The Interaction Between Alzheimer’s Disease and Bilingualism

By: Emily Bergeron

Alzheimer’s Disease (AD) has baffled scientists for decades. This neurologically

degenerative disease currently affects six million Americans, and is forecasted to increase to

thirteen million patients by 2050.1 With the increase of life expectancy over the last century,

unknown diseases and effects of aging are being discovered, creating a whole new realm of

research for doctors. Although the cause of Alzheimer’s Disease is unknown, age appears to be

the greatest factor. After the age of sixty-five, the risk of developing Alzheimer’s doubles every

five years. After age eighty-five, a patient has a one in three chance of acquiring the disease,

making it one of the most prevalent and deadly diseases. One of every three elderly people will

die from Alzheimer’s Disease, giving it a higher mortality rate than breast and prostate cancer.2

Thus far, research has shown that the most effective way to decrease the probability of

developing this disease is a healthy lifestyle, including exercise of the body and of the mind.

One form of mental exercise that has fascinated the research community is bilingualism. It is

believed that bilingualism is one of the many ways to increase cognitive reserve and executive

function. Cognitive reserve generally refers to overall brain health. As the brain ages, cognitive

reserve acts as a backup generator. Once certain parts of the brain begin to fail, cognitive

reserve aids the brain in functioning as normally as possible despite atrophy. Expanding on this

idea, since bilinguals have two languages or two mental concepts that come to mind, they are

constantly forced to inhibit the language that is undesired in that situation, causing them to

constantly practice this type of executive function. Executive function can be broken into two

categories: organizational abilities like planning and working memory or regulatory abilities,

1
Alzheimer’s and dementia. Alzheimer’s Disease and Dementia. (n.d.-a).
https://www.alz.org/alzheimer_s_dementia
2
Alzheimer’s and dementia. Alzheimer’s Disease and Dementia. (n.d.).
https://www.alz.org/alzheimer_s_dementia
concerning decision making and self-control. While there is no specific preventative or cure to

Alzheimer’s Disease, consistent use of cognitive reserve and executive function, thereby

improving brain health, through mental exercises like learning a second language is promising.

Dr. Bialystok, a researcher based in Australia, has spent decades studying the potential

relationship between bilingualism and Alzheimer’s Disease. She has performed many studies

that have initiated other studies on Alzheimer’s and its relationship with bilingualism. She

monitored one hundred and eighty-four elderly patients diagnosed with AD for eighteen months

through MRI scans and neuro-physical testing of cognitive reserve and executive function. Over

time, Dr. Bialystok began to see temporal lobe abnormalities, an important piece of support in

explaining why memory is so heavily affected by AD. The temporal lobe houses both important

communication parts of the brain as well has the hippocampus which correlates directly with

long-term memory. If the language center and hippocampus begin to deteriorate, memory and

communication will be the first functions affected. Dr. Ferguson built off of Dr. Bialystok’s

research by observing both monolinguals and bilinguals for several years. Bilinguals were older

at both their first clinical visit and diagnosis of AD. It was determined, based on self-reporting,

that bilinguals on average report a five year delay in symptoms compared to monolinguals. To

further support this idea that bilinguals were able to delay the onset of symptoms, Dr. Moore

examined one hundred and thirty seven elderly post-mortem patients and discovered that the

bilinguals had more severe atrophy than the monolinguals, but according to their caregivers,

never showed any symptoms of cognitive decline.

Brain scans have proven to be the most helpful when testing for Alzheimer’s. Dr. Tom

Schweizer and Dr. Michael Weiner studied two groups of elderly patients with probable

Alzheimer’s Disease, with one half being bilingual and the other half monolingual. They were

matched by similar education and skill sets. Each group did equally well on the executive

function tests. However, MRI scans revealed that bilinguals had two times the brain atrophy in

comparison to the monolinguals. Dr. Schweizer and Dr. Michael Weiner concluded that since
bilinguals are constantly forced to inhibit one language, which is an executive function, their

brain is in a constant state of activity. Due to this activity, the overall cognitive function and brain

health increases, so that once neurodegenerative diseases like AD begin, the brain is apt

enough to find alternate pathways to function. Therefore, the brain is able to function at similar

rates to a monolingual with AD, even if the bilingual has worse brain atrophy.

One hypothesis as to why the brain of a bilingual is able to find other ways to

compensate for neural deterioration is due to increased gray and white matter in the brain,

which is associated with enhanced cognitive reserve. Gray matter correlates primarily with

processing sensation and perception, learning, speech and cognition, while white matter aids in

communication between masses of gray matter. With the knowledge that Alzheimer’s Disease

affects memory and processing the most, it is understandable that gray and white matter is

crucial in maintaining cognitive function. In a study done by Dr. Perani, eighty-five patients were

studied, with bilinguals being on average five years older than the monolinguals.3 Several MRI’s

showed that in comparison to monolinguals, the bilingual patients had increased gray and white

matter in the areas most associated with executive function, like the left prefrontal cortex and

the left caudate. The left caudate controls movement, learning, memory, and emotion, which

again helps explain why those who suffer from AD experience memory loss. Although bilinguals

did struggle with language tests in comparison to the monolinguals, this is a trend that is seen

amongst children as well, so these results did not cause concern. Bilinguals tend to struggle

with language or vocab across the board since they are receiving less exposure to the syntax

and semantics of the language. However, as further evidence to support this idea of increased

gray and white matter supporting cognitive reserve, older bilinguals did better on visuo-spatial

tasks and long term memory than monolinguals. Bilinguals were better able to combat AD

symptoms than monolinguals due to better cognitive reserve.

3
The impact of bilingualism on Brain Reserve and metabolic ... - PNAS. (n.d.).
https://www.pnas.org/doi/full/10.1073/pnas.1610909114
 A cross-sectional study was completed on ninety-nine bilinguals and monolinguals from

Valencia, Spain by Dr. Costumero to discover how they interacted with AD. 4 Each patient was

diagnosed with Mild Cognitive Impairment (MCI) but were still able to complete daily activities

individually. Patients were excluded if they suffered from other nervous system diseases like

brain tumors, suffered from depression, or were taking psychiatric medication. The bilinguals

had grown up speaking Catalan in the home, and learned Spanish as they entered school. They

tended to continue to be exposed to both languages throughout their lives. Monolinguals were

defined as only speaking Spanish. It was discovered that the bilinguals had worse atrophy in the

left middle temporal lobes, which is where the hippocampus and language center is housed,

evidence once again supporting why patients who suffer from AD struggle with memory and

communication. As seen in the Schweizer and Weiner study, although the bilinguals had more

atrophied brains, there was no difference in age or cognitive level. A potential issue for this

study is that it could be possible to better define the monolinguals as passive bilinguals. Many of

the patients stated that they had received enough exposure to Catalan to be able to understand

it, but were unable to speak it, making them receptive or passive bilinguals. This either negates

the study, since there was no true monolingual group, or is interesting evidence that the impacts

of passive versus expressive bilingualism matters. Although the “monolinguals” could

understand the language, the inability to produce Catalan meant that they had the same brain

function as a true monolingual.

A majority of studies found have been on simultaneous bilinguals. Since one could be a

sequential bilingual at any age after three years old, the window for study is too large to be able

to perform sound research on the difference between simultaneous and sequential bilinguals.

4
Costumero, V., Marin-Marin, L., Calabria, M., Belloch, V., Escudero, J., Baquero, M., Hernandez, M.,
Miras, J. R. de, Costa, A., Parcet, M.-A., & Ávila, C. (2020, January 10). A cross-sectional and
longitudinal study on the protective effect of bilingualism against dementia using brain atrophy and
cognitive measures - alzheimer’s research & therapy. BioMed Central.
https://alzres.biomedcentral.com/articles/10.1186/s13195-020-0581-1
One interesting study, however, focused on two groups of students: a civilian control group and

a group of students who were forced to learn a language at a rapid pace. The civilian control

group had no change to their brain. The student group who was forced to learn the language

rapidly saw growth in the hippocampus, which houses long term memory, and the frontal cortex.

The students who had to put in more effort to learn the new language had greater growth in the

middle frontal gyrus, a motor region of the cerebral cortex, although there was no indication of

how or why these students were classified as putting in more effort.

Bilingualism is merely one example of the endless ways one may increase their cognitive

reserve and executive function. Any kind of mental exercise can cause the increase in gray and

white matter correlated with improved cognitive reserve. For bilinguals, the constant inhibition of

one language over the other is constantly putting executive function into use. However, it is

important to recognize that although bilingualism can aid in delaying the effects of Alzheimer’s

Disease and other neurodegenerative diseases, it does not act as a preventative or a cure. It is

evident that more research is needed in both the areas of bilingualism, Alzheimer’s Disease,

and how they interact with each other. Unfortunately, researching the impact of specifically

bilingualism is difficult. Other variables such as education level, socioeconomic class, hobbies,

age of language acquisition, and usage of the language can all impact the amount of cognitive

reserve. These variables can be difficult to control for, and are oftentimes also reliant on the

self-reporting of either the client or their caregiver. This opens the door for unreliable

information, opportunities to make mistakes, or inconclusive data. Researchers will have to be

open minded to the multitude of potential variables that impact their studies, and how they might

impact their results. Generally speaking, studies show that bilingualism is just one of the great

ways to maintain brain health throughout one’s life, simultaneously developing greater cognitive

reserve and executive function to hopefully delay the onset of symptoms of neurodegenerative

diseases.