Association Between Greater Cerebellar Network Connectivity and Improved Phonemic Fluency Performance After Exercise Training in Older Adults.

Little is known about the effects of exercise training (ET) on lexical characteristics during fluency task and its association with cerebellum functional connectivity. The purposes of this study were (1) to investigate whether ET alters response patterns during phonemic and semantic fluency tasks and (2) to assess the association between ET-related changes in cerebellum functional connectivity (FC) and lexical characteristics during fluency tasks. Thirty-five older adults (78.0 ± 7.1 years; 17 mild cognitive impairment (MCI) and 18 healthy cognition (HC)) underwent a 12-week treadmill ET. Before and after ET, cardiorespiratory fitness tests, phonemic and semantic fluency tests, and resting-state fMRI scans were administered. We utilized a seed-based correlation analysis to measure cerebellum FC and linear regression to assess the association of residualized ET-induced Δcerebellum FC with Δtask performance. Improved mean switches and frequency during the phonemic fluency task were observed following ET in all participants. There were significant associations between ET-induced increases in cerebellum FC and greater phonemic fluency task log frequency, increases in mean switches, and a reduction in the number of syllables in HC. Lastly, there was a significant interaction between group and cerebellar connectivity on phonemic fluency mean log frequency and number of syllables. A 12-week walking ET is related to enhanced phonemic fluency lexical characteristics in older adults with MCI and HC. The association between ET-induced increases in cerebellum FC and enhanced response patterns after ET suggests that the cerebellum may play an important role in ET-related improvement in phonemic fluency performance in cognitively healthy older adults.

Performance of Korean-English bilinguals on an adaptation of the screening bilingual aphasia test.

BACKGROUND: The use of standardized tests specifically designed for and normed on bilingual groups is crucial for the accurate diagnosis and language profiling of bilingual speakers with aphasia. Currently, there is a dearth of norms and supporting psychometric data for the few available bilingual aphasia assessments. The only available aphasia test for Korean-English (KE) bilinguals is the Korean-English Bilingual Aphasia Test (KE-BAT). The absence of bilingual normative data for the KE-BAT limits its clinical and research utility. AIMS: (1) To revise the original screening KE-BAT to clarify ambiguities in its instructions and stimuli; and (2) to examine subtest and item performance across the two languages for the revised screening KE-BAT with a local sample of highly proficient KE bilinguals. METHODS & PROCEDURES: The original screening KE-BAT was first revised to replace unrecognizable drawings, address ambiguities in the instructions and stimuli, and increase the number of items on naming subtests. This revised test is henceforth referred to as the adapted screening KE-BAT (AS KE-BAT). A total of 21 neurologically healthy, highly proficient and college-educated KE bilinguals (19-34 years old) were recruited from a large city in the United States. Participants completed three measures of language proficiency and the AS KE-BAT including the KE translation test (Part C). Total and subtest scores were compared across the two languages, and individual item accuracy was calculated. Incorrect responses of low scoring items were examined. OUTCOMES & RESULTS: Performance was comparable across Korean and English for all subtests, except for the spontaneous speech subtest. The item accuracy of 17 items (7% of total items) in the AS KE-BAT fell to < 80%, and four items (1.6% of total items) had an accuracy < 60%. Incorrect responses of low scoring items were caused by phoneme misperception, lexical substitution and morphosyntactic L2 patterns. CONCLUSIONS & IMPLICATIONS: The results of the study highlight the importance of empirically examining the performance of neurotypical bilinguals on bilingual aphasia assessments to establish their psychometric properties. Based on the small-sized local bilingual normative sample obtained in this study, appropriate cut-off criteria, recommendations for clinical interpretation and further modifications of the AS KE-BAT are proposed. WHAT THIS PAPER ADDS: What is already known on the subject The pair of English and Korean aphasia assessments (e.g., Western Aphasia Battery-Revised; WAB-R) (Kertesz 2012) and Korean Western Aphasia Battery (Kim and Na 2001) cannot be used to assess language impairments in KE bilinguals with aphasia since these tests have not been designed for and normed on the bilingual group. Clinical utility of the Korean-English Bilingual Aphasia Test (KE-BAT), which is the only resource currently available to assess KE bilinguals with aphasia, is greatly compromised by the lack of KE bilingual normative data. What this study adds to existing knowledge This study provides cut-off scores, comparability of test performance and item difficulty metrics and it identifies additional ways in which items and spontaneous speech scoring of the adapted screening KE-BAT (AS KE-BAT) could be modified. Suggested guidelines allow improved interpretations of the linguistic performance of local KE bilinguals with aphasia who have a similar demographic and linguistic background. What are the potential or actual clinical implications of this work? The AS KE-BAT with cut-off criteria of 95% for Part B and 80% for Part C is suitable for the language assessment of highly proficient and young KE bilinguals with a high level of education and it yields comparable performance across the two languages. Clinicians may decide to adjust spontaneous speech scoring criteria if the client's language history is suggestive of code-switching and use the item difficulty data to guide test item selection for this group of bilinguals.

Neural representation of word categories is distinct in the temporal lobe: An activation likelihood analysis.

The distinction between nouns and verbs is a language universal. Yet, functional neuroimaging studies comparing noun and verb processing have yielded inconsistent findings, ranging from a complete frontal(verb)-temporal(noun) dichotomy to a complete overlap in activation patterns. The current study addressed the debate about neural distinctions between nouns and verbs by conducting an activation likelihood estimation (ALE) meta-analysis of probabilistic cytoarchitectonic maps. Two levels of analysis were conducted: simple effects (Verbs vs. Baseline, Nouns vs. Baseline), and direct comparisons (Verbs vs. Nouns, Nouns vs. Verbs). Nouns were uniquely associated with a left medial temporal cluster (BA37). Activation foci for verbs included extensive inferior frontal (BA44-47) and mid-temporal (BA22, 21) regions in the left hemisphere. These findings confirm that the two grammatical classes have distinct neural architecture in supra-modal brain regions. Further, nouns and verbs overlapped in a small left lateral inferior temporal activation cluster (BA37), which is a region for modality-independent, grammatical class-independent lexical representations. These findings are most consistent with the view that as one acquires language, linguistic representations for a lexical category shift from the modality specific cortices which represent prototypical members of that category (e.g., motion for verbs) to abstract amodal representations in close proximity to modality specific cortices.

Comparison of animal, action and phonemic fluency in aphasia.

BACKGROUND: The ability to generate words that follow certain constraints, or verbal fluency, is a sensitive indicator of neurocognitive impairment, and is impacted by a variety of variables. AIMS: To investigate the effect of post-stroke aphasia, elicitation category and linguistic variables on verbal fluency performance. METHODS & PROCEDURES: Twenty-eight persons with aphasia (PWA) with a single left-hemisphere lesion and 40 age-matched neurotypical community-dwelling adults were administered three verbal fluency tasks: two semantic (animals and actions) and one phonemic (the letters F, A and S). Data analysis included comparison of total scores, clusters and perseverations. Individual responses were coded for frequency of occurrence, age of acquisition and syllable length to investigate qualitative differences in word generation. OUTCOMES & RESULTS: PWA performed worse than neurotypical participants across all verbal fluency tasks, and animal fluency scores were farthest from neurotypical performance. PWAs' animal and action fluency were correlated with other language measures, while phonemic fluency was uncorrelated with language measures. While some PWAs showed dissociations between verbal fluency tasks, the dissociations did not pattern along with aphasia fluency. PWAs produced fewer clusters and responses with higher word frequency across all three verbal fluency tasks. Responses had earlier age of acquisition and shorter word length for animal and phonemic fluency, but not action fluency. CONCLUSIONS & IMPLICATIONS: Verbal fluency, particularly animal fluency, is sensitive to even mild aphasia. PWA produced lexically simpler responses than their neurotypical peers. This study identifies the relevance of qualitative analysis of verbal fluency responses.

Preserved processing of musical structure in a person with agrammatic aphasia.

Evidence for shared processing of structure (or syntax) in language and in music conflicts with neuropsychological dissociations between the two. However, while harmonic structural processing can be impaired in patients with spared linguistic syntactic abilities (Peretz, I. (1993). Auditory atonalia for melodies. Cognitive Neuropsychology, 10, 21-56. doi:10.1080/02643299308253455), evidence for the opposite dissociation-preserved harmonic processing despite agrammatism-is largely lacking. Here, we report one such case: HV, a former musician with Broca's aphasia and agrammatic speech, was impaired in making linguistic, but not musical, acceptability judgments. Similarly, she showed no sensitivity to linguistic structure, but normal sensitivity to musical structure, in implicit priming tasks. To our knowledge, this is the first non-anecdotal report of a patient with agrammatic aphasia demonstrating preserved harmonic processing abilities, supporting claims that aspects of musical and linguistic structure rely on distinct neural mechanisms.

The Rise of Big Data in Neurorehabilitation.

In some fields, Big Data has been instrumental in analyzing, predicting, and influencing human behavior. However, Big Data approaches have so far been less central in speech-language pathology. This article introduces the concept of Big Data and provides examples of Big Data initiatives pertaining to adult neurorehabilitation. It also discusses the potential theoretical and clinical contributions that Big Data can make. The article also recognizes some impediments in building and using Big Data for scientific and clinical inquiry.

Verb Production in Aphasia: Testing the Division of Labor between Syntax and Semantics.

Some individuals with aphasia preferably use semantically general light verbs, whereas others prefer semantically specific heavy verbs. This study aimed to test Gordon and Dell's "division of labor" hypothesis that light versus heavy verb usage depends on syntactic and semantic processes, respectively. In a retrospective analysis of data from the AphasiaBank corpus, narrative language of neurologically healthy individuals and individuals with aphasia was analyzed for the proportion of light verbs used, and its relationship with narrative measures of syntactic and semantic sophistication and verb naming scores was examined. In individuals with aphasia, light verb usage was positively correlated with a syntactic measure (developmental sentence score) and negatively associated with two semantic measures (idea density and verb naming). For healthy individuals, the number of verbs per utterance, which is a measure of syntactic complexity, predicted light verb use. These findings suggest that light verb usage in aphasia observes an inverse relationship with syntactic and semantic abilities, supporting the division of labor hypothesis.

A Meta-Analysis of Anomia Treatment in Bilingual Aphasia: Within- and Cross-Language Generalization and Predictors of the Treatment Outcomes.

PURPOSE: The present meta-analysis investigated the efficacy of anomia treatment in bilingual and multilingual persons with aphasia (BPWAs) by assessing the magnitudes of six anomia treatment outcomes. Three of the treatment outcomes pertained to the "trained language": improvement of trained words (treatment effect [TE]), within-language generalization of semantically related untrained words (WLG-Related), and within-language generalization of unrelated words (WLG-Unrelated). Three treatment outcomes were for the "untrained language": improvement of translations of the trained words (cross-language generalization of trained words [CLG-Tx]), cross-language generalization of semantically related untrained words (CLG-Related), and cross-language generalization of unrelated untrained words (CLG-Unrelated). This study also examined participant- and treatment-related predictors of these treatment outcomes. METHOD: This study is registered in the International Prospective Register of Systematic Reviews (PROSPERO) under the number CRD42023418147. Nine electronic databases were searched to identify word retrieval treatment studies of poststroke BPWAs of at least 6 months postonset. Pre- and posttreatment single-word naming scores were extracted for each eligible participant and used to calculate effect sizes (within-case Cohen's d) of the six treatment outcomes. Random-effects meta-analyses were conducted to assess weighted mean effect sizes of the treatment outcomes across studies. Multiple linear regression analyses were used to examine the effects of participant-related variables (pretreatment single-word naming and comprehension representing poststroke lexical processing abilities) and treatment-related variables (type, language, and duration). The methodological quality of eligible studies and the risk of bias in this meta-analysis were assessed. RESULTS: A total of 17 published studies with 39 BPWAs were included in the meta-analysis. The methodological quality of the included studies ranged from fair (n = 4) to good (n = 13). Anomia treatment produced a medium effect size for TE (M = 8.36) and marginally small effect sizes for WLG-Related (M = 1.63), WLG-Unrelated (M = 0.68), and CLG-Tx (M = 1.56). Effect sizes were nonsignificant for CLG-Related and CLG-Unrelated. TE was significantly larger than the other five types of treatment outcomes. TE and WLG-Related effect sizes were larger for BPWAs with milder comprehension or naming impairments and for treatments of longer duration. WLG-Unrelated was larger when BPWAs received phonological treatment than semantic and mixed treatments. The overall risk of bias in the meta-analysis was low with a potential risk of bias present in the study identification process. CONCLUSIONS: Current anomia treatment practices for bilingual speakers are efficacious in improving trained items but produce marginally small within-language generalization and cross-language generalization to translations of the trained items. These results highlight the need to provide treatment in each language of BPWAs and/or investigate other approaches to promote cross-language generalization. Furthermore, anomia treatment outcomes are influenced by BPWAs' poststroke single-word naming and comprehension abilities as well as treatment duration and the provision of phonological treatment. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.25595712.

Neuroimaging in aphasia treatment research: standards for establishing the effects of treatment.

The goal of this paper is to discuss experimental design options available for establishing the effects of treatment in studies that aim to examine the neural mechanisms associated with treatment-induced language recovery in aphasia, using functional magnetic resonance imaging (fMRI). We present both group and single-subject experimental or case-series design options for doing this and address advantages and disadvantages of each. We also discuss general components of and requirements for treatment research studies, including operational definitions of variables, criteria for defining behavioral change and treatment efficacy, and reliability of measurement. Important considerations that are unique to neuroimaging-based treatment research are addressed, pertaining to the relation between the selected treatment approach and anticipated changes in language processes/functions and how such changes are hypothesized to map onto the brain.

Neural correlates of pronoun processing: An activation likelihood estimation meta-analysis.

Pronouns are unique linguistic devices that allow for the expression of referential relationships. Despite their communicative utility, the neural correlates of the operations involved in reference assignment and/or resolution, are not well-understood. The present study synthesized the neuroimaging literature on pronoun processing to test extant theories of pronoun comprehension. Following the PRISMA guidelines and thebest-practice recommendations for neuroimaging meta-analyses, a systematic literature search and record assessment were performed. As a result, 16 fMRI studies were included in the meta-analysis, and were coded in Scribe 3.6 for inclusion in the BrainMap database. The activation coordinates for the contrasts of interest were transformed into Talairach space and submitted to an Activation Likelihood Estimation (ALE) meta-analysis in GingerALE 3.0.1. The results indicated that pronoun processing had functional convergence in the left posterior middle and superior temporal gyri, potentially reflecting the retrieval, prediction and integration roles of these areas for pronoun processing.

Resting Respiratory Resistance in Female Teenage Athletes With and Without Exercise-Induced Laryngeal Obstruction.

OBJECTIVE: Exercise-induced laryngeal obstruction (EILO) occurs with paradoxical vocal fold motion or supraglottic collapse during moderate to vigorous exercise. Previously, Gallena et al (2015) reported lower-than-normal inspiratory (Ri) and expiratory (Re) resistances during resting tidal breathing (RTB) in female teenage athletes with EILO. This study aimed to replicate that unexpected result. METHOD: The Airflow Perturbation Device measured Ri and Re during three 1-minute trials of RTB in 16 teenage female athletes with EILO and 16 sex-, age-, and height-matched controls. Multiple linear regression examined group, age, height, and weight as predictors of Ri and Re. RESULTS: Ri and Re tended to be lower in the EILO group than the control group [Ri: F(1,30) = 3.58, P = 0.068, d = 0.686; Re: F(1,30) = 3.28, P = 0.080, d = 0.640], but there was no statistically significant difference in the overall effect [F(2,29) = 1.75, P = 0.192]. After one outlier for Re from the EILO group and her matched control were removed, the overall difference was statistically significant, F(2,27) = 3.38, P = 0.049, with Re primarily contributing to the difference [Ri: F(1,28) = 3.66, P = 0.066, d = 0.719; Re: F(1,28) = 5.69, P = 0.024, d = 0.899]. CONCLUSION: These results did not replicate the robust differences found previously between Ri and Re during RTB in teenage girls with and without EILO, but the results trended in the same direction and met criterion for statistical significance once an outlier was removed from analysis. Overall, the observation that resting respiratory resistances were lower in most teenage girls with EILO suggests that reduced tone of the laryngeal and/or lower airways may predispose young athletes to EILO.

Treatment of semantic verb classes in aphasia: acquisition and generalization effects.

Verb retrieval difficulties are common in aphasia; however, few successful treatments have been documented (e.g. Conroy, P., Sage, K., & Lambon Ralph, M. A. (2006) . Towards theory-driven therapies for aphasic verb impairments: A review of current theory and practice. Aphasiology, 20, 1159-1185). This study investigated the efficacy of a novel verb retrieval treatment in two individuals with aphasia who experience verb retrieval difficulty. It involved training verb classes with large (e.g. cut verbs) and limited (e.g. contact verbs) sets of semantic features. Based on action representation theories, semantically based training of cut verbs was predicted to generalize to retrieval of untrained cut and contact verbs. One participant improved on trained verbs whereas the other participant did not. Neither participant demonstrated within nor across-class generalization to untrained verbs. However, both participants significantly improved in verb naming as measured by An Object and Action Naming Battery, and their predominant error pattern changed from noun to verb substitutions. Therefore, both participants improved in overall verb retrieval strategies despite limited success with verbs trained in this treatment. Implications for the design of future treatments are discussed.

The Role of Processing Speed and Cognitive Control on Word Retrieval in Aging and Aphasia.

Purpose When speakers retrieve words, they do so extremely quickly and accurately-both speed and accuracy of word retrieval are compromised in persons with aphasia (PWA). This study examined the contribution of two domain-general mechanisms: processing speed and cognitive control on word retrieval in PWA. Method Three groups of participants, neurologically healthy young and older adults and PWA (n = 15 in each group), performed processing speed, cognitive control, lexical decision, and word retrieval tasks on a computer. The relationship between word retrieval speed and other tasks was examined for each group. Results Both aging and aphasia resulted in slower processing speed but did not affect cognitive control. Word retrieval response time delays in PWA were eliminated when processing speed was accounted for. Word retrieval speed was predicted by individual differences in cognitive control in young and older adults and additionally by processing speed in older adults. In PWA, word retrieval speed was predicted by severity of language deficit and cognitive control. Conclusions This study shows that processing speed is compromised in aphasia and could account for their slowed response times. Individual differences in cognitive control predicted word retrieval speed in healthy adults and PWA. These findings highlight the need to include nonlinguistic cognitive mechanisms in future models of word retrieval in healthy adults and word retrieval deficits in aphasia.

Grammatical category dissociation in multilingual aphasia.

Word retrieval deficits for specific grammatical categories, such as verbs versus nouns, occur as a consequence of brain damage. Such deficits are informative about the nature of lexical organization in the human brain. This study examined retrieval of grammatical categories across three languages in a trilingual person with aphasia who spoke Arabic, French, and English. In order to delineate the nature of word production difficulty, comprehension was tested, and a variety of concomitant lexical-semantic variables were analysed. The patient demonstrated a consistent noun-verb dissociation in picture naming and narrative speech, with severely impaired production of verbs across all three languages. The cross-linguistically similar noun-verb dissociation, coupled with little evidence of semantic impairment, suggests that (a) the patient has a true "nonsemantic" grammatical category specific deficit, and (b) lexical organization in multilingual speakers shares grammatical class information between languages. The findings of this study contribute to our understanding of the architecture of lexical organization in bilinguals.

Production latencies of morphologically simple and complex verbs in aphasia.

There are several accounts of why some individuals with post-stroke aphasia experience difficulty in producing morphologically complex verbs. Although a majority of these individuals also produce syntactically flawed utterances, at least two accounts focus on word-level encoding operations. One account proposes a difficulty with rule-governed affixation, predicting that verbs without affixes (stems and irregular past) should be produced with ease. The second account emphasises the contribution of phonological encoding, noting that morphological complexity is often confounded by phonological complexity. The present study investigated the effect of morphological complexity (presence vs. absence of affixes) on verb production when phonological complexity and lexical frequency was controlled. A novel delayed repetition paradigm was used, accuracy and latency of production were the dependent measures. Data from nine agrammatic aphasic and nine unimpaired participants revealed no effects of morphological complexity, but a significant effect of frequency on production latency. The results indicate that morphological complexity plays little role, if any, in production difficulty, at least for this experimental task and this group of non-apraxic agrammatic aphasic individuals. A difficulty in usage of contextually appropriate verb inflections, rather than in morphophonological encoding, is suggested.

Using narratives in differential diagnosis of neurodegenerative syndromes.

PURPOSE: Language decline has been associated with healthy aging and with various neurodegenerative conditions, making it challenging to differentiate among these conditions. This study examined the utility of linguistic measures derived from a short narrative language sample for 1) identifying language characteristics and cut-off scores to differentiate between healthy aging, Primary Progressive Aphasia (PPA), Mild Cognitive Impairment (MCI), and Alzheimer's dementia (AD); and 2) differentiating among PPA variants in which language is the primary impairment. METHOD: Participants were 25 neurologically healthy English speakers, 20 individuals with MCI, 20 with AD, and 26 with PPA (non-fluent/agrammatic N = 10, logopenic N = 9, semantic N = 7). Narrative language samples of the Cookie Theft Picture of persons with healthy aging, MCI and AD were retrospectively obtained from the DementiaBank database (https://talkbank.org/DementiaBank/) and PPA samples were obtained from an ongoing research study. The language samples were analyzed for fluency, word retrieval success, grammatical accuracy, and errors using automated and manual analysis methods. The sensitivity and specificity of various language measures was computed. RESULTS: Participants with PPA scored lower than neurologically healthy and MCI groups on fluency (words per minute and disfluencies), word retrieval (Correct Information Units and number of errors), and sentence grammaticality. PPA and AD groups did not differ on language measures. Agrammatic PPA participants scored lower than logopenic and semantic PPA groups on several measures, while logopenic and semantic PPA did not differ on any measures. CONCLUSION: Measures derived from brief language samples and analyzed using mostly automated methods are clinically useful in differentiating PPA from healthy aging and MCI, and agrammatic PPA from other variants. The sensitivity and specificity of these measures is modest and can be improved when coupled with clinical presentation.

Expert Group Meeting on Aphasia: A Report.

A multidisciplinary team of experts took stock of the current state of affairs about many aspects of aphasia in India, including community burden, diagnostic assessment, therapy, rehabilitation, research, education, and advocacy. The broad spectrum of aphasiology was matched by the types of participants ranging from neurologists, speech-language pathologists, clinical psychologists, linguists, to experts in neuroimaging and computer sciences. Threadbare discussion in 16 sessions over 3 days leads to the identification of pressing problems and possible solutions. Many action plans have been envisaged and recommendations made. A few examples with high priority are community-based and hospital-based study incidence and prevalence of aphasia, development of test batteries for the assessment of many components of speech and communication in Indian languages which are validated on rigorous psychometric, and linguistic criteria, national registry for aphasia, educational modules about aphasia for different target groups, resources for advocacy and its training, a bank of research questions and outlines of research protocols for young professionals to pursue. The expert group will continue to oversee execution of some of the actionable plans in short and long term.

A comparison of two theoretically driven treatments for verb inflection deficits in aphasia.

Errors in the production of verb inflections, especially tense inflections, are pervasive in agrammatic Broca's aphasia (*The boy eat). The neurolinguistic underpinnings of these errors are debated. One group of theories attributes verb inflection errors to disruptions in encoding the verb's morphophonological form, resulting from either a general phonological deficit or a morphological affixation impairment. A second group of theories attribute verb inflection errors to disruptions that arise during sentence formulation, either for syntactic reasons or due to impairments in making fine semantic distinctions between inflectional variants of a verb (+PAST-->ate, hugged; +FUTURE-->will eat, will hug). These morphophonological and morphosemantic accounts were evaluated by comparing the efficacy of two treatment protocols that exclusively targeted either morphophonological operations or morphosemantic distinctions. Using a single participant design, it was found that aphasic individuals who received morphosemantic treatment showed significant improvement in accurate production of trained and untrained verb inflections in sentence contexts. In contrast, individuals who received morphophonological treatment failed to show improvements in accuracy of sentence production, although the number and diversity of inflected verbs increased. The differential outcomes suggest that morphosemantic impairments contribute to verb inflection deficits in agrammatic aphasia to a greater extent than morphophonological impairments, at least in this group of participants.

Interpreting Mini-Mental State Examination Performance in Highly Proficient Bilingual Spanish-English and Asian Indian-English Speakers: Demographic Adjustments, Item Analyses, and Supplemental Measures.

Purpose: Performance on the Mini-Mental State Examination (MMSE), among the most widely used global screens of adult cognitive status, is affected by demographic variables including age, education, and ethnicity. This study extends prior research by examining the specific effects of bilingualism on MMSE performance. Method: Sixty independent community-dwelling monolingual and bilingual adults were recruited from eastern and western regions of the United States in this cross-sectional group study. Independent sample t tests were used to compare 2 bilingual groups (Spanish-English and Asian Indian-English) with matched monolingual speakers on the MMSE, demographically adjusted MMSE scores, MMSE item scores, and a nonverbal cognitive measure. Regression analyses were also performed to determine whether language proficiency predicted MMSE performance in both groups of bilingual speakers. Results: Group differences were evident on the MMSE, on demographically adjusted MMSE scores, and on a small subset of individual MMSE items. Scores on a standardized screen of language proficiency predicted a significant proportion of the variance in the MMSE scores of both bilingual groups. Conclusions: Bilingual speakers demonstrated distinct performance profiles on the MMSE. Results suggest that supplementing the MMSE with a language screen, administering a nonverbal measure, and/or evaluating item-based patterns of performance may assist with test interpretation for this population.