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Screening for Cognitive Impairment in Bilinguals: What Is the Influence of the Language of Assessment?
Published online by Cambridge University Press: 03 May 2024
Abstract
Background:
Bilingualism’s impact on cognitive assessment remains underexplored. This study analyzes the efficacy of the Mini-Mental State Examination (MMSE) as a screening tool for bilinguals, specifically examining the influence of language choice on balanced and unbalanced Lebanese bilinguals (Arabic-French) and its implications for diagnosing cognitive impairment.
Methods:
Ninety-three bilingual healthy controls (mean age = 67.99 ± 9.3) and 29 Alzheimer’s disease patients (mean age = 77.2 ± 5.9), including 26 with mild and 3 with moderate dementia, underwent MMSE assessments in both Arabic and French. The study aimed to assess language impact on cognitive screening outcomes in different bilingual subtypes.
Results:
Sensitivity in screening for cognitive impairment using the MMSE varied based on language and bilingualism subtype. For unbalanced bilinguals, using the prominent language increased sensitivity. Conversely, in balanced bilinguals, employing the societal majority language enhanced sensitivity. This suggests that the conventional use of the non-prominent language in cognitive screening for foreigners/immigrants may result in a subtle loss of MMSE sensitivity.
Conclusion:
This study emphasizes the critical role of language choice in cognitive assessment for bilinguals. The MMSE’s sensitivity is influenced by language selection, with clinical implications for screening procedures. Recommendations include using the prominent language for cognitive screening in dominant bilinguals and the societal majority language for balanced bilinguals. This nuanced approach aims to improve the accuracy and cultural sensitivity of cognitive screening in bilingual populations, addressing the gap in current assessment practices.
Résumé
Dépistage des troubles cognitifs chez les individus bilingues : quelle est l’influence de la langue d’évaluation ?
L’impact du bilinguisme de patients sur leur évaluation cognitive demeure sous-exploré. Cette étude entend donc analyser l’efficacité du test de Folstein (TF ou Mini-Mental State Examination) en tant qu’outil de dépistage chez des individus bilingues en examinant plus particulièrement l’influence du choix de la langue chez des individus d’origine libanaise dont le bilinguisme (arabe et français) est équilibré et non équilibré de même que les implications sous-jacentes en vue d’un diagnostic de troubles cognitifs.
Au total, 93 témoins en santé et bilingues (âge moyen = 67,99 ± 9,3), ainsi que 29 patients atteints de la maladie d’Alzheimer (âge moyen = 77,2 ± 5,9), dont 26 souffraient de démence légère et 3 de démence modérée, ont subi un TF en arabe et en français. Notre étude visait donc à évaluer l’impact de la langue sur les résultats du dépistage cognitif dans différents sous-types d’individus bilingues.
La sensibilité du dépistage de troubles cognitifs à l’aide du TF a varié en fonction de la langue et du sous-type d’individus bilingues. Chez les individus bilingues « déséquilibrés », l’utilisation de la langue dominante a augmenté le niveau de sensibilité du test. Inversement, chez les bilingues « équilibrés », l’utilisation de la langue majoritaire de la société a augmenté la sensibilité. Cela suggère en somme que l’utilisation conventionnelle de la langue non dominante dans le dépistage cognitif des étrangers ou des immigrants peut entraîner une perte subtile de sensibilité du TF.
Cette étude souligne en définitive le rôle essentiel du choix de la langue dans l’évaluation cognitive des individus bilingues. La sensibilité du TF est en effet influencée par le choix de la langue, ce qui a des implications cliniques pour les procédures de dépistage. Voilà pourquoi il est recommandé d’utiliser la langue dominante pour le dépistage cognitif effectué chez des individus bilingues « déséquilibrés » et la langue majoritaire de la société chez des individus bilingues « équilibrés ». En comblant les lacunes des pratiques actuelles d’évaluation, cette approche nuancée entend améliorer la précision et la sensibilité culturelle du dépistage cognitif au sein de populations bilingues.
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- © The Author(s), 2024. Published by Cambridge University Press on behalf of Canadian Neurological Sciences Federation
References
Grosjean, F, Bilingual: Life and Reality. 2010 Harvard University Press. DOI: 10.4159/9780674056459.CrossRefGoogle Scholar
Geiger-Jaillet, A. Les enjeux du bilinguisme. in: L’éducation bilingue en France: politique linguistique et réalité éducative. L’Harmattan; 2005. pp. 1–215.Google Scholar
Rezzoug, A, Sprenger-Charolles, L, Colé, P. Bilinguisme: aspects cognitifs et linguistiques. L'Année Psychol. 2007;107:385–418.Google Scholar
De Houwer, A, A., Bilingual First Language Acquisition. In:1st edn. Critical Issues in Infant-Toddler Language Development.1st edn. Routledge; 2022:73–81. DOI: 10.4324/9781003227816-11.Google Scholar
Heredia, RR, Cieślicka, AB. Bilingual memory: Its structure, function, and development. in: Bilingualism Across the Lifespan: Factors Moderating Language Proficiency. American Psychological Association; 2014. pp. 1–22.Google Scholar
Birdsong, D. Dominance and age in bilingualism. Appl Linguist. 2014;35:374–92.CrossRefGoogle Scholar
Gathercole, VC, Thomas, EM. Bilingual first-language development: dominant language takeover, threatened minority language take-up. Biling Lang Cogn. 2009;12:213–37.CrossRefGoogle Scholar
Kohnert, K. Second language acquisition: success factors in sequential bilingualism. K. Leader. 2008;13(2):10–13. DOI: 10.1044/leader.FTR1.13022008.10.CrossRefGoogle Scholar
Bialystok, E, Poarch, G, Luo, L, Craik, FI. Effects of bilingualism and aging on executive function and working memory. Psychol Aging. 2014;29:696–705.CrossRefGoogle ScholarPubMed
Celik, S, Kokje, E, Meyer, P, Frölich, L, Teichmann, B. Does bilingualism influence neuropsychological test performance in older adults? A systematic review. Appl Neuropsychol Adult. 2020;27:1–19. DOI: 10.1080/23279095.2020.1788032.Google Scholar
Anderson, JA, Saleemi, S, Bialystok, E. Neuropsychological assessments of cognitive aging in monolingual and bilingual older adults. J Neuroling. 2017;43:17–27. DOI: 10.1016/j.jneuroling.2016.08.001.CrossRefGoogle ScholarPubMed
Bialystok, E, Craik, F, Luk, G. Cognitive control and lexical access in younger and older bilinguals. J Exp Psychol Learn Mem Cogn. 2008;34:859–73. DOI: 10.1037/0278-7393.34.4.859.CrossRefGoogle ScholarPubMed
Clare, L, Whitaker, CJ, Craik, FI, et al. Bilingualism, executive control, and age at diagnosis among people with early-stage Alzheimer’s disease in Wales. J Neuropsychol. 2016;10:163–85. DOI: 10.1111/jnp.12061.CrossRefGoogle ScholarPubMed
Luo, L, Craik, FI, Moreno, S, Bialystok, E. Bilingualism interacts with domain in a working memory task: evidence from aging. Psychol Aging. 2013;28:28–34. DOI: 10.1037/a0030875.CrossRefGoogle Scholar
Rosselli, M, Ardila, A, Araujo, K, et al. Verbal fluency and repetition skills in healthy older Spanish-English bilinguals. Appl Neuropsychol. 2000;7:17–24. DOI: 10.1207/S15324826AN0701_3.CrossRefGoogle ScholarPubMed
Sadat, J, Martin, CD, Alario, FX, Costa, A. Characterizing the bilingual disadvantage in noun phrase production. J Psycholing Res. 2012;41:159–79. DOI: 10.1007/s10936-011-9183-1.CrossRefGoogle ScholarPubMed
Sandoval, TC, Gollan, TH, Ferreira, VS, Salmon, DP. What causes the bilingual disadvantage in verbal fluency? The dual-task analogy. Biling Lang Cogn. 2010;13:231–52. DOI: 10.1017/S1366728909990514.CrossRefGoogle Scholar
Zeng, Z, Kalashnikova, M, Antoniou, M. Integrating bilingualism, verbal fluency, and executive functioning across the lifespan. J Cogn Dev. 2019;20:656–79. DOI: 10.1080/15248372.2019.1648267.CrossRefGoogle Scholar
Bialystok, E. Bilingualism: the good, the bad, and the indifferent. Biling Lang Cogn. 2009;12:3–11. DOI: 10.1017/S1366728908003477.CrossRefGoogle Scholar
Christoffels, IK, Firk, C, Schiller, NO. Bilingual language control: an event-related brain potential study. Brain Res. 2007;1147:192–208. DOI: 10.1016/j.brainres.2007.01.137.CrossRefGoogle ScholarPubMed
Treccani, B, Mulatti, C. No matter who, no matter how. and no matter whether the white matter matters. Why theories of bilingual advantage in executive functioning are so difficult to falsify. Cortex. 2015;73:349–51. DOI: 10.1016/j.cortex.2015.07.015.CrossRefGoogle ScholarPubMed
Kousaie, S. Executive function and bilingualism in young and older adults. Front Behav Neurosci. 2014;8: Article 250. DOI: 10.3389/fnbeh.2014.00250.CrossRefGoogle ScholarPubMed
Massa, E, Köpke, B, El Yagoubi, R. Age-related effect on language control and executive control in bilingual and monolingual speakers: behavioral and electrophysiological evidence. Neuropsychologia. 2020;138:107336. DOI: 10.1016/j.neuropsychologia.2020.107336.CrossRefGoogle ScholarPubMed
Abutalebi, J, Green, DW. Control mechanisms in bilingual language production: Neural evidence from language switching studies. Lang Cogn Process. 2008;23:557–82. DOI: 10.1080/01690960801920602.CrossRefGoogle Scholar
Paap, KR, Greenberg, ZI. There is no coherent evidence for a bilingual advantage in executive processing. Cogn Psychol. 2013;66:232–58. DOI: 10.1016/j.cogpsych.2012.12.002.CrossRefGoogle ScholarPubMed
von Bastian, CC, Souza, AS, Gade, M. No evidence for bilingual cognitive advantages: a test of four hypotheses. J Exp Psychol Gen. 2016;145:246–58. DOI: 10.1037/xge0000120.CrossRefGoogle ScholarPubMed
Ivanova, I, Salmon, DP, Gollan, TH. The multilingual naming test in Alzheimer’s disease: clues to the origin of naming impairments. J Int Neuropsychol Soc. 2013;19:272–83. DOI: 10.1017/S1355617712001282.CrossRefGoogle Scholar
Ivanova, I, Salmon, DP, Gollan, TH. Which language declines more? Longitudinal versus cross-sectional decline of picture naming in bilinguals with Alzheimer’s disease. J Int Neuropsychol Soc. 2014;20:534–46. DOI: 10.1017/S1355617714000228.CrossRefGoogle ScholarPubMed
Kowoll, ME, Degen, C, Gladis, S, Schröder, J. Neuropsychological profiles and verbal abilities in lifelong bilinguals with mild cognitive impairment and Alzheimer’s disease. J Alzheimer’s Dis. 2020;45:1257–68. DOI: 10.3233/JAD-142880.CrossRefGoogle Scholar
Mendez, MF, Perryman, KM, Pontón, MO, Cummings, JL. Bilingualism and dementia. J Neuropsychiatry Clin Neurosci. 1999;11:411–2. DOI: 10.1176/jnp.11.3.411.CrossRefGoogle ScholarPubMed
Gollan, TH, Salmon, DP, Montoya, RI, da Pena, E. Accessibility of the nondominant language in picture naming: a counterintuitive effect of dementia on bilingual language production. Neuropsychologia. 2010;48:1356–66. DOI: 10.1016/j.neuropsychologia.2009.12.038.CrossRefGoogle ScholarPubMed
Gómez-Ruiz, I, Aguilar-Alonso, Á. Capacity of the catalan and spanish versions of the bilingual aphasia test to distinguish between healthy aging, mild cognitive impairment and Alzheimer’s disease. Clin Ling Phon. 2011;25:444–63. DOI: 10.3109/02699206.2011.560989.CrossRefGoogle ScholarPubMed
Salvatierra, J, Rosselli, M, Acevedo, A, Duara, R. Verbal fluency in bilingual spanish/English Alzheimer’s disease patients. Am J Alzheimer’s Dis Other Demen. 2007;22:190–201. DOI: 10.1177/1533317507301792.CrossRefGoogle ScholarPubMed
Gollan, TH, Stasenko, A, Salmon, DP. Which language is more affected in bilinguals with Alzheimer’s disease? Diagnostic sensitivity of the multilingual naming test. Neuropsychology. 2023;37:595–606. DOI: 10.1037/neu0000999.CrossRefGoogle ScholarPubMed
Briceño, EM, Mehdipanah, R, Gonzales, XF, et al. Bilingualism, assessment language, and the montreal cognitive assessment in Mexican Americans. J Am Geriatr Soc. 2021;69:1971–81. DOI: 10.1111/jgs.17209.CrossRefGoogle ScholarPubMed
Nasreddine, ZS, Phillips, NA, Bédirian, V, et al. The montreal cognitive assessment, moCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005;53:695–9. DOI: 10.1111/j.1532-5415.2005.53221.x.CrossRefGoogle Scholar
Folstein, MF, Folstein, SE, McHugh, PR. Mini-mental state. J Psychiatr Res. 1975;12:189–98. DOI: 10.1016/0022-3956(75)90026-6.CrossRefGoogle ScholarPubMed
Ní Chaoimh, D, De Bhaldraithe, S, O’Malley, G, et al. Importance of different language versions of cognitive screening tests: comparison of Irish and English versions of the MMSE in bilingual irish patients. Eur Geriatr Med. 2015;6:551–3. DOI: 10.1016/j.eurger.2015.10.006.CrossRefGoogle Scholar
Leclerc, JL. L’aménagement linguistique dans le monde : le Liban. Québec: CEFAN, Université Laval. http://www.axl.cefan.ulaval.ca/asie/liban.htm.Google Scholar
Hoteit, S.
Enseignement-apprentissage du français au sud du Liban: didactique contextualisée et intégration dans une dynamique culturelle francophone?
, 2010, Doctoral Thesis, Université Rennes 2;. Université Européenne de Bretagne
Google Scholar
Kanaan, L.
Reformulations, contacts de langues et compétence de communication: analyse linguistique et interactionnelle dans des discussions entre jeunes Libanais francophones
, 2011, Doctoral Dissertation. Université d’Orléans
Google Scholar
Makki, M. La langue française au Liban: langue de division, langue de consensus? Hérodote. 2007;3:161–7. DOI: 10.3917/her.126.0161.CrossRefGoogle Scholar
Saliba, M. Pluralisme linguistique au Liban. Int Rev Educ. 1978;24:381–3. DOI: 10.1007/BF00598054.CrossRefGoogle Scholar
Kotob, HB. Bilingue malgré lui! in: Psycholinguistique au Liban: Etat des lieux. Publications de l’Université de Balamand; 2002. pp. 59–75.Google Scholar
Bayloun, HJ. The Effect of Teaching and Learning in Native and Foreign Language Students' Conceptual Understanding in Science in a Lebanese Context. Doctoral dissertation. Lebanese American University; 2015.CrossRefGoogle Scholar
Marian, V, Blumenfeld, HK, Kaushanskaya, M. The language experience and proficiency questionnaire (LEAP-Q): assessing language profiles in bilinguals and multilinguals. J Speech Lang Hear Res. 2007;50:940–67. DOI: 10.1044/1092-4388(2007/067).CrossRefGoogle ScholarPubMed
Kassir, R, Abboud, H, Godefroy, O. Determination of bilingualism subtypes and their relationship with linguistic abilities in Lebanese bilinguals. Int J Biling. Published online October 24, 2023;13670069231203834. DOI: 10.1177/13670069231203834
CrossRefGoogle Scholar
McKhann, G, Drachman, D, Folstein, M, et al. Clinical diagnosis of Alzheimer’s disease: report of the NINCDS-ADRDA work group under the auspices of department of health and human services task force on Alzheimer’s disease. Neurology. 1984;34:939–939. DOI: 10.1212/WNL.34.7.939.CrossRefGoogle ScholarPubMed
De Renzi, E, Faglioni, P. Normative data and screening power of a shortened version of the token test. Cortex. 1978;14:41–9. DOI: 10.1016/S0010-9452(78)80006-9.CrossRefGoogle ScholarPubMed
El-Hayeck, R, Baddoura, R, Wehbé, A, et al. An Arabic version of the mini-mental state examination for the lebanese population: reliability, validity, and normative data. J Alzheimer’s Dis. 2019;71:525–40. DOI: 10.3233/JAD-181232.CrossRefGoogle ScholarPubMed
Kalafat, M, Hugonot-Diener, L, Poitrenaud, J. Standardisation et étalonnage français du mini mental state (MMS) version GRÉCO. Rev Neuropsychol. 2003;13:209–36.Google Scholar
Kassir, R, Roussel, M, Abboud, H,
Godefroy, O. Verbal fluency in bilingual Lebanese adults: is the prominent language advantage due to executive processes, language processes, or both? Appl Neuropsychol Adult. 2023;1–13. DOI: 10.1080/23279095.2023.2234536 (Advanced online publication).CrossRefGoogle ScholarPubMed
Godefroy, O, Gibbons, L, Diouf, M, et al. Validation of an integrated method for determining cognitive ability: implications for routine assessments and clinical trials. Cortex. 2014;54:51–62. DOI: 10.1016/j.cortex.2014.01.016.CrossRefGoogle ScholarPubMed