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What multilingual nuns can tell us about dementia

Data from the Nun Study found that linguistic ability broadly was a significant predictor of dementia, although it was written linguistic ability (specifically idea density) rather than multilingualism that was the strongest predictor.

Research, led by Suzanne Tyas, a public health professor at the University of Waterloo, has examined the health outcomes of 325 Roman Catholic nuns who were members of the Sisters of Notre Dame in the US. The data was drawn from a larger, internationally recognised study examining the Sisters, known as the Nun Study.

The researchers found that 6% of the nuns who spoke four or more languages developed dementia, compared to 31% of those who only spoke one. However, knowing two or three languages did not significantly reduce the risk in this study, which differs from some previous research.

"The Nun Study is unique: It is a natural experiment, with very different lives in childhood and adolescence before entering the convent, contrasted with very similar adult lives in the convent," said Tyas. "This gives us the ability to look at early-life factors on health later in life without worrying about all the other factors, such as socioeconomic status and genetics, which usually vary from person to person during adulthood and can weaken other studies."

Tyas added, "Language is a complex ability of the human brain, and switching between different languages takes cognitive flexibility. So, it makes sense that the extra mental exercise multilinguals would get from speaking four or more languages might help their brains be in better shape than monolinguals."

The researchers also examined 106 samples of the nuns' written work and compared it to the broader findings. They found that written linguistic ability affected whether the individuals were at greater risk of developing dementia. For example, idea density – the number of ideas expressed succinctly in written work – helped reduce the risk even more than multilingualism.

"This study shows that while multilingualism may be important, we should also be looking further into other examples of linguistic ability," said Tyas. "In addition, we need to know more about multilingualism and what aspects are important – such as the age when a language is first learned, how often each language is spoken, and how similar or different these languages are. This knowledge can guide strategies to promote multilingualism and other linguistic training to reduce the risk of developing dementia."

Abstract
Background: Multilingualism is associated with enhanced executive function and may thus prevent cognitive decline and reduce the risk of dementia.
Objective: To determine whether multilingualism is associated with delayed onset or reduced risk of dementia.
Methods: Dementia was diagnosed in the Nun Study, a longitudinal study of religious sisters aged 75+ years. Multilingualism was self-reported. Dementia likelihood was determined in 325 participants using discrete-time survival analysis; sensitivity analyses (n = 106) incorporated additional linguistic measures (idea density and grammatical complexity).

Results: Multilingualism did not delay the onset of dementia. However, participants speaking four or more languages (but not two or three) were significantly less likely to develop dementia than monolinguals (OR = 0.13; 95% CI = 0.01, 0.65, adjusted for age, apolipoprotein E, and transition period). This significant protective effect of speaking four or more languages weakened (OR = 0.53; 95% CI = 0.06, 4.91) in the presence of idea density in models adjusted for education and apolipoprotein E.
Conclusion: Linguistic ability broadly was a significant predictor of dementia, although it was written linguistic ability (specifically idea density) rather than multilingualism that was the strongest predictor. The impact of language on dementia may extend beyond number of languages spoken to encompass other indicators of linguistic ability. Further research to identify the characteristics of multilingualism most salient for risk of dementia could clarify the value, target audience, and design of interventions to promote multilingualism and other linguistic training as a strategy to reduce the risk of dementia and its individual and societal impacts.

Authors
Erica E Hack, Joel A Dubin, Myra A Fernandes, Sanduni M Costa, Suzanne L Tyas

[link url="https://uwaterloo.ca/news/news/what-multilingual-nuns-can-tell-us-about-dementia"]University of Waterloo material[/link]

[link url="https://content.iospress.com/articles/journal-of-alzheimers-disease/jad181302"]Journal of Alzheimer’s Disease abstract[/link]

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