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Public Health.

Miguel A Santos-Santos1,2, Stephanie M Grasso3, Marco Calabria4

  • 1Sant Pau Memory Unit, Hospital de la Santa Creu i Sant Pau - Biomedical Research Institute Sant Pau - Universitat Autònoma de Barcelona, Barcelona, Barcelona, Spain.

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|December 23, 2025
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Summary
This summary is machine-generated.

Active bilingualism may protect against Alzheimer's disease (AD) cognitive decline through resilience, not resistance to AD pathology. This suggests cognitive reserve benefits may be linked to language use, impacting neuroinflammation in some individuals.

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Area of Science:

  • Neuroscience
  • Cognitive Science
  • Biomarker Research

Background:

  • Bilingualism is linked to delayed dementia onset, but underlying biological mechanisms remain understudied.
  • Understanding bilingualism's impact on Alzheimer's disease (AD) progression is crucial for therapeutic development.
  • This study examines the relationship between bilingual status, cognitive decline, and cerebrospinal fluid (CSF) biomarkers in AD.

Purpose of the Study:

  • To investigate whether active bilingualism confers resilience or resistance to Alzheimer's disease (AD) pathology.
  • To explore the association between bilingualism, cognitive function, and AD biomarkers in CSF.
  • To determine if bilingualism influences cognitive decline through biological mechanisms related to AD pathology.

Main Methods:

  • Analysis of 567 participants with biomarker-confirmed AD from the Sant Pau Initiative on Neurodegeneration (SPIN) cohort.
  • Assessment of neurological, neuropsychological, CSF biomarkers (Aβ42, tau, NFL, GFAP, YKL-40), and language use.
  • Categorization into active bilinguals and passive bilinguals, with statistical modeling to assess resilience and resistance.

Main Results:

  • Active bilingualism was associated with better cognitive performance (resilience) on specific tests, independent of education.
  • Limited evidence for resistance was observed, with active bilingualism linked to lower YKL-40 (neuroinflammation) in low- and mid-education participants.
  • No significant associations were found between active bilingualism and other AD biomarkers (Aβ42, tau, NFL).

Conclusions:

  • Active bilingualism appears to protect against cognitive decline in AD primarily via resilience.
  • A potential resistance effect against neuroinflammation (YKL-40) may be specific to individuals with lower education levels.
  • Further research with larger cohorts is needed to confirm the resistance findings and explore educational interactions.