Abstract
Previous studies have reported bilingualism to be a proxy of cognitive reserve (CR) based on evidence that bilinguals express dementia symptoms ~ 4 years later than monolinguals yet present with greater neuropathology at time of diagnosis when clinical levels are similar. The current study provides new evidence supporting bilingualism’s contribution to CR using a novel brain health matching paradigm. Forty cognitively normal bilinguals with diffusion-weighted magnetic resonance images recruited from the community were matched with monolinguals drawn from a pool of 165 individuals in the Alzheimer’s Disease Neuroimaging Initiative (ADNI) database. White matter integrity was determined for all participants using fractional anisotropy, axial diffusivity, and radial diffusivity scores. Propensity scores were obtained using white matter measures, sex, age, and education as predictive covariates, and then used in one-to-one matching between language groups, creating a matched sample of 32 participants per group. Matched monolinguals had poorer clinical diagnoses than that predicted by chance from a theoretical null distribution, and poorer cognitive performances than matched bilinguals as measured by scores on the MMSE. The findings provide support for the interpretation that bilingualism acts as a proxy of CR such that monolinguals have poorer clinical and cognitive outcomes than bilinguals for similar levels of white matter integrity even before clinical symptoms appear.
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Acknowledgements
Data used in preparation of this article were obtained from the Alzheimer’s Disease Neuroimaging Initiative (ADNI) database (adni.loni.usc.edu). As such, the investigators within the ADNI contributed to the design and implementation of ADNI and/or provided data but did not participate in analysis or writing of this report. A complete listing of ADNI investigators can be found at: http://adni.loni.usc.edu/wp-content/uploads/how_to_apply/ADNI_Acknowledgement_List.pdf.
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Preparation of this manuscript was supported by grants R01HD052523 and R21AG048431 from the US National Institutes of Health and grant A2559 from the Natural Sciences and Engineering Research Council of Canada to EB.
Data collection and sharing for this project was funded by the Alzheimer's Disease Neuroimaging Initiative (ADNI) (National Institutes of Health Grant U01 AG024904) and DOD ADNI (Department of Defense award number W81XWH-12-2-0012). ADNI is funded by the National Institute on Aging, the National Institute of Biomedical Imaging and Bioengineering, and through generous contributions from the following: AbbVie, Alzheimer’s Association; Alzheimer’s Drug Discovery Foundation; Araclon Biotech; BioClinica, Inc.; Biogen; Bristol-Myers Squibb Company; CereSpir, Inc.; Cogstate; Eisai Inc.; Elan Pharmaceuticals, Inc.; Eli Lilly and Company; EuroImmun; F. Hoffmann-La Roche Ltd and its affiliated company Genentech, Inc.; Fujirebio; GE Healthcare; IXICO Ltd.; Janssen Alzheimer Immunotherapy Research & Development, LLC.; Johnson & Johnson Pharmaceutical Research & Development LLC.; Lumosity; Lundbeck; Merck & Co., Inc.; Meso Scale Diagnostics, LLC.; NeuroRx Research; Neurotrack Technologies; Novartis Pharmaceuticals Corporation; Pfizer Inc.; Piramal Imaging; Servier; Takeda Pharmaceutical Company; and Transition Therapeutics. The Canadian Institutes of Health Research is providing funds to support ADNI clinical sites in Canada. Private sector contributions are facilitated by the Foundation for the National Institutes of Health (www.fnih.org). The grantee organization is the Northern California Institute for Research and Education, and the study is coordinated by the Alzheimer’s Therapeutic Research Institute at the University of Southern California. ADNI data are disseminated by the Laboratory for Neuro Imaging at the University of Southern California.
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Matthias Berkes, Noelia Calvo, and Ellen Bialystok contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Matthias Berkes, Noelia Calvo, and John A. E. Anderson. The first draft of the manuscript was written by Matthias Berkes and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
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Berkes, M., Calvo, N., Anderson, J.A.E. et al. Poorer clinical outcomes for older adult monolinguals when matched to bilinguals on brain health. Brain Struct Funct 226, 415–424 (2021). https://doi.org/10.1007/s00429-020-02185-5
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DOI: https://doi.org/10.1007/s00429-020-02185-5