Conversion of Mild Cognitive Impairment to Alzheimer Disease in Monolingual and Bilingual Patients

Early diagnosis of Alzheimer's Disease based on multi-attention mechanism

Alzheimer's Disease is a neurodegenerative disorder, and one of its common and prominent early symptoms is language impairment. Therefore, early diagnosis of Alzheimer's Disease through speech and text information is of significant importance. However, the multimodal data is often complex and inconsistent, which leads to inadequate feature extraction. To address the problem, We propose a model for early diagnosis of Alzheimer's Disease based on multimodal attention(EDAMM). Specifically, we first evaluate and select three optimal feature extraction methods, Wav2Vec2.0, TF-IDF and Word2Vec, to extract acoustic and linguistic features. Next, by leveraging self-attention mechanism and cross-modal attention mechanisms, we generate fused features to enhance and capture the inter-modal correlation information. Finally, we concatenate the multimodal features into a composite feature vector and employ a Neural Network(NN) classifier to diagnose Alzheimer's Disease. To evaluate EDAMM, we perform experiments on two public datasets, i.e., NCMMSC2021 and ADReSSo. The results show that EDAMM improves the performance of Alzheimer's Disease diagnosis over state-of-the-art baseline approaches on both datasets.

Brain-computer interfaces and human factors: the role of language and cultural differences-Still a missing gap?

Brain-computer interfaces (BCIs) aim at the non-invasive investigation of brain activity for supporting communication and interaction of the users with their environment by means of brain-machine assisted technologies. Despite technological progress and promising research aimed at understanding the influence of human factors on BCI effectiveness, some topics still remain unexplored. The aim of this article is to discuss why it is important to consider the language of the user, its embodied grounding in perception, action and emotions, and its interaction with cultural differences in information processing in future BCI research. Based on evidence from recent studies, it is proposed that detection of language abilities and language training are two main topics of enquiry of future BCI studies to extend communication among vulnerable and healthy BCI users from bench to bedside and real world applications. In addition, cultural differences shape perception, actions, cognition, language and emotions subjectively, behaviorally as well as neuronally. Therefore, BCI applications should consider cultural differences in information processing to develop culture- and language-sensitive BCI applications for different user groups and BCIs, and investigate the linguistic and cultural contexts in which the BCI will be used.

Investigating Sex Differences in Risk and Protective Factors in the Progression of Mild Cognitive Impairment to Dementia: A Systematic Review

BACKGROUND

Developing effective strategies for reducing dementia risk requires a detailed understanding of the risk and protective factors associated with the progression of mild cognitive impairment (MCI) to dementia.

OBJECTIVE

We aimed to systematically review the evidence for sex differences in these factors.

METHODS

Five online databases (PubMed/CINAHL/EMBASE/PsycINFO/Cochrane) were searched from inception until 17 October 2022 for cohort studies that focused on sex differences in risk and protective factors in the progression of MCI to dementia.

RESULTS

A total of 2,972 studies were identified, of which 12 studies from five countries were included in the systematic review. There was substantial variability in study designs, study populations and outcome measures. Sex differences were present in the associations of sociodemographic, health, psychological factors, genetic and other biomarkers with the progression of MCI to dementia. APOE ɛ4 status and depression appeared to increase the risk of progression for females, whereas history of stroke, MRI markers and cerebrospinal fluid biomarkers appeared to increase the risk of progression for males. APOE ɛ2 status and marital status (unmarried) were observed to reduce risk of progression in males and females, respectively.

CONCLUSIONS

The ability of studies to accurately detail risk factors for dementia are likely limited when solely controlling for the effects of sex. Although the heterogeneity and underpowered nature of the studies made it difficult to synthesize the findings for each risk factor, this study highlights the apparent need for further research examining risk factors for dementia in males and females with MCI separately.

Gray Matter Volume as Evidence for Cognitive Reserve in Bilinguals With Mild Cognitive Impairment

BACKGROUND

Compared with monolinguals, bilinguals have a later onset of mild cognitive impairment (MCI) and Alzheimer disease symptoms and greater neuropathology at similar cognitive and clinical levels. The present study follows a previous report showing the faster conversion from MCI to Alzheimer disease for bilingual patients than comparable monolinguals, as predicted by a cognitive reserve (CR).

PURPOSE

Identify whether the increased CR found for bilinguals in the previous study was accompanied by greater gray matter (GM) atrophy than was present for the monolinguals.

METHODS

A novel deep-learning technique based on convolutional neural networks was used to enhance clinical scans into 1 mm MPRAGEs and analyze the GM volume at the time of MCI diagnosis in the earlier study.

PATIENTS

Twenty-four bilingual and 24 monolingual patients were diagnosed with MCI at a hospital memory clinic.

RESULTS

Bilingual patients had more GM loss than monolingual patients in areas related to language processing, attention, decision-making, motor function, and episodic memory retrieval. Bilingualism and age were the strongest predictors of atrophy after other variables such as immigration and education were included in a multivariate model.

DISCUSSION

CR from bilingualism is evident in the initial stages of neurodegeneration after MCI has been diagnosed.

Does Language Distance Modulate the Contribution of Bilingualism to Cognitive Reserve in Seniors? A Systematic Review

We report a systematic review and exploratory meta-regression investigating the hypothesis that the effects of bilingualism on cognitive reserve are modulated by the distance between the pair of languages a bilingual uses. An inclusive multiple database search was performed in order to identify all relevant published research conducted in bilingual seniors. A combination of qualitative and quantitative synthesis methods were used in order to investigate our research questions. Results suggest that healthy bilingual seniors speaking more distant language pairs show improved monitoring performance on cognitive tasks. Evidence regarding a modulatory influence of language distance (LD) on the age of dementia diagnosis was inconclusive due to the small number of published studies meeting our inclusion criteria. We recommend more detailed reporting of individual differences in bilingual experience to assess the impact of LD and other variables on typical cognitive aging and the development of dementia. Linguistic differences in samples should also be considered as a constraint on bilingual advantages in future studies. Preregistration: PROSPERO CRD42021238705; OSF DOI 10.17605/OSF.IO/VPRBU.

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.

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.

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.

Bilingualism as a Contributor to Cognitive Reserve: What it Can do and What it Cannot do

In the absence of effective pharmacological interventions for the prevention of dementia, attention has turned to lifestyle factors that contribute to cognitive reserve. Although cognitive reserve cannot prevent the occurrence of disease, the trajectory is different for high reserve and low reserve patients, giving more time for independent living to high reserve individuals. We argue that lifelong bilingual experience meets the criteria for an experience that confers cognitive reserve, although neural reserve, a related concept, is more difficult to validate. Bilingual patients show symptoms at a later stage of disease and decline more rapidly than comparable monolingual patients. These patterns are considered in terms of evidence from behavioural, imaging and epidemiological studies. Finally, the role of bilingualism in protecting against symptoms of some forms of dementia are discussed in the context of other protective factors and the limits of this reserve approach in dealing with the consequences of dementia.

Using concept typicality to explore semantic representation and control in healthy ageing

Successful use of conceptual knowledge entails the assembling of semantic representations and control processes to access the subsets of knowledge relevant in each situation. Research has suggested that representation and control mechanisms interact to support categorization. Notably, depleted representations in semantic dementia and disrupted control processes in semantic aphasia impair categorization of atypical concepts. Yet, it remains unclear how knowledge accumulation and control decay in healthy ageing impact categorization. To address this question, we compared young and older adults' performance in a categorization task of items varying in concept typicality. Critically, older adults were more accurate in categorizing atypical concepts than the younger counterparts, as indicated by the interaction between group and typicality. Moreover, the elderly outperformed the younger in categorizing atypical concepts that were also less familiar. Thus, the decay in semantic control observed along ageing did not significantly hinder the categorization of atypical items. Our data suggest that, relative to young adults, older adults possess enriched conceptual knowledge, which supports retrieval of the category-related features needed for categorizing atypical and less familiar exemplars.

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.

Poorer clinical outcomes for older adult monolinguals when matched to bilinguals on brain health

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.

Moderation-Mediation Effects in Bilingualism and Cognitive Reserve

We first provide a critical review of the existing findings on bilingualism as a contributor to cognitive reserve from moderator-mediator warranting cause-effect research conclusions. We next address the question of direct or indirect effects between bilingualism and neurocognitive protective factors influencing the associated age-related mental deficits. The existing findings support bilingualism as a predictor and as a moderator. Third, we propose cognitive reserve models of bilingualism describing analytical approaches that allow testing of these models and hypotheses related to path strength and causal relationships between predictors, moderators, and mediators. Lastly and most importantly, we suggest using large datasets available via open repositories. This can aid in the testing of theoretical models, clarifying the roles of moderators and mediators, and assessing the research viability of multi-causal paths that can influence cognitive reserve. Creating collaborative datasets to test these models would greatly advance our field and identify critical variables in the study of the bilingual aging brain.

Effects of bilingualism on age at onset in two clinical Alzheimer's disease variants

INTRODUCTION

The effect of bilingualism on age at onset has yet to be examined within different clinical variants of Alzheimer's disease.

METHODS

We reviewed the research charts of 287 well-characterized participants with either amnestic Alzheimer's dementia or logopenic variant primary progressive aphasia (lvPPA) and identified bilingual speakers based on regular use of two or more languages and/or ability to communicate with native speakers in two or more languages. We evaluated whether bilingual speakers demonstrated a delay in age of symptom onset relative to monolingual speakers while controlling for other variables known to influence cognitive reserve.

RESULTS

A 5-year delay in age at symptom onset was observed for bilingual relative to monolingual speakers with lvPPA. This delay in onset was not observed in the amnestic Alzheimer's dementia cohort.

DISCUSSION

Bilingualism may serve as a unique cognitive reserve variable in lvPPA, but not in amnestic Alzheimer's dementia.