive control is affected by both bilingualism and demographic factors. Future studies are encouraged to further identify the relationship between bilingualism and cognitive control from specific bilingual experience.

A cross-sectional and longitudinal study on the protective effect of bilingualism against dementia using brain atrophy and cognitive measures

Background

Evidence from previous studies suggests that bilingualism contributes to cognitive reserve because bilinguals manifest the first symptoms of Alzheimer’s disease (AD) up to 5 years later than monolinguals. Other cross-sectional studies demonstrate that bilinguals show greater amounts of brain atrophy and hypometabolism than monolinguals, despite sharing the same diagnosis and suffering from the same symptoms. However, these studies may be biased by possible pre-existing between-group differences.

Methods

In this study, we used global parenchymal measures of atrophy and cognitive tests to investigate the protective effect of bilingualism against dementia cross-sectionally and prospectively, using a sample of bilinguals and monolinguals in the same clinical stage and matched on sociodemographic variables.

Results

Our results suggest that the two groups did not differ in their cognitive status at baseline, but bilinguals had less parenchymal volume than monolinguals, especially in areas related to brain atrophy in dementia. In addition, a longitudinal prospective analysis revealed that monolinguals lost more parenchyma and had more cognitive decline than bilinguals in a mean follow-up period of 7 months.

Conclusion

These results provide the first prospective evidence that bilingualism may act as a neuroprotective factor against dementia and could be considered a factor in cognitive reserve.

The Role of Cognitive Reserve in Alzheimer's Disease and Aging: A Multi-Modal Imaging Review

Comforts in modern society have generally been associated with longer survival rates, enabling individuals to reach advanced age as never before in history. With the increase in longevity, however, the incidence of neurodegenerative diseases, especially Alzheimer's disease, has also doubled. Nevertheless, most of the observed variance, in terms of time of clinical diagnosis and progression, often remains striking. Only recently, differences in the social, educational and occupational background of the individual, as proxies of cognitive reserve (CR), have been hypothesized to play a role in accounting for such discrepancies. CR is a well-established concept in literature; lots of studies have been conducted in trying to better understand its underlying neural substrates and associated biomarkers, resulting in an incredible amount of data being produced. Here, we aimed to summarize recent relevant published work addressing the issue, gathering evidence for the existence of a common path across research efforts that might ease future investigations by providing a general perspective on the actual state of the arts. An innovative model is hereby proposed, addressing the role of CR across structural and functional evidences, as well as the potential implementation of non-invasive brain stimulation techniques in the causal validation of such theoretical frame.

Bilingualism for Dementia: Neurological Mechanisms Associated With Functional and Structural Changes in the Brain

As the number of older adults increases, the prevalence of dementias, such as Alzheimer’s dementia (AD), vascular dementia, dementia with Lewy bodies, and frontotemporal dementias, also increases. Despite research into pharmacological approaches for treating diverse diseases, there is still no cure. Recently, novel non-pharmacological interventions are attracting attention. Non-pharmacological approaches include cognitive stimulation, alterations in diet, physical activity, and social engagement. Cognitive stimulating activities protect against the negative effects of cognitive decline caused by age-related neurogenerative diseases. Bilingualism is one form of cognitive stimulation that requires multiple aspects of brain activity and has been shown to delay the onset of dementia symptoms in patients by approximately 4–5 years as compared with monolingual patients through cognitive reserve. The purpose of this review was to bilingualism protects against cognitive decline associated with AD and other dementias. We discuss potential underlying neurological mechanisms, including: (1) stimulating adult neurogenesis, (2) enhancing synaptogenesis, (3) strengthening functional connectivity that bilingualism may delay clinical AD symptoms, (4) protecting white matter integrity, and (5) preserving gray matter density.

The relationship between bilingual experience and gyrification in adulthood: A cross-sectional surface-based morphometry study

Neuroimaging evidence suggests that bilingualism may act as a source of neural plasticity. However, prior work has mostly focused on bilingualism-induced alterations in gray matter volume and white matter tract microstructure, with additional effects related to other neurostructural indices that might have remained undetected. The degree of cortical folding or gyrification is a morphometric parameter which provides information about changes on the brain's surface during development, aging and disease. We used Surface-based Morphometry (SBM) to investigate the contribution of bilingual experience to gyrification from early adulthood to old age in a sample of bilinguals and monolingual controls. Despite widespread cortical folding reductions for all participants with increasing age, preserved gyrification exclusive to bilinguals was detected in the right cingulate and entorhinal cortices, regions vulnerable with normal and pathological brain aging. Our results provide novel insights on experience-related cortical reshaping and bilingualism-induced cortical plasticity in adulthood.

Testing the influence of musical expertise on novel word learning across the lifespan using a cross-sectional approach in children, young adults and older adults

Word learning is a multifaceted perceptual and cognitive task that is omnipresent in everyday life. Currently, it is unclear whether this ability is influenced by age, musical expertise or both variables. Accordingly, we used EEG and compared behavioral and electrophysiological indices of word learning between older adults with and without musical expertise (older adults' perspective) as well as between musically trained and untrained children, young adults, and older adults (lifespan perspective). Results of the older adults' perspective showed that the ability to learn new words is preserved in elderly, however, without a beneficial influence of musical expertise. Otherwise, results of the lifespan perspective revealed lower error rates and faster reaction times in young adults compared to children and older adults. Furthermore, musically trained children and young adults outperformed participants without musical expertise, and this advantage was accompanied by EEG manifestations reflecting faster learning and neural facilitation in accessing lexical-semantic representations.

A Bilingual Advantage? An Appeal for a Change in Perspective and Recommendations for Future Research

The debate on possible cognitive advantages bilinguals have over monolinguals continues to occupy the research community. There is an ever-growing research body focusing on adjudicating whether there is, in fact, an effect of using two or more languages regularly on cognition. In this paper, we briefly review some of the more pertinent literature that has attempted to identify attenuating, modulating, and confounding factors in research comparing monolingual and bilingual populations, and we highlight issues that should be taken into account in future research to move forward as a research community. At the same time, we argue for a change in perspective concerning what is deemed an advantage and what is not and argue for more ecologically valid research that investigates real-life advantages.

Distinct structural correlates of the dominant and nondominant languages in bilinguals with Alzheimer's disease (AD)

Structural adaptations in brain regions involved in domain-general cognitive control are associated with life-long bilingualism and may contribute to the executive function advantage of bilinguals over monolinguals. To the degree that these adaptations support bilingualism, their disruption by Alzheimer's disease (AD) may compromise the ability to maintain proficiency in two languages, particularly in the less proficient, or nondominant, language that has greater control demands. The present study assessed this possibility in Spanish-English bilinguals with AD (n = 21) and cognitively normal controls (n = 30) by examining the brain correlates of dominant versus nondominant language performance on the Multilingual Naming Test (MINT), adjusting for age and education. There were no significant structural correlates of naming performance for either language in controls. In patients with AD, dominant language MINT performance was associated with cortical thickness of the entorhinal cortex and middle temporal gyrus, consistent with previous findings of temporal atrophy and related decline of naming abilities in AD. Nondominant language MINT performance, in contrast, was correlated with thickness of the left caudal anterior cingulate cortex (ACC), a central cognitive control region involved in error monitoring and task switching. The relationship between naming in the nondominant language and ACC in patients with AD but not in controls may reflect increased reliance on the ACC for nondominant language use in the face of atrophy of other control network components. The results are consistent with the possibility that the increased burden nondominant language use places on cognitive control systems compromised in AD may account for faster nondominant than dominant language decline in AD.

Retracted: The Effect of Bilingualism on Older Adults' Inhibitory Control: A Meta-Analysis

BACKGROUND AND OBJECTIVES

The effect bilingualism has on older adults' inhibitory control has been extensively investigated, yet there is continued controversy regarding whether older adult bilinguals show superior inhibitory control compared with monolinguals. The objective of the current meta-analysis was to examine the reliability and magnitude of the bilingualism effect on older adults' inhibitory control as measured by the Simon and Stroop tasks. In addition, we examined whether individual characteristics moderate the bilingual advantage in inhibition, including age (young-old vs old-old), age of second language acquisition, immigrant status, language proficiency, and frequency of language use.

RESEARCH DESIGN AND METHODS

A total of 22 samples for the Simon task and 14 samples for the Stroop task were derived from 28 published and unpublished articles (32 independent samples, with 4 of these samples using more than 1 task) and were analyzed in 2 separate meta-analyses.

RESULTS

Analyses revealed a reliable effect of bilingualism on older adults' performance on the Simon (g = 0.60) and Stroop (g = 0.27) tasks. Interestingly, individual characteristics did not moderate the association between bilingualism and older adults' inhibitory control.

DISCUSSION AND IMPLICATIONS

The results suggest there is a bilingual advantage in inhibitory control for older bilinguals compared with older monolinguals, regardless of the individual characteristics previously thought to moderate this effect. Based on these findings, bilingualism may protect inhibitory control from normal cognitive decline with age.

Consequences of multilingualism for neural architecture

Language has the power to shape cognition, behavior, and even the form and function of the brain. Technological and scientific developments have recently yielded an increasingly diverse set of tools with which to study the way language changes neural structures and processes. Here, we review research investigating the consequences of multilingualism as revealed by brain imaging. A key feature of multilingual cognition is that two or more languages can become activated at the same time, requiring mechanisms to control interference. Consequently, extensive experience managing multiple languages can influence cognitive processes as well as their neural correlates. We begin with a brief discussion of how bilinguals activate language, and of the brain regions implicated in resolving language conflict. We then review evidence for the pervasive impact of bilingual experience on the function and structure of neural networks that support linguistic and non-linguistic cognitive control, speech processing and production, and language learning. We conclude that even seemingly distinct effects of language on cognitive operations likely arise from interdependent functions, and that future work directly exploring the interactions between multiple levels of processing could offer a more comprehensive view of how language molds the mind.

Comprehending Non-literal Language: Effects of Aging and Bilingualism

A pressing issue that the twenty-first century is facing in many parts of the developed world is a rapidly aging population. Whilst several studies have looked at aging older adults and their language use in terms of vocabulary, syntax and sentence comprehension, few have focused on the comprehension of non-literal language (i.e., pragmatic inference-making) by aging older adults, and even fewer, if any, have explored the effects of bilingualism on pragmatic inferences of non-literal language by aging older bilinguals. Thus, the present study examined the effects of age(ing) and the effects of bilingualism on aging older adults' ability to infer non-literal meaning. Four groups of participants made up of monolingual English-speaking and bilingual English-Tamil speaking young (17-23 years) and older (60-83 years) adults were tested with pragmatic tasks that included non-conventional indirect requests, conversational implicatures, conventional metaphors and novel metaphors for both accuracy and efficiency in terms of response times. While the study did not find any significant difference between monolinguals and bilinguals on pragmatic inferences, there was a significant effect of age on one type of non-literal language tested: conventional metaphors. The effect of age was present only for the monolinguals with aging older monolinguals performing less well than the young monolinguals. Aging older bilingual adults were not affected by age whilst processing conventional metaphors. This suggests a bilingual advantage in pragmatic inferences of conventional metaphors.

Exploring the Opportunities and Challenges of the Digital World for Early Childhood Services with Vulnerable Children

Potentially addictive behaviours supported by the internet and mobile phones raise concerns in education services for early childhood. Although there is evidence that screen media can distract the attention of young children, there was a massive uptake of digital devices by early childhood centres (ECCs). We investigated practices of families (n = 85) and of six ECCs serving vulnerable children in New Zealand, many of whom are emergent bilinguals. Descriptions of the limited and exemplary choice of screen media of the ECCs include digital portfolios containing children’s learning stories in multiple languages illustrated with digital photos. This was facilitated by increasing partnership with the families and the inclusion of their languages in the physical and digital landscapes of the ECCs. However, these families and the ECCs are seeking additional guidance to face the complex challenges of the digital world. These early findings from our national research programme, A Better Start, E Tipu E Rea, already informed significant changes in the ECCs; we also identified the potential for young children to act as agents of change.

Neural signatures of inhibitory control in bilingual spoken production

Bilinguals activate both languages when they intend to speak even one language alone (e.g., Kroll, Bobb, & Wodniekca, 2006). At the same time, they are able to select the language they intend to speak and switch back and forth between languages rapidly, with few production errors. Previous research utilizing behavioral (Linck, Kroll, & Sunderman, 2009) and neuroimaging techniques (ERPs and fMRI; Guo, Liu, Misra, & Kroll, 2011; Misra, Guo, Bobb, & Kroll, 2012) suggest that successful bilingual speech production is enabled by active inhibition of the language not in use. Results showing an asymmetric switching cost for the L1 compared to the L2 (with a larger cost -reflected in longer naming latencies-when switching from the L2 to the L1) have been taken as evidence that the L1 (usually the dominant language for bilinguals who learned their second language later in life) may need to be inhibited when speaking in the L2. However, there is still little research on the scope of this inhibitory process. The goal of this event-related functional magnetic resonance imaging study is to understand how the recruitment of neural areas implicated during bilingual language processing are shaped by the scope of language use. The results show that bilinguals engage a wide functional control network that is hierarchically engaged in local control for single lexical items, but extends further to the broader semantic level, and finally to the whole language. This functional network is modulated by proficiency in the L2.

Neuroplasticity across the lifespan and aging effects in bilinguals and monolinguals

Evidence that bilingualism protects against age-related neurocognitive decline is mixed. One relatively consistent finding is that bilingual seniors have greater grey matter volume (GMV) in regions implicated in executive control (EC) and language processing. Here, we compare the neuroplastic effects of bilingual experience on the EC network of young and aging populations directly, and for the first time we evaluate the extent to which such effects may predict executive control performance across age. We used GMV as an index of neural reserve and response time (RT) performance on the Flanker task for measuring EC efficiency. In the presence of age-related widespread GM deterioration, bilinguals had greater GMV than monolinguals in key regions of interest across age. Moreover, whereas EC performance in monolingual seniors was strictly related to GMV, this was not observed for bilingual seniors or younger participants in either group. Interactions between expected effects-of-age and language group on the relationships between GMV and RT suggested that bilingualism affords differential benefits across the lifespan. In younger participants, greater GMV offered no behavioral benefit on EC performance, whilst it did for seniors. It thus appears that age-related cognitive decline following GMV loss in the EC network is delayed in bilinguals.

Neural basis of bilingual language control

Acquiring and speaking a second language increases demand on the processes of language control for bilingual as compared to monolingual speakers. Language control for bilingual speakers involves the ability to keep the two languages separated to avoid interference and to select one language or the other in a given conversational context. This ability is what we refer with the term "bilingual language control" (BLC). It is now well established that the architecture of this complex system of language control encompasses brain networks involving cortical and subcortical structures, each responsible for different cognitive processes such as goal maintenance, conflict monitoring, interference suppression, and selective response inhibition. Furthermore, advances have been made in determining the overlap between the BLC and the nonlinguistic executive control networks, under the hypothesis that the BLC processes are just an instantiation of a more domain-general control system. Here, we review the current knowledge about the neural basis of these control systems. Results from brain imaging studies of healthy adults and on the performance of bilingual individuals with brain damage are discussed.

A core avenue for transcultural research on dementia: on the cross-linguistic generalization of language-related effects in Alzheimer's disease and Parkinson's disease

OBJECTIVE

Language is a key source of cross-cultural variability, which may have both subtle and major effects on neurocognition. However, this issue has been largely overlooked in two flourishing lines of research assessing the relationship between language-related neural systems and dementia. This paper assesses the limitations of the evidence on (i) the neuroprotective effects of bilingualism in Alzheimer's disease and (ii) specific language deficits as markers of Parkinson's disease.

DESIGN

First, we outline the rationale behind each line of research. Second, we review available evidence and discuss the potential impact of cross-linguistic factors. Third, we outline ideas to foster progress in both fields and, with it, in cross-cultural neuroscience at large.

RESULTS

On the one hand, studies on bilingualism suggest that sustained use of more than one language may protect against Alzheimer's disease symptoms. On the other hand, insights from the embodied cognition framework point to syntactic and action-verb deficits as early (and even preclinical) markers of Parkinson's disease. However, both fields share a key limitation that lies at the heart of cultural neuroscience: the issue of cross-linguistic generalizability.

CONCLUSION

Relevant evidence for both research trends comes from only a handful of (mostly Indo-European) languages, which are far from capturing the full scope of structural and typological diversity of the linguistic landscape worldwide. This raises questions on the external validity of reported findings. Greater collaboration between linguistic typology and cognitive neuroscience seems crucial as a first step to assess the impact of transcultural differences on language-related effects across neurodegenerative diseases. Copyright © 2017 John Wiley & Sons, Ltd.

Does bilingualism increase brain or cognitive reserve in patients with temporal lobe epilepsy?

OBJECTIVE

Bilingual healthy adults have been shown to exhibit an advantage in executive functioning (EF) that is associated with microstructural changes in white matter (WM) networks. Patients with temporal lobe epilepsy (TLE) often show EF deficits that are associated with WM compromise. In this study, we investigate whether bilingualism can increase cognitive reserve and/or brain reserve in bilingual patients with TLE, mitigating EF impairment and WM compromise.

METHODS

Diffusion tensor imaging was obtained in 19 bilingual and 26 monolingual patients with TLE, 12 bilingual healthy controls (HC), and 21 monolingual HC. Fractional anisotropy (FA) and mean diffusivity (MD) were calculated for the uncinate fasciculus (Unc) and cingulum (Cing), superior frontostriatal tract (SFS), and inferior frontostriatal tract (IFS). Measures of EF included Trail Making Test-B (TMT-B) and Delis-Kaplan Executive Function System Color-Word Inhibition/Switching. Analyses of covariance were conducted to compare FA and MD of the Unc, Cing, SFS, and IFS and EF performance across groups.

RESULTS

In bilingual patients, FA was lower in the ipsilateral Cing and Unc compared to all other groups. For both patient groups, MD of the ipsilateral Unc was higher relative to HC. Despite more pronounced reductions in WM integrity, bilingual patients performed similarly to monolingual TLE and both HC groups on EF measures. By contrast, monolingual patients performed worse than HC on TMT-B. In addition, differences in group means between bilingual and monolingual patients on TMT-B approached significance when controlling for the extent of WM damage (P = .071; d = 0.62), suggesting a tendency toward higher performance for bilingual patients.

SIGNIFICANCE

Despite poorer integrity of regional frontal lobe WM, bilingual patients performed similarly to monolingual patients and HC on EF measures. These findings align with studies suggesting that bilingualism may provide a protective factor for individuals with neurological disease, potentially through reorganization of EF networks that promote greater cognitive reserve.