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November 26, 2013; 81 (22) Article

Bilingualism delays age at onset of dementia, independent of education and immigration status

Suvarna Alladi, Thomas H. Bak, Vasanta Duggirala, Bapiraju Surampudi, Mekala Shailaja, Anuj Kumar Shukla, Jaydip Ray Chaudhuri, Subhash Kaul
First published November 6, 2013, DOI: https://doi.org/10.1212/01.wnl.0000436620.33155.a4
Suvarna Alladi
From the Department of Neurology (S.A., M.S., A.K.S., S.K.), Nizam's Institute of Medical Sciences, Hyderabad, India; Department of Psychology (T.H.B.), Centre for Cognitive Aging and Cognitive Epidemiology and Centre for Clinical Brain Sciences, University of Edinburgh, UK; Department of Linguistics (V.D.), Osmania University, Hyderabad; Centre for Neural and Cognitive Sciences (B.S.), University of Hyderabad; and Department of Neurology (J.R.C.), Yashoda Hospitals, Hyderabad, India.
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Thomas H. Bak
From the Department of Neurology (S.A., M.S., A.K.S., S.K.), Nizam's Institute of Medical Sciences, Hyderabad, India; Department of Psychology (T.H.B.), Centre for Cognitive Aging and Cognitive Epidemiology and Centre for Clinical Brain Sciences, University of Edinburgh, UK; Department of Linguistics (V.D.), Osmania University, Hyderabad; Centre for Neural and Cognitive Sciences (B.S.), University of Hyderabad; and Department of Neurology (J.R.C.), Yashoda Hospitals, Hyderabad, India.
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Vasanta Duggirala
From the Department of Neurology (S.A., M.S., A.K.S., S.K.), Nizam's Institute of Medical Sciences, Hyderabad, India; Department of Psychology (T.H.B.), Centre for Cognitive Aging and Cognitive Epidemiology and Centre for Clinical Brain Sciences, University of Edinburgh, UK; Department of Linguistics (V.D.), Osmania University, Hyderabad; Centre for Neural and Cognitive Sciences (B.S.), University of Hyderabad; and Department of Neurology (J.R.C.), Yashoda Hospitals, Hyderabad, India.
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Bapiraju Surampudi
From the Department of Neurology (S.A., M.S., A.K.S., S.K.), Nizam's Institute of Medical Sciences, Hyderabad, India; Department of Psychology (T.H.B.), Centre for Cognitive Aging and Cognitive Epidemiology and Centre for Clinical Brain Sciences, University of Edinburgh, UK; Department of Linguistics (V.D.), Osmania University, Hyderabad; Centre for Neural and Cognitive Sciences (B.S.), University of Hyderabad; and Department of Neurology (J.R.C.), Yashoda Hospitals, Hyderabad, India.
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Mekala Shailaja
From the Department of Neurology (S.A., M.S., A.K.S., S.K.), Nizam's Institute of Medical Sciences, Hyderabad, India; Department of Psychology (T.H.B.), Centre for Cognitive Aging and Cognitive Epidemiology and Centre for Clinical Brain Sciences, University of Edinburgh, UK; Department of Linguistics (V.D.), Osmania University, Hyderabad; Centre for Neural and Cognitive Sciences (B.S.), University of Hyderabad; and Department of Neurology (J.R.C.), Yashoda Hospitals, Hyderabad, India.
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Anuj Kumar Shukla
From the Department of Neurology (S.A., M.S., A.K.S., S.K.), Nizam's Institute of Medical Sciences, Hyderabad, India; Department of Psychology (T.H.B.), Centre for Cognitive Aging and Cognitive Epidemiology and Centre for Clinical Brain Sciences, University of Edinburgh, UK; Department of Linguistics (V.D.), Osmania University, Hyderabad; Centre for Neural and Cognitive Sciences (B.S.), University of Hyderabad; and Department of Neurology (J.R.C.), Yashoda Hospitals, Hyderabad, India.
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Jaydip Ray Chaudhuri
From the Department of Neurology (S.A., M.S., A.K.S., S.K.), Nizam's Institute of Medical Sciences, Hyderabad, India; Department of Psychology (T.H.B.), Centre for Cognitive Aging and Cognitive Epidemiology and Centre for Clinical Brain Sciences, University of Edinburgh, UK; Department of Linguistics (V.D.), Osmania University, Hyderabad; Centre for Neural and Cognitive Sciences (B.S.), University of Hyderabad; and Department of Neurology (J.R.C.), Yashoda Hospitals, Hyderabad, India.
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Subhash Kaul
From the Department of Neurology (S.A., M.S., A.K.S., S.K.), Nizam's Institute of Medical Sciences, Hyderabad, India; Department of Psychology (T.H.B.), Centre for Cognitive Aging and Cognitive Epidemiology and Centre for Clinical Brain Sciences, University of Edinburgh, UK; Department of Linguistics (V.D.), Osmania University, Hyderabad; Centre for Neural and Cognitive Sciences (B.S.), University of Hyderabad; and Department of Neurology (J.R.C.), Yashoda Hospitals, Hyderabad, India.
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Citation
Bilingualism delays age at onset of dementia, independent of education and immigration status
Suvarna Alladi, Thomas H. Bak, Vasanta Duggirala, Bapiraju Surampudi, Mekala Shailaja, Anuj Kumar Shukla, Jaydip Ray Chaudhuri, Subhash Kaul
Neurology Nov 2013, 81 (22) 1938-1944; DOI: 10.1212/01.wnl.0000436620.33155.a4

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Abstract

Objectives: The purpose of the study was to determine the association between bilingualism and age at onset of dementia and its subtypes, taking into account potential confounding factors.

Methods: Case records of 648 patients with dementia (391 of them bilingual) diagnosed in a specialist clinic were reviewed. The age at onset of first symptoms was compared between monolingual and bilingual groups. The influence of number of languages spoken, education, occupation, and other potentially interacting variables was examined.

Results: Overall, bilingual patients developed dementia 4.5 years later than the monolingual ones. A significant difference in age at onset was found across Alzheimer disease dementia as well as frontotemporal dementia and vascular dementia, and was also observed in illiterate patients. There was no additional benefit to speaking more than 2 languages. The bilingual effect on age at dementia onset was shown independently of other potential confounding factors such as education, sex, occupation, and urban vs rural dwelling of subjects.

Conclusions: This is the largest study so far documenting a delayed onset of dementia in bilingual patients and the first one to show it separately in different dementia subtypes. It is the first study reporting a bilingual advantage in those who are illiterate, suggesting that education is not a sufficient explanation for the observed difference. The findings are interpreted in the context of the bilingual advantages in attention and executive functions.

GLOSSARY

ACE-R=
Addenbrooke's Cognitive Examination–revised;
AD=
Alzheimer disease;
CDR=
Clinical Dementia Rating;
DLB=
dementia with Lewy bodies;
FTD=
frontotemporal dementia;
GLM=
general linear model;
VaD=
vascular dementia

Footnotes

  • Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Received June 4, 2013.
  • Accepted in final form August 26, 2013.
  • © 2013 American Academy of Neurology
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Letters: Rapid online correspondence

  • WHY RURAL DWELLING DOES NOT MATTER, BUT THE TYPE OF DEMENTIA DOES - A RESPONSE TO MORTIMER
    • Suvarna Alladi, Additional Professor, Nizam's Institute of Medical Sciencesalladisuvarna@hotmail.com
    • Thomas H Bak, Edinburgh, UK; Tom C Russ, Edinburgh, UK; Mekala Shailaja, Hyderabad, India, ; Vasanta Duggirala, Hyderabad, India.
    Submitted December 04, 2013
  • Bilingualism delays age at onset of dementia, independent of education and immigration status
    • James A. Mortimer, Professor, Department of Epidemiology and Biostatistics, University of South Floridajmortime@health.usf.edu
    Submitted November 27, 2013
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