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Workshop on bilingualism and cognitive reserve and resilience

Videocast Recordings

View the videocast recording of Day 1

View the videocast recording of Day 2

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Executive Summary

To better understand the role of bilingualism in cognitive aging and Alzheimer’s Disease and Related Dementias (AD/ADRD), the NIA Division of Neuroscience held a 2-day workshop on Bilingualism and Cognitive Reserve and Resilience on March 2nd and 3rd, 2021. The workshop set out to review the current state of the science on bilingualism and cognitive aging, address gaps in the current understanding of bilingualism as a driver of cognitive reserve, and identify new opportunities to expand explorations of the impact of bilingualism on cognition, brain health, and age-related neurodegenerative disease.

Cognitive performance exhibits wide variation even among individuals with similar neuropathology. Cognitive reserve is a construct that researchers use to explain this variability. Cognitive reserve may modulate the impact of neuropathology on cognitive outcomes, making individuals with greater reserve more resilient to age-related neurodegeneration. Bilingualism is one potential driver of cognitive reserve and thus is an important phenomenon for deepening understanding of this construct. A richer understanding of cognitive reserve may enable researchers to more directly and accurately measure individual resilience and develop models of the specific mechanisms of cognitive decline. Identifying these mechanisms can ultimately enable researchers to develop clinical interventions to support individuals experiencing cognitive decline and age-related neurodegenerative diseases.

However, identifying the specific impacts of bilingualism on cognitive reserve—and developing a theoretical framework that accounts for this impact—remains challenging for several reasons. Bilingualism is a dynamic and complex phenomenon with a wide array of components, including an individual’s age of second language acquisition, degree of language exposure, varying contexts of language use (e.g., single language or dual language), cultural aspects of language use, and many other factors. Moreover, bilingualism can have measurable impacts on both brain structure and individual behavior; the variety and breadth of these impacts can make direct measurement difficult. This multi-faceted complexity has challenged efforts to articulate a widely accepted definition or measure of bilingualism, and this divergence has contributed to inconsistent or potentially misleading null findings.

Bilingualism can also be hard to disentangle from other phenomena. In some cultures, bilingualism is tightly intertwined with potential confounding factors, such as education or socioeconomic status. Where bilingualism is widely distributed, it can be hard to disentangle its effects from those of other complex skills that may confer comparable cognitive benefits.

Despite these complexities, some studies have found that bilingual individuals are more likely than monolinguals to maintain cognitive performance even with underlying neuropathology. Retrospective research has suggested a 4- to 6-year delay in the clinical diagnosis and onset of symptoms of dementia in high-proficiency bilingual individuals. Research has also found related differences in brain structure, with bilingual individuals exhibiting increased dopamine levels, increased grey matter, and increased cortical folding, although levels vary with age.

During the workshop, experts in bilingualism and cognitive aging discussed ways to build on established research findings and surmount persistent challenges. Participants described the variation of bilingual individuals as a research opportunity and called for the field to embrace the complexity of bilingualism's impacts on cognitive aging, to use more rigorous objective measurements of bilingual language proficiency and use, and to increase the diversity of investigations—for example, by investigating various language pairings and by developing specific measures based on specific languages. As the field moves forward, researchers should design studies to deliberately address learning experiences, the use of languages in school versus home, and the phenomenon of bimodal bilingualism (i.e., the ability to sign as well as speak a language). Researchers may also consider the possibility that any consistent cognitive advantages of bilingualism stem from the presence of a combination of factors, thus limiting the number of people for whom the advantage is possible.

Participants agreed that transdisciplinary collaborations would promote and facilitate efforts to account for bilingualism's complex relationship with cognitive aging. Collaborations should include input from experts in neurobiology, neuropsychology, cognitive psychology, epidemiology, and other related fields. Integration of studies of bilingualism into existing longitudinal studies on aging could also provide a broader understanding of bilingualism’s impact over the life course and in the context of the real-world environments in which bilingualism is experienced.

Workshop Agenda

Note: All times listed are Eastern Standard Time (EST)

Tuesday, March 2nd

10:00 a.m. - 10:15 a.m. Welcome & Introductions, Matt Sutterer, Ph.D.

Richard Hodes, M.D., Director, National Institute on Aging (NIA)

Eliezer Masliah, M.D., Director, Division of Neuroscience, NIA

Lis Nielsen, Ph.D., Director, Division of Behavioral and Social Research, NIA

Matt Sutterer, Ph.D.; Molly Wagster, Ph.D., Division of Neuroscience

Jonathan King, Ph.D.; Dana Plude, Ph.D., Division of Behavioral and Social Research

10:15 a.m. - 10:45 a.m. Overview: Cognitive Reserve & Resilience in Aging

Dan Mungas, Ph.D., University of California, Davis, Davis, California, USA

Session 1: Bilingualism across the lifespan and its impact on reserve and resilience

Session Chair: Jon King, Ph.D.

10:45 a.m. - 11:15 a.m. Beyond bilingual juggling: Hypotheses about the source of reserve and resilience

Judith Kroll, Ph.D., University of California, Irvine, Irvine, California, USA

11:15 a.m. - 11:45 a.m. Maybe, Sometimes, Bilingualism Also Selects for Executive Function Ability

Erika Hoff, Ph.D. Florida Atlantic University, Boca Raton, Florida, USA

11:45 a.m. - 12:00 p.m. Break

12:00 p.m. - 12:30 p.m. Bilingualism, Brain and Development: A Neuroemergentist Perspective

Arturo E. Hernandez, Ph.D., University of Houston, Houston, Texas, USA

12:30 p.m. - 1:00 p.m. Onset of dementia in bilingual adults: Evidence for cognitive reserve

Ellen Bialystok, Ph.D., York University, Toronto, Ontario, Canada

1:00 p.m. - 1:30 p.m. Discussion of Session 1, Moderated by Jon King, Ph.D.

1:30 p.m. Break

Session 2: Factors complicating the study of bilingualism and its impact on cognition and the brain

Session Chair: Dana Plude, Ph.D.

1:45 p.m. - 2:15 p.m. Bilingualism and cognitive reserve: concepts, confounds and controversies

Thomas Bak, M.D., University of Edinburgh, Edinburgh, Scotland, United Kingdom

2:15 p.m. - 2:45 p.m. Deconstructing bilingualism and its sociocultural determinants for research on cognitive aging

Miguel Arce Renteria, Ph.D., Columbia University Medical Center, New York, New York, USA

2:45 p.m. - 3:00 p.m. Break

3:00 p.m. - 3:30 p.m. Idiosyncratic linguistic features: potential impact in dementia and bilingualism studies

Boon Lead Tee, M.D., University of California, San Francisco, San Francisco, California, USA

3:30 p.m. - 4:00 p.m. Bimodal bilingualism, deafness, and aging

Karen Emmorey, Ph.D., San Diego State University, San Diego, California, USA

4:00 p.m. - 4:30 p.m. Aging and Bilingual Language Control

Tamar Gollan, Ph.D., University of California, San Diego, San Diego, California, USA

4:30 p.m. - 4:45 p.m. Break

4:45 p.m. - 5:15 p.m. Discussion of Session 2, Moderated by Dana Plude, Ph.D.

5:15p.m. Adjourn Day 1, Matt Sutterer, Ph.D.

Wednesday, March 3rd

Welcome and Announcements, Jon King, Ph.D.

10:00 a.m. - 10:30 a.m. Perspective: Is there a bilingual advantage?

Kenneth Paap, Ph.D., San Francisco State University, San Francisco, California, USA

Session 3: Mechanisms by which bilingualism may drive neuroplasticity in the brain

Session Chair: Molly Wagster, Ph.D.

10:30 a.m. - 11:00 a.m. Structural neuroplasticity in the healthy bilingual brain and its relevance to healthy aging

Christos Pliatsikas, Ph.D., University of Reading, Reading, England, United Kingdom

11:00 a.m. - 11:30 a.m. The complexity of bilingualism and its effects on neuroplasticity

John G. Grundy, Ph.D., Iowa State University, Ames, Iowa, USA

11:30 a.m. - 12:00 p.m. Neuroanatomical perspectives on bilingualism and aging

Jubin Abutalebi, M.D., University Vita Salute San Raffaele, Milan, Italy

12:00 p.m. - 12:30 p.m. Break

12:30 p.m. - 1:00 p.m. Bilingualism, reserve and resilience across dementia subtypes

Suvarna Alladi, M.D., National Institute of Mental Health and Neurosciences, Bangalore, India

1:00 p.m. - 1:30 p.m. Bilingualism as a precursor for a cognitive reserve: What are the required premises?

Esti Blanco-Elorrieta, Ph.D., Harvard University, Cambridge, Massachusetts, USA

1:30 pm - 2:00 p.m. Discussion of Session 3, Moderated by Molly Wagster, Ph.D.

2:00 p.m. - 2:15 p.m. Break

2:15 p.m. - 3:00 p.m. Final Discussion: Gaps and Opportunities, Moderated by Matt Sutterer, Ph.D.

3:00 p.m. Meeting Adjourns, Jon King, Ph.D.