Bilingual language intrusions and other speech errors in Alzheimer's disease

Revisiting which language declines more in Spanish-English bilinguals with Alzheimer's disease: Longitudinal decline patterns on the multilingual naming test

Theories of bilingual language production predict that bilinguals with Alzheimer's disease (AD) should exhibit one of two decline patterns. Either parallel decline of both languages (if decline reflects damage to semantic representations that are accessed by both languages), or asymmetrical decline, with greater decline of the nondominant language (if decline reflects reduced ability to resolve competition from the dominant language with disease progression). Only two previous studies examined decline longitudinally with one showing parallel, and the other asymmetrical, decline. We examined decline over 2-7 years (3.9 on average) in Spanish-English bilinguals (N = 23). Logistic regression revealed a parallel decline pattern at one year from baseline, but an asymmetrical decline pattern over the longer decline period, with greater decline of the nondominant language (when calculating predicted probabilities of a correct response). The asymmetrical decline pattern was significantly greater for the nondominant language only when including item-difficulty in the model. Exploratory analyses across dominance groups looking at proportional decline relative to initial naming accuracy further suggested that decline of the nondominant language may be more precipitous if that language was acquired later in life, but the critical interaction needed to support this possibility was not statistically significant in a logistic regression analysis. These results suggest that accessibility of the nondominant language may initially be more resilient in early versus more advanced AD, and that AD affects shared semantic representations before executive control declines to a point where the ability to name pictures in single-language testing block is disrupted. Additional work is needed to determine if asymmetrical decline patterns are magnified by late age of acquisition of the nondominant language, and if more subtle impairments to executive control underlie impairments to language switching that occur in the earliest stages of AD (even preclinically).

Language switching and speaking a nondominant language challenge executive control: Preliminary data for novel behavioral markers of Alzheimer's risk in Spanish-English bilinguals

OBJECTIVE

The present study explored psycholinguistic analysis of spoken responses produced in a structured interview and cued linguistic and nonlinguistic task switching as possible novel markers of Alzheimer's disease (AD) risk in Spanish-English bilinguals.

METHOD

Nineteen Spanish-English bilinguals completed an Oral Proficiency Interview (OPI) in both languages, cued-switching tasks, and a battery of traditional neuropsychological tests (in a separate testing session). All were cognitively healthy at the time of testing, but eight decliners were later diagnosed with AD (on average 4.5 years after testing; SD = 2.3), while 11 controls remained cognitively healthy.

RESULTS

Past studies showed picture naming was more sensitive to AD in the dominant than in the nondominant language, but we found the opposite for a composite measure of spoken utterances produced in the OPI that included revisions, repetitions, and filled pauses (RRFPs), which were especially sensitive to AD risk in the nondominant language. Errors produced on language switch trials best discriminated decliners from controls (in receiver operating characteristic curves), and though the nonlinguistic switching task was also sensitive to AD risk, it elicited more errors overall and was also negatively affected by increased age and low education level.

CONCLUSIONS

Speaking a nondominant language and errors in cued language switching provided sensitive and specific markers of pending cognitive decline and AD risk in bilinguals. These measures may reflect early decline in executive control abilities that are needed to plan and monitor the production of connected speech and to manage competition for selection between languages. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Speech disfluencies in bilingual Greek-English young adults

PURPOSE

The purpose of this study was to investigate the frequency and types of disfluencies in Greek-English bilingual adults across naturalistic speech samples and compare frequency and types of disfluencies between the participants' L1 and L2.

METHODS

Participants in the study included 26 Greek-English bilingual young adults. All participants were sequential bilinguals, whose first language was Greek and second language was English. Two speech samples were collected in each language, a conversational and a narrative sample, which were subsequently analyzed for the frequency and types of disfluencies.

RESULTS

Results indicated that participants produced more typical disfluencies in English compared to Greek across speaking samples. The most frequent types of disfluencies were filled pauses and vowel prolongations (without tension or struggle) across speaking samples and languages.

CONCLUSION

Our results revealed differences in the types and frequencies of disfluencies produced in participants' native compared to their second language. Results add to the growing body of literature addressing the manifestation of speech disfluencies in bilingual speakers.

Autocorrection if→of function words in reading aloud: A novel marker of Alzheimer's risk

OBJECTIVE

The present study investigated cognitive mechanisms underlying the ability to stop "autocorrect" errors elicited by unexpected words in a read-aloud task, and the utility of autocorrection for predicting Alzheimer's disease (AD) biomarkers.

METHOD

Cognitively normal participants (total n = 85; n = 64 with cerebrospinal fluid [CSF] biomarkers) read aloud six short paragraphs in which 10 critical target words were replaced with autocorrect targets, for example, The player who scored that final [paint] for the local team reported [him] experience. Autocorrect targets either replaced the most expected/dominant completion (i.e., point) or a less expected/nondominant completion (i.e., basket), and within each paragraph half of the autocorrect targets were content words (e.g., point/paint) and half were function words (e.g., his/him). Participants were instructed to avoid autocorrecting.

RESULTS

Participants produced more autocorrect errors in paragraphs with dominant than with nondominant targets, and with function than with content targets. Cognitively normal participants with high CSF Tau/Aβ42 (i.e., an AD-like biomarker profile) produced more autocorrect total errors than those below the Tau/Aβ42 threshold, an effect also significant with dominant-function targets alone (e.g., saying his instead of him). A logistic regression model with dominant-function errors and age showed errors as the stronger predictor of biomarker status (sensitivity 83%; specificity 85%).

CONCLUSIONS

Difficulty stopping autocorrect errors is associated with biomarkers indicating preclinical AD, and reveals promise as a diagnostic tool. Greater vulnerability of function over content words to autocorrection in individuals with AD-like biomarkers implicates monitoring and attention (rather than semantic processing) in the earliest of cognitive changes associated with AD risk. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Which language is more affected in bilinguals with Alzheimer's disease? Diagnostic sensitivity of the Multilingual Naming Test

OBJECTIVE

This study examined the joint consequences of bilingualism and Alzheimer's disease (AD) for picture naming ability to determine which language is more affected by AD and what scoring methods best distinguish patients from controls.

METHOD

Sixty-five Spanish-English bilinguals including 26 with dementia and 39 controls with equivalent age, education, and bilingual proficiency level, were tested on the Multilingual Naming Test (Gollan et al., 2012).

RESULTS

Bilinguals with AD named fewer pictures than controls, and overall AD seemed to affect both languages about equally, but exploratory analyses suggested that this varied with item difficulty. In the dominant language difficult items exhibited a larger effect of AD than easy items (which were at ceiling for both patients and controls), whereas in the nondominant language items of all difficulty levels were about equally affected by AD. An "either-language" scoring procedure (that counted items as correct if produced only in one of the two languages) increased naming scores especially in balanced bilinguals, and to an equal extent in patients and controls. Receiver Operating Characteristic analyses revealed that dominant language and either-language naming scores classified bilinguals as patients versus controls equally well and adding nondominant language scores did not improve diagnostic sensitivity.

CONCLUSIONS

Testing primarily or exclusively in the dominant language is best for detecting AD naming impairments in bilinguals. However, AD affects the ability to access names in both languages, possibly for different reasons, and simple descriptions of language decline as "parallel" or "asymmetrical" (i.e., AD affecting one language more than the other) may be misleading in terms of the theoretical implications for bilingual language processing. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Inhibitory control of the dominant language: Reversed language dominance is the tip of the iceberg

Theories of speech production have proposed that in contexts where multiple languages are produced, bilinguals inhibit the dominant language with the goal of making both languages equally accessible. This process often overshoots this goal, leading to a surprising pattern: better performance in the nondominant vs. dominant language, or reversed language dominance effects. However, the reliability of this effect in single word production studies with cued language switches has been challenged by a recent meta-analysis. Correcting for errors in this analysis, we find that dominance effects are reliably reduced and reversed during language mixing. Reversed dominance has also consistently been reported in the production of connected speech elicited by reading aloud of mixed language paragraphs. When switching, bilinguals produced translation-equivalent intrusion errors (e.g., saying pero instead of but) more often when intending to produce words in the dominant language. We show this dominant language vulnerability is not exclusive to switching out of the nondominant language and extends to non-switch words, linking connected speech results to patterns first reported in single word studies. Reversed language dominance is a robust phenomenon that reflects the tip of the iceberg of inhibitory control of the dominant language in bilingual language production.

The Spanish-English bilingual experience and cognitive change in Hispanics/Latinos from the Hispanic Community Health Study/Study of Latinos-Investigation of Neurocognitive Aging

INTRODUCTION

Studies suggest bilingualism may delay behavioral manifestations of adverse cognitive aging including Alzheimer's dementia.

METHODS

Three thousand nine hundred sixty-three participants (unweighted mean population age ≈56 years) at Hispanic Community Health Study/Study of Latinos baseline (2008-2011) self-reported their and their parents' birth outside the United States, Spanish as their first language, and used Spanish for baseline and comparable cognitive testing 7 years later (2015-2018). Spanish/English language proficiency and patterns of use were self-rated from 1 = only Spanish to 4 = English > Spanish. Cognitive testing included test-specific and global composite score(s) of verbal learning, memory, word fluency, and Digit Symbol Substitution (DSS). Survey linear regression models examined associations between baseline bilingualism scores and cognition.

RESULTS

Higher second-language (English) proficiency and use were associated with higher global cognition, fluency, and DSS at follow-up and better than predicted change in fluency.

DISCUSSION

The bilingual experience was more consistently related to 7-year level versus change in cognition for Hispanics/Latinos.

Including ethnic minorities in dementia research: Recommendations from a scoping review

Introduction

Ethnicity influences dementia etiology, prognosis, and treatment, while culture shapes help-seeking and care. Despite increasing population diversity in high-income settlement countries, ethnic minorities remain underrepresented in dementia research. We investigated approaches to enhance the recruitment, and consistent collection and analysis of variables relevant to, ethnic minorities in dementia studies to make recommendations for consistent practice in dementia research.

Methods

We did a scoping review, searching Embase, PsycINFO, Medline, CENTRAL, and CINAHL between January 1, 2010 and January 7, 2020. Dementia clinical and cohort studies that actively recruited ethnic minorities in high-income countries were included. A steering group of experts developed criteria through which high-quality studies were identified.

Results

Sixty-six articles were retrieved (51 observational; 15 experimental). Use of interpreters and translators (n = 17) was the most common method to facilitate participant recruitment. Race and ethnicity (n = 59) were the most common variables collected, followed by information on native language (n = 14), country of birth (n = 9), and length of time in country of settlement (n = 8). Thirty-three studies translated or used a culturally validated instrument. Twenty-three articles conducted subgroup analyses based on ethnicity. Six high-quality studies facilitated inclusion through community engagement, collected information on multiple aspects of ethnic diversity, and adjusted/substratified to analyze the impact of ethnicity on dementia.

Discussion

We make recommendations for consistent recruitment, collection, and reporting of variables relating to ethnic and cultural diversity in dementia research.

Older bilinguals reverse language dominance less than younger bilinguals: Evidence for the inhibitory deficit hypothesis

Inhibitory control is thought to play a key role in how bilinguals switch languages and may decline in aging. We tested these hypotheses by examining age group differences in the reversed language dominance effect-a signature of inhibition of the dominant language that leads bilinguals to name pictures more slowly in the dominant than the nondominant language in mixed-language testing blocks. Twenty-five older and 48 younger Spanish-English bilinguals completed a cued language-switching task. To test if inhibition is applied at the whole-language or lexical level, we first presented one set of pictures repeatedly, then introduced a second list halfway through the experiment. Younger bilinguals exhibited significantly greater reversed language dominance effects than older bilinguals (who exhibited nonsignificant language dominance effects). In younger bilinguals, dominance reversal transferred to, and was even larger in, the second list (compared to the first). The latter result may suggest that inhibition is partially offset by repetition in ways that are not yet fully understood. More generally, these results support the hypotheses that aging impairs inhibitory control of the dominant language, which young bilinguals rely on to switch languages. Additionally, inhibition is applied primarily at the whole-language level, and speculatively, this form of language control may be analogous to nonlinguistic proactive control. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

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.

Failure to stop autocorrect errors in reading aloud increases in aging especially with a positive biomarker for Alzheimer's disease

The present study examined the effects of aging and CSF biomarkers of Alzheimer's disease (AD) on the ability to control production of unexpected words in connected speech elicited by reading aloud. Fifty-two cognitively healthy participants aged 66-86 read aloud 6 paragraphs with 10 malapropisms including 5 on content words (e.g., "window cartons" that elicited autocorrect errors to "window curtains") and 5 on function words (e.g., "thus concept" that elicited autocorrections to "this concept") and completed a battery of neuropsychological tests including a standardized Stroop task. Reading aloud elicited more autocorrect errors on function than content words, but these were equally correlated with age and Aβ1-42 levels. The ability to stop autocorrect errors declined in aging and with lower (more AD-like) levels of Aβ1-42, and multiplicatively so, such that autocorrect errors were highest in the oldest-old with the lowest Aβ1-42 levels. Critically, aging effects were significant even when controlling statistically for Aβ1-42. Finally, both autocorrect and Stroop errors were correlated with Aβ1-42, but only autocorrect errors captured unique variance in predicting Aβ1-42 levels. Reading aloud requires simultaneous planning and monitoring of upcoming speech. These results suggest that healthy aging leads to decline in the ability to intermittently monitor for and detect conflict during speech planning and that subtle cognitive changes in preclinical AD magnify this aging deficit. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Codeswitching: A Bilingual Toolkit for Opportunistic Speech Planning

The ability to engage in fluent codeswitching is a hallmark of the flexibility and creativity of bilingual language use. Recent discoveries have changed the way we think about codeswitching and its implications for language processing and language control. One is that codeswitching is not haphazard, but subject to unique linguistic and cognitive constraints. Another is that not all bilinguals codeswitch, but those who do, exhibit usage patterns conforming to community-based norms. However, less is known about the cognitive processes that regulate and promote the likelihood of codeswitched speech. We review recent empirical studies and provide corpus evidence that highlight how codeswitching serves as an opportunistic strategy for optimizing performance in cooperative communication. From this perspective, codeswitching is part and parcel of a toolkit available to bilingual codeswitching speakers to assist in language production by allowing both languages to remain active and accessible, and therefore providing an alternative means to convey meaning, with implications for bilingual speech planning and language control more generally.

Cognitive control regions are recruited in bilinguals' silent reading of mixed-language paragraphs

When switching languages, bilinguals recruit a language control network that overlaps with brain regions known to support general cognitive control, but it is unclear whether these same regions are recruited in passive comprehension of language switches. Using fMRI with a blocked design, 24 Spanish-English bilinguals silently read 36 paragraphs in which the default language was Spanish or English, and that had either (1) no switches, (2) function word switches or (3) content word switches. Relative to no switches, function switches activated the right IFG, bilateral MFG, and left IPL/SMG. In contrast, switching on content words produced limited neural switching costs observed only in the left IFG. Switching into the dominant language was more costly in the right SMG than switching into the nondominant language, and neural switching costs were correlated with switching costs in the dominant language in cued picture-naming. Seemingly passive reading comprehension involves brain regions known to support cognitive control in active switching during production, possibly reflecting the operation of a modality-general switch mechanism.

Minimal Overlap in Language Control Across Production And Comprehension: Evidence from Read-Aloud Versus Eye-Tracking Tasks

Bilinguals are remarkable at language control-switching between languages only when they want. However, language control in production can involve switch costs. That is, switching to another language takes longer than staying in the same language. Moreover, bilinguals sometimes produce language intrusion errors, mistakenly producing words in an unintended language (e.g., Spanish-English bilinguals saying "pero" instead of "but"). Switch costs are also found in comprehension. For example, reading times are longer when bilinguals read sentences with language switches compared to sentences with no language switches. Given that both production and comprehension involve switch costs, some language-control mechanisms might be shared across modalities. To test this, we compared language switch costs found in eye-movement measures during silent sentence reading (comprehension) and intrusion errors produced when reading aloud switched words in mixed-language paragraphs (production). Bilinguals who made more intrusion errors during the read-aloud task did not show different switch cost patterns in most measures in the silent-reading task, except on skipping rates. We suggest that language switching is mostly controlled by separate, modality-specific processes in production and comprehension, although some points of overlap might indicate the role of domain general control and how it can influence individual differences in bilingual language control.

What about proactive language control?

While several reviews provide an in-depth discussion on reactive language control, which is the language control process that is initiated when the non-target language disrupts the selection of target language words, few have touched on proactive language control, which is the language control process implemented as an anticipation of any non-target language interference disrupting the selection of target language words. In the current review, three prominent markers of proactive language control are discussed (i.e., the reversed language dominance effect, language-mixing costs, and the blocked language-order effect). Based on these three markers, it appears that proactive language control can be implemented to mainly restrict interference from the first language during bilingual language production, but is typically absent during bilingual language comprehension. The literature also implies that proactive language control might be partly domain general. With respect to the underlying mechanism of proactive language control, there are some indications that proactive language control relies on inhibition, but no unequivocal evidence has been provided so far.

Intact reversed language-dominance but exaggerated cognate effects in reading aloud of language switches in bilingual Alzheimer's disease

OBJECTIVE

The current study investigated how Alzheimer's disease (AD) affects production of speech errors in reading-aloud of mixed-language passages with language switches on cognates (e.g., family/familia), noncognates (e.g., people/gente), and function words (the/la).

METHOD

Twelve Spanish-English bilinguals with AD and 22 controls read-aloud 8 paragraphs in 4 conditions: (a) English-default content switches, (b) English-default function switches, (c) Spanish-default content switches, and (d) Spanish-default function switches.

RESULTS

Reading elicited language intrusions (e.g., saying la instead of the), and several types of within-language errors (e.g., saying their instead of the). Reversed language-dominance effects were intact in AD; both patients and controls produced many intrusions on dominant language targets, and relatively fewer intrusions on nondominant language targets. The opposite held for within-language errors, which were more common with nondominant than dominant targets. Patients produced the most intrusion errors with cognate switch words (which best distinguished patients from controls in ROC curves of all speech error types), while controls had equal difficulty switching on cognate and function word targets.

CONCLUSIONS

Reversed language-dominance effects appear to illustrate automatic inhibitory control over the dominant language, but could instead reflect limited resources available for monitoring when completing a task in the nondominant language. The greater sensitivity of intrusion errors with cognate than with function word targets for distinguishing patients from controls implies that language control may be aided by relatively intact knowledge of grammatical constraints over code-switching in bilinguals with AD. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Using what's there: Bilinguals adaptively rely on orthographic and color cues to achieve language control

We examined if bilinguals of two different language combinations can rely on novel and arbitrary cues to facilitate switching between languages in a read-aloud task. Spanish-English (Experiment 1) and Hebrew-English (Experiment 2) bilinguals read aloud mixed-language paragraphs, known to induce language intrusion errors (e.g., saying el instead of the), to test if intrusion rates are affected by: language combination, color-cues, language dominance, and part of speech. For Spanish-English bilinguals, written input is not rich in visual cues to language membership, whereas for Hebrew-English bilinguals rich cues are present (i.e., the two languages have different orthographies and are read in opposite directions). Hebrew-English bilinguals made fewer intrusion errors than Spanish-English bilinguals, and color cues significantly reduced intrusions on switches to the dominant language but not to the nondominant language, to the same extent in both bilingual populations. These results reveal powerful effects of visual cues for facilitating production of language switches, and illustrate that switching mechanisms are highly adaptable and sensitive, in that they can both recruit language- and orthography-specific cues when available and also rapidly exploit novel arbitrary cues to language membership when these are afforded. Finally, such incidental, experimentally induced cues, were recruited even in the presence of other already powerful cues, when task demands were high.

Cognates interfere with language selection but enhance monitoring in connected speech

The current study investigated the contribution of phonology to bilingual language control in connected speech. Speech production was elicited by asking Mandarin-English bilinguals to read aloud paragraphs either in Chinese or English, while six words were switched to the other language in each paragraph. The switch words were either cognates or noncognates, and switching difficulty was measured by production of cross-language intrusion errors on the switch words (e.g., mistakenly saying (qiao3-ke4-li4) instead of chocolate). All the bilinguals were Mandarin-dominant, but produced more intrusion errors when target words were written in Chinese than when written in English (i.e., they exhibited robust reversed dominance effects). Most critically, bilinguals produced significantly more intrusions on Chinese cognates, but also detected and self-corrected these same errors more quickly than with noncognates. Phonological overlap boosts dual-language activation thus leading to greater competition between languages, and increased response conflict, thereby increasing production of intrusions but also facilitating error detection during speech monitoring.

What reading aloud reveals about speaking: Regressive saccades implicate a failure to monitor, not inattention, in the prevalence of intrusion errors on function words

Bilinguals occasionally produce language intrusion errors (inadvertent translations of the intended word), especially when attempting to produce function word targets, and often when reading aloud mixed-language paragraphs. We investigate whether these errors are due to a failure of attention during speech planning, or failure of monitoring speech output by classifying errors based on whether and when they were corrected, and investigating eye movement behaviour surrounding them. Prior research on this topic has primarily tested alphabetic languages (e.g., Spanish-English bilinguals) in which part of speech is confounded with word length, which is related to word skipping (i.e., decreased attention). Therefore, we tested 29 Chinese-English bilinguals whose languages differ in orthography, visually cueing language membership, and for whom part of speech (in Chinese) is less confounded with word length. Despite the strong orthographic cue, Chinese-English bilinguals produced intrusion errors with similar effects as previously reported (e.g., especially with function word targets written in the dominant language). Gaze durations did differ by whether errors were made and corrected or not, but these patterns were similar for function and content words and therefore cannot explain part of speech effects. However, bilinguals regressed to words produced as errors more often than to correctly produced words, but regressions facilitated correction of errors only for content, not for function words. These data suggest that the vulnerability of function words to language intrusion errors primarily reflects automatic retrieval and failures of speech monitoring mechanisms from stopping function versus content word errors after they are planned for production.