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.

Bilingualism as a gradient measure modulates functional connectivity of language and control networks.

There is currently no agreement on which factor modulates most effectively and enduringly brain plasticity in bilingual individuals. Grouping heterogeneous linguistic profiles under a dichotomous condition (bilingualism versus monolingualism) may obscure critical aspects of language experience underlying neural changes, thus leading to variable and often conflicting findings. In the present study, we overcome these limitations by analyzing the individual and joint contribution of L2 AoA, proficiency and usage - all measured as continuous variables - on the resting-state functional connectivity of the brain networks mediating the specific demands of bilingual language processing: the language network and the executive control network. Our results indicate that bilingual experience - defined as a continuous and multifaceted phenomenon - impacts brain plasticity by modulating the functional connectivity both within and between language and control networks. Each experience-related factor considered played a role in changing the connectivity of these regions. Moreover, the effect of AoA was modulated by proficiency and usage. These findings shed new light on the importance of modeling bilingualism as a gradient measure rather than an all-or-none phenomenon.

ACC Sulcal Patterns and Their Modulation on Cognitive Control Efficiency Across Lifespan: A Neuroanatomical Study on Bilinguals and Monolinguals.

The anterior cingulate cortex (ACC) is a key structure implicated in the regulation of cognitive control (CC). Previous studies suggest that variability in the ACC sulcal pattern-a neurodevelopmental marker unaffected by maturation or plasticity after birth-is associated with intersubject differences in CC performance. Here, we investigated whether bilingual experience modulates the effects of ACC sulcal variability on CC performance across the lifespan. Using structural MRI, we first established the distribution of the ACC sulcal patterns in a large sample of healthy individuals (N = 270) differing on gender and ethnicity. Second, a participants' subsample (N = 157) was selected to test whether CC performance was differentially affected by ACC sulcation in bilinguals and monolinguals across age. A prevalent leftward asymmetry unaffected by gender or ethnicity was reported. Sulcal variability in the ACC predicted CC performance differently in bilinguals and monolinguals, with a reversed pattern of structure-function relationship: asymmetrical versus symmetrical ACC sulcal patterns were associated with a performance advantage in monolinguals and a performance detriment to bilinguals and vice versa. Altogether, these findings provide novel insights on the dynamic interplay between early neurodevelopment, environmental background and cognitive efficiency across age.

The impact of bilingualism on brain reserve and metabolic connectivity in Alzheimer's dementia.

Cognitive reserve (CR) prevents cognitive decline and delays neurodegeneration. Recent epidemiological evidence suggests that lifelong bilingualism may act as CR delaying the onset of dementia by ∼4.5 y. Much controversy surrounds the issue of bilingualism and its putative neuroprotective effects. We studied brain metabolism, a direct index of synaptic function and density, and neural connectivity to shed light on the effects of bilingualism in vivo in Alzheimer's dementia (AD). Eighty-five patients with probable AD and matched for disease duration (45 German-Italian bilingual speakers and 40 monolingual speakers) were included. Notably, bilingual individuals were on average 5 y older than their monolingual peers. In agreement with our predictions and with models of CR, cerebral hypometabolism was more severe in the group of bilingual individuals with AD. The metabolic connectivity analyses crucially supported the neuroprotective effect of bilingualism by showing an increased connectivity in the executive control and the default mode networks in the bilingual, compared with the monolingual, AD patients. Furthermore, the degree of lifelong bilingualism (i.e., high, moderate, or low use) was significantly correlated to functional modulations in crucial neural networks, suggesting both neural reserve and compensatory mechanisms. These findings indicate that lifelong bilingualism acts as a powerful CR proxy in dementia and exerts neuroprotective effects against neurodegeneration. Delaying the onset of dementia is a top priority of modern societies, and the present in vivo neurobiological evidence should stimulate social programs and interventions to support bilingual or multilingual education and the maintenance of the second language among senior citizens.

The neural basis of free language choice in bilingual speakers: Disentangling language choice and language execution.

For everyday communication, bilingual speakers need to face the complex task of rapidly choosing the most appropriate language given the context, maintaining this choice over the current communicative act, and shielding lexical selection from competing alternatives from non-target languages. Yet, speech production of bilinguals is typically flawless and fluent. Most of the studies available to date constrain speakers' language choice by cueing the target language and conflate language choice with language use. This left largely unexplored the neural mechanisms underlying free language choice, i.e., the voluntary situation of choosing the language to speak. In this study, we used fMRI and Multivariate Pattern Analysis to identify brain regions encoding the target language when bilinguals are free to choose in which language to name pictures. We found that the medial prefrontal cortex encoded the chosen language prior to speaking. By contrast, during language use, language control recruited a wider brain network including the left inferior frontal lobe, the basal ganglia, and the angular and inferior parietal gyrus bilaterally. None of these regions were involved in language choice. We argue that the control processes involved in language choice are different from those involved in language use. Furthermore, our findings confirm that the medial prefrontal cortex is a domain-general region critical for free choice and that bilingual language choice relies on domain general processes.

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.

How bilingualism protects the brain from aging: Insights from bimodal bilinguals.

Bilingual experience can delay cognitive decline during aging. A general hypothesis is that the executive control system of bilinguals faces an increased load due to controlling two languages, and this increased load results in a more "tuned brain" that eventually creates a neural reserve. Here we explored whether such a neuroprotective effect is independent of language modality, i.e., not limited to bilinguals who speak two languages but also occurs for bilinguals who use a spoken and a signed language. We addressed this issue by comparing bimodal bilinguals to monolinguals in order to detect age-induced structural brain changes and to determine whether we can detect the same beneficial effects on brain structure, in terms of preservation of gray matter volume (GMV), for bimodal bilinguals as has been reported for unimodal bilinguals. Our GMV analyses revealed a significant interaction effect of age × group in the bilateral anterior temporal lobes, left hippocampus/amygdala, and left insula where bimodal bilinguals showed slight GMV increases while monolinguals showed significant age-induced GMV decreases. We further found through cortical surface-based measurements that this effect was present for surface area and not for cortical thickness. Moreover, to further explore the hypothesis that overall bilingualism provides neuroprotection, we carried out a direct comparison of GMV, extracted from the brain regions reported above, between bimodal bilinguals, unimodal bilinguals, and monolinguals. Bilinguals, regardless of language modality, exhibited higher GMV compared to monolinguals. This finding highlights the general beneficial effects provided by experience handling two language systems, whether signed or spoken. Hum Brain Mapp 38:4109-4124, 2017. © 2017 Wiley Periodicals, Inc.

Language Control in Bilinguals: Monitoring and Response Selection.

Language control refers to the cognitive mechanism that allows bilinguals to correctly speak in one language avoiding interference from the nontarget language. Bilinguals achieve this feat by engaging brain areas closely related to cognitive control. However, 2 questions still await resolution: whether this network is differently engaged when controlling nonlinguistic representations, and whether this network is differently engaged when control is exerted upon a restricted set of lexical representations that were previously used (i.e., local control) as opposed to control of the entire language system (i.e., global control). In the present event-related functional magnetic resonance imaging study, we investigated these 2 questions by employing linguistic and nonlinguistic blocked switching tasks in the same bilingual participants. We first report that the left prefrontal cortex is driven similarly for control of linguistic and nonlinguistic representations, suggesting its domain-general role in the implementation of response selection. Second, we propose that language control in bilinguals is hierarchically organized with the dorsal anterior cingulate cortex/presupplementary motor area acting as the supervisory attentional system, recruited for increased monitoring demands such as local control in the second language. On the other hand, prefrontal, inferior parietal areas and the caudate would act as the response selection system, tailored for language selection for both local and global control.

Semantic interference and its control: A functional neuroimaging and connectivity study.

During picture naming, the ease with which humans generate words is dependent upon the context in which they are named. For instances, naming previously presented items results in facilitation. Instead, naming a picture semantically related to previous items displays persistent interference effects (i.e., cumulative semantic interference, CSI). The neural correlates of CSI are still unclear and it is a matter of debate whether semantic control, or cognitive control more in general, is necessary for the resolution of CSI. We carried out an event-related fMRI experiment to assess the neural underpinnings of the CSI effect and the involvement and nature of semantic control. Both left inferior frontal gyrus (LIFG) and the left caudate nucleus (LCN) showed a linear increase of BOLD response positively associated with the consecutive number of presentations of semantically related pictures independently of task-load. The generalized psychophysiological interaction analysis showed that LIFG demonstrated a quantitative neural connectivity difference with the left supramarginal and angular gyri for increases of task-load and with the fusiform gyri for linear CSI increases. Furthermore, seed-to-voxel functional connectivity showed that LIFG activity coupled with different regions involved in cognitive control and lexicosemantic processing when semantic interference was elicited to a minimum or maximum degree. Our results are consistent with the lexical-competitive nature of the CSI effect, and we provide novel evidence that semantic control lies upon a more general cognitive control network (i.e., LIFG and LCN) responsible for resolving interference between competing semantically related items through connectivity with different brain areas in order to guarantee the correct response. Hum Brain Mapp 37:4179-4196, 2016. © 2016 Wiley Periodicals, Inc.

The Role of the Cognitive Control System in Recovery from Bilingual Aphasia: A Multiple Single-Case fMRI Study.

Aphasia in bilingual patients is a therapeutic challenge since both languages can be impacted by the same lesion. Language control has been suggested to play an important role in the recovery of first (L1) and second (L2) language in bilingual aphasia following stroke. To test this hypothesis, we collected behavioral measures of language production (general aphasia evaluation and picture naming) in each language and language control (linguistic and nonlinguistic switching tasks), as well as fMRI during a naming task at one and four months following stroke in five bilingual patients suffering from poststroke aphasia. We further applied dynamic causal modelling (DCM) analyses to the connections between language and control brain areas. Three patients showed parallel recovery in language production, one patient improved in L1, and one improved in L2 only. Language-control functions improved in two patients. Consistent with the dynamic view of language recovery, DCM analyses showed a higher connectedness between language and control areas in the language with the better recovery. Moreover, similar degrees of connectedness between language and control areas were found in the patients who recovered in both languages. Our data suggest that engagement of the interconnected language-control network is crucial in the recovery of languages.

The effects of Transcranial Direct Current Stimulation (tDCS) on Idiopathic Hypersomnia: a pilot study.

Idiopathic Hypersomnia (IH) is a rare sleep disorder characterised by excessive daytime sleepiness (EDS) that leads to invalidating daytime consequences. Till now the treatment of IH has mirrored that of sleepiness in narcolepsy, and it is mainly focused on symptoms' management. We employed an anodal transcranic Direct Current Stimulation (tDCS) treatment in order to induce a shift toward arousal in IH patients' cortex during the day. Every patients underwent a 4 weeks treatment (3 stimulations per week, for a total of 12 stimulations over a period of 28 days) with an assessment at the baseline and after treatment aimed to the evaluation of subjective daytime sleepiness, neurocognitive functions, and attentional domain tested by means of the Attentional Network Task (ANT). The dependent variables of the ANT are accuracy and reaction times, which represent the objective outcome of our study. A significant effect of tDCS' treatment in reducing EDS was found. Besides the amelioration in subjective EDS,  an objective improvement in RTs in all conditions of the ANT, in particular in the more difficult component, was observed. Our results indicate that tDCS may foster the management of EDS in IH, improving also the attentional domain.

Bilingualism, dementia, cognitive and neural reserve.

PURPOSE OF REVIEW: We discuss the role of bilingualism as a source of cognitive reserve and we propose the putative neural mechanisms through which lifelong bilingualism leads to a neural reserve that delays the onset of dementia. RECENT FINDINGS: Recent findings highlight that the use of more than one language affects the human brain in terms of anatomo-structural changes. It is noteworthy that recent evidence from different places and cultures throughout the world points to a significant delay of dementia onset in bilingual/multilingual individuals. This delay has been reported not only for Alzheimer's dementia and its prodromal mild cognitive impairment phase, but also for other dementias such as vascular and fronto-temporal dementia, and was found to be independent of literacy, education and immigrant status. SUMMARY: Lifelong bilingualism represents a powerful cognitive reserve delaying the onset of dementia by approximately 4 years. As to the causal mechanism, because speaking more than one language heavily relies upon executive control and attention, brain systems handling these functions are more developed in bilinguals resulting in increases of gray and white matter densities that may help protect from dementia onset. These neurocognitive benefits are even more prominent when second language proficiency and exposure are kept high throughout life.

Original language versus dubbed movies: Effects on our brain and emotions.

Converging evidence suggests that emotions are often dulled in one's foreign language. Here, we paired fMRI with a naturalistic viewing paradigm (i.e., original vs. dubbed versions of sad, fun and neutral movie clips) to investigate the neural correlates of emotion perception as a function of native (L1) and foreign (L2) language context. Watching emotional clips in L1 (vs. L2) reflected in activations of anterior temporal cortices involved in semantic cognition, arguably indicating a closer association of emotion concepts with the native language. The processing of fun clips in L1 (vs. L2) reflected in enhanced response of the right amygdala, suggesting a deeper emotional experience of positively valenced stimuli in the L1. Of interest, the amygdala response to fun clips positively correlated with participants' proficiency in the L2, indicating that a higher L2 competence may reduce emotional processing differences across a bilingual's two languages. Our findings are compatible with the view that language provides a context for the construction of emotions.

Degree of multilingual engagement modulates resting state oscillatory activity across the lifespan.

Multilingualism has been demonstrated to lead to a more favorable trajectory of neurocognitive aging, yet our understanding of its effect on neurocognition across the lifespan remains limited. We collected resting state EEG recordings from a sample of multilingual individuals across a wide age range. Additionally, we obtained data on participant multilingual language use patterns alongside other known lifestyle enrichment factors. Language experience was operationalized via a modified multilingual diversity (MLD) score. Generalized additive modeling was employed to examine the effects and interactions of age and MLD on resting state oscillatory power and coherence. The data suggest an independent modulatory effect of individualized multilingual engagement on age-related differences in whole brain resting state power across alpha and theta bands, and an interaction between age and MLD on resting state coherence in alpha, theta, and low beta. These results provide evidence of multilingual engagement as an independent correlational factor related to differences in resting state EEG power, consistent with the claim that multilingualism can serve as a protective factor in neurocognitive aging.

On the brain struggles to recognize basic facial emotions with face masks: an fMRI study.

Introduction: The COVID-19 pandemic impacted public health and our lifestyles, leading to new social adaptations such as quarantine, social distancing, and facial masks. Face masks, covering extended facial zones, hamper our ability to extract relevant socio-emotional information from others' faces. In this fMRI study, we investigated how face masks interfere with facial emotion recognition, focusing on brain responses and connectivity patterns as a function of the presence of a face mask. Methods: A total of 25 healthy participants (13F; mean age: 32.64 ± 7.24y; mean education: 18.28 ± 1.31y) were included. Participants underwent task-related fMRI during the presentation of images of faces expressing basic emotions (joy or fear versus neutral expression). Half of the faces were covered by a face mask. Subjects had to recognize the facial emotion (masked or unmasked). FMRI whole-brain and regions-of-interest analyses were performed, as well as psychophysiological interaction analysis (PPI). Results: Subjects recognized better and faster emotions on unmasked faces. FMRI analyses showed that masked faces induced a stronger activation of a right occipito-temporal cluster, including the fusiform gyrus and the occipital face area bilaterally. The same activation pattern was found for the neutral masked > neutral unmasked contrast. PPI analyses of the masked > unmasked contrast showed, in the right occipital face area, a stronger correlation with the left superior frontal gyrus, left precentral gyrus, left superior parietal lobe, and the right supramarginal gyrus. Discussion: Our study showed how our brain differentially struggles to recognize face-masked basic emotions, implementing more neural resources to correctly categorize those incomplete facial expressions.

Increased interhemispheric functional connectivity after right anodal tDCS in chronic non-fluent aphasia: preliminary findings.

Introduction: Anodal transcranial Direct Current Stimulation (tDCS) is a non-invasive, low-cost and environment-friendly brain neuromodulation technique that increases cortical excitability. In post-stroke aphasia, the role of the right hemisphere in language recovery remains debated. In this preliminary study, we aimed to investigate the efficacy of excitatory tDCS on the right hemisphere in chronic aphasic patients. Methods: We applied anodal tDCS to the right homologous region of Broca's area in four chronic aphasic patients while performing a one-month naming rehabilitation treatment. Longitudinal data on language assessment and naming performance were collected. Resting-state fMRI images were acquired before and after treatment to measure changes in functional connectivity. Results: Results showed enhanced positive functional connectivity of the right Broca homologous with the left middle frontal and middle temporal gyri. Every patient showed improvements in language functions, but no major changes in naming performance. Conclusion: These preliminary findings suggest that tDCS applied over the unaffected hemisphere may result in longitudinal inter-hemispheric functional neuroplastic changes that could specifically improve language recovery and could potentially be included in therapeutic neurorehabilitative plans.

Neurocognitive mechanisms of emotional interference in native and foreign languages: evidence from proficient bilinguals.

Currently available data show mixed results as to whether the processing of emotional information has the same characteristics in the native (L1) as in the second language (L2) of bilinguals. We conducted a functional magnetic resonance imaging (fMRI) experiment to shed light on the neurocognitive mechanisms underlying bilinguals' emotional processing in L1 and L2 during an emotional interference task (i.e., the Emotional Stroop Task - EST). Our sample comprised proficient Italian-English bilinguals who learned their L2 during childhood mainly in instructional rather than immersive contexts. In spite of no detectable behavioural effects, we found stronger brain activations for L1 versus L2 emotional words in sectors of the posteromedial cortex involved in attention modulation, episodic memory, and affective processing. While fMRI findings are consistent with the hypothesis of a stronger emotional resonance when processing words in a native language, our overall pattern of results points to the different sensitivity of behavioural and hemodynamic responses to emotional information in the two languages of bilingual speakers.

Bilingualism tunes the anterior cingulate cortex for conflict monitoring.

Monitoring and controlling 2 language systems is fundamental to language use in bilinguals. Here, we reveal in a combined functional (event-related functional magnetic resonance imaging) and structural neuroimaging (voxel-based morphometry) study that dorsal anterior cingulate cortex (ACC), a structure tightly bound to domain-general executive control functions, is a common locus for language control and resolving nonverbal conflict. We also show an experience-dependent effect in the same region: Bilinguals use this structure more efficiently than monolinguals to monitor nonlinguistic cognitive conflicts. They adapted better to conflicting situations showing less ACC activity while outperforming monolinguals. Importantly, for bilinguals, brain activity in the ACC, as well as behavioral measures, also correlated positively with local gray matter volume. These results suggest that early learning and lifelong practice of 2 languages exert a strong impact upon human neocortical development. The bilingual brain adapts better to resolve cognitive conflicts in domain-general cognitive tasks.

Second language experience modulates functional brain network for the native language production in bimodal bilinguals.

The functional brain network of a bilingual's first language (L1) plays a crucial role in shaping that of his or her second language (L2). However, it is less clear how L2 acquisition changes the functional network of L1 processing in bilinguals. In this study, we demonstrate that in bimodal (Chinese spoken-sign) bilinguals, the functional network supporting L1 production (spoken language) has been reorganized to accommodate the network underlying L2 production (sign language). Using functional magnetic resonance imaging (fMRI) and a picture naming task, we find greater recruitment of the right supramarginal gyrus (RSMG), the right temporal gyrus (RSTG), and the right superior occipital gyrus (RSOG) for bilingual speakers versus monolingual speakers during L1 production. In addition, our second experiment reveals that these regions reflect either automatic activation of L2 (RSOG) or extra cognitive coordination (RSMG and RSTG) between both languages during L1 production. The functional connectivity between these regions, as well as between other regions that are L1- or L2-specific, is enhanced during L1 production in bimodal bilinguals as compared to their monolingual peers. These findings suggest that L1 production in bimodal bilinguals involves an interaction between L1 and L2, supporting the claim that learning a second language does, in fact, change the functional brain network of the first language.

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.