There is consistent evidence of a disadvantage in bilinguals’ speech production compared to monolinguals in healthy individuals, but studies investigating this phenomenon in clinical populations such as mild cognitive impairment (MCI) and Alzheimer's disease (AD) are scarce. Given that both clinical groups are characterized by word-finding difficulties, understanding how bilingualism influences speech production in these populations is essential.
Objective
To investigate the effect of bilingualism on dominant-language speech production in individuals with MCI and AD relative to cognitively unimpaired (CU) older adults.
Methods
Early and highly proficient Catalan–Spanish bilinguals (active bilinguals) were compared to Spanish-dominant speakers with low proficiency in Catalan (passive bilinguals) using a picture-naming task. The study included 58 CU older adults, 66 patients with AD, and 124 individuals with MCI. Reaction times, accuracy, and error types were collected in the naming task in each individual's dominant language.
Results
First, we observed an advantage for active bilinguals compared to passive bilinguals, as indexed by faster responses, particularly for cognate words. Second, active bilinguals with MCI exhibited a disadvantage, making more naming errors than passive bilinguals with MCI, especially for non-cognates, including a higher incidence of cross-language intrusions and anomia. Third, passive bilinguals with MCI and AD showed more semantic errors than active bilinguals.
Conclusions
Disadvantages in naming are discussed in terms of predictions from cognitive and linguistic theories, whereas potential advantages of speaking a second language are considered as a protective factor, consistent with frameworks such as cognitive reserve.
LawsKRAdlingtonRLGaleTM, et al.A meta-analytic review of category naming in Alzheimer’s disease. Neuropsychologia2007; 45: 2674–2682.
2.
TalerVPhillipsNA. Language performance in Alzheimer’s disease and mild cognitive impairment: a comparative review. J Clin Exp Neuropsychol2008; 30: 501–556.
3.
VermaMHowardRJ. Semantic memory and language dysfunction in early Alzheimer’s disease: a review. Int J Geriatr Psychiatry2012; 27: 1209–1217.
4.
KavéGGoralM. Do age-related word retrieval difficulties appear (or disappear) in connected speech?Aging, Neuropsychol Cogn2017; 24: 508–527.
5.
StilwellBLDowRMLamersC, et al.Language changes in bilingual individuals with Alzheimer’s disease. Int J Lang Commun Disord2016; 51: 113–127.
6.
CostaASantestebanMCañoA. On the facilitatory effects of cognate words in bilingual speech production. Brain Lang2005; 94: 94–103.
7.
KrollJFBobbSCMisraM, et al.Language selection in bilingual speech: evidence for inhibitory processes. Acta Psychol (Amst)2008; 128: 416–430.
8.
KrollJFBobbSCWodnieckaZ. Language selectivity is the exception, not the rule: arguments against a fixed locus of language selection in bilingual speech. Biling Lang Cogn2006; 9: 119–135.
9.
La HeijW. Selection processes in monolingual and bilingual lexical access. In: KrollJFde GrootAMB (eds) Handbook of bilingualism: psycholinguistic approaches. New York: Oxford University Press, 2005, pp.289–307.
10.
GollanTHMontoyaRICeraC, et al.More use almost always a means a smaller frequency effect: aging, bilingualism, and the weaker links hypothesis. J Mem Lang2008; 58: 787–814.
11.
GollanTHAcenasL-AR. What is a TOT? Cognate and translation effects on tip-of-the-tongue states in Spanish-English and tagalog-English bilinguals. J Exp Psychol Learn Mem Cogn2004; 30: 246–269.
12.
Basnight-BrownDM. Models of lexical access and bilingualism. In: HerediaRRAltarribaJ (eds) Foundations of bilingual memory. New York, NY: Springer Science + Business Media, 2014, pp.85–107.
13.
GollanTHMontoyaRIFennema-NotestineC, et al.Bilingualism affects picture naming but not picture classification. Mem Cognit2005; 33: 1220–1234.
14.
BialystokE. Effects of bilingualism on cognitive and linguistic performance across the lifespan. In: GogolinINeumannU (eds) Streitfall Zweisprachigkeit–The Bilingualism controversy. Wiesbaden, Germany: Springer, 2009, pp.53–67.
15.
BialystokECraikFIM. Cognitive and linguistic processing in the bilingual mind. Curr Dir Psychol Sci2010; 19: 19–23.
16.
RosselliMArdilaAAraujoK, et al.Verbal fluency and repetition skills in healthy older Spanish-English bilinguals. Appl Neuropsychol2000; 7: 17–24.
17.
Tahami MonfaredAByrnesMJWhiteLA, et al.Alzheimer’s disease: epidemiology and clinical progression. Neurol Ther2022; 11: 553–569.
18.
GarcíaAMde LeonJTeeBL, et al.Speech and language markers of neurodegeneration: a call for global equity. Brain2023; 146: 4870–4879.
19.
BylundEAntfolkJAbrahamssonN, et al.Does bilingualism come with linguistic costs? A meta-analytic review of the bilingual lexical deficit. Psychon Bull Rev2023; 30: 897–913.
20.
BaileyCVentaALangleyH. The bilingual [dis] advantage. Lang Cogn2020; 12: 225–281.
21.
GollanTHKrollJF. Bilingual lexical access. In: RappB (eds) Handbook of cognitive neuropsychology. . New York: Psychology Press, 2015, pp.321–345.
22.
GreenDW. Mental control of the bilingual lexico-semantic system. Biling Lang Cogn1998; 1: 67–81.
23.
SantestebanMSchwieterJW. Lexical selection and competition in bilinguals. In: HerediaRRCieślickaAB (eds) Bilingual lexical ambiguity resolution. Cambridge: Cambridge University Press, 2020, pp.126–156.
24.
ColoméÀ. . Lexical activation in bilinguals’ speech production: language-specific or language-independent?J Mem Lang2001; 45: 721–736.
25.
KrollJFMaF. The Bilingual Lexicon. In: FernándezEMCairnsHS (eds) The handbook of psycholinguistics. Chichester, UK: Wiley Blackwell, 2018, pp.294–319.
26.
GollanTHSlatteryTJGoldenbergD, et al.Frequency drives lexical access in Reading but not in speaking: the frequency-lag hypothesis. J Exp Psychol Gen2011; 140: 186.
27.
IvanovaICostaA. Does bilingualism hamper lexical access in speech production?Acta Psychol (Amst)2008; 127: 277–288.
28.
AndersonJAESaleemiSBialystokE. Neuropsychological assessments of cognitive aging in monolingual and bilingual older adults. J Neurolinguistics2017; 43: 17–27.
29.
SullivanMDPoarchGJBialystokE. Why is lexical retrieval slower for bilinguals? Evidence from picture naming. Biling Lang Cogn2018; 21: 479–488.
30.
BialystokECraikFLukG. Cognitive control and lexical access in younger and older bilinguals. In: BialystokE (ed.) Where language meets thought. New York, NY: Routledge, 2024, pp.84–117.
31.
TalerVJohnsB. Using big data to understand bilingual performance in semantic fluency: findings from the Canadian Longitudinal Study on Aging. PLoS One2022; 17: e0277660.
32.
GollanTHFennema-NotestineCMontoyaRI, et al.The bilingual effect on Boston Naming Test performance. J Int Neuropsychol Soc2007; 13: 197–208.
33.
GollanTHGarciaDLMurilloM, et al.Sprinting in two languages: picture naming performance of older Spanish–English bilinguals on the Multilingual Naming Test Sprint 2.0. Neuropsychology2024; 38: 653–664.
34.
FriesenDCLuoLLukG, et al.Proficiency and control in verbal fluency performance across the lifespan for monolinguals and bilinguals. Lang Cogn Neurosci2015; 30: 238–250.
GallagherMKohMT. Episodic memory on the path to Alzheimer’s disease. Curr Opin Neurobiol2011; 21: 929–934.
37.
JohnsEKPhillipsNABellevilleS, et al.The profile of executive functioning in amnestic mild cognitive impairment: disproportionate deficits in inhibitory control. J Int Neuropsychol Soc2012; 18: 541–555.
38.
ReinvangIGrambaiteREspesethT. Executive dysfunction in MCI: subtype or early symptom. Int J Alzheimers Dis2012; 2012: 936272.
39.
MuellerKDHermannBMecollariJ, et al.Connected speech and language in mild cognitive impairment and Alzheimer’s disease: a review of picture description tasks. J Clin Exp Neuropsychol2018; 40: 917–939.
40.
ReillyJPeelleJEAntonucciSM, et al.Anomia as a marker of distinct semantic memory impairments in Alzheimer’s disease and semantic dementia. Neuropsychology2011; 25: 413–426.
41.
DuongAWhiteheadVHanrattyK, et al.The nature of lexico-semantic processing deficits in mild cognitive impairment. Neuropsychologia2006; 44: 1928–1935.
42.
GarrardPLambon RalphMAPattersonK, et al.Semantic feature knowledge and picture naming in dementia of Alzheimer’s type: a new approach. Brain Lang2005; 93: 79–94.
43.
CalabriaMCattaneoGMarneP, et al.Language deterioration in bilingual Alzheimer’s disease patients: a longitudinal study. J Neurolinguistics2017; 43: 59–74.
44.
CostaACalabriaMMarneP, et al.On the parallel deterioration of lexico-semantic processes in the bilinguals’ two languages: evidence from Alzheimer’s disease. Neuropsychologia2012; 50: 740–753.
45.
NeveuAGoldrickMKleinmanD, et al.Revisiting which language declines more in spanish-English bilinguals with Alzheimer’s disease: longitudinal decline patterns on the multilingual naming test. Neuropsychologia2024; 202: 108948.
46.
GardSSaadJSheppardCL, et al.Monolinguals outperform bilinguals in language but not executive function in aging and cognitive impairment. Neuropsychology2025; 39: 781–790.
47.
BialystokECraikFIMBinnsMA, et al.Effects of bilingualism on the age of onset and progression of MCI and AD: evidence from executive function tests. Neuropsychology2014; 28: 290–304.
48.
KowollMEDegenCGladisS, et al.Neuropsychological profiles and verbal abilities in lifelong bilinguals with mild cognitive impairment and Alzheimer’s disease. J Alzheimers Dis2015; 45: 1257–1268.
49.
CostumeroVMarin-MarinLCalabriaM, et al.A cross-sectional and longitudinal study on the protective effect of bilingualism against dementia using brain atrophy and cognitive measures. Alzheimers Res Ther2020; 12: 11.
50.
De BruinADella SalaSBakTH. The effects of language use on lexical processing in bilinguals. Lang Cogn Neurosci2016; 31: 967–974.
51.
LiampasIFoliaVMorfakidouR, et al.Language differences among individuals with normal cognition, amnestic and non-amnestic MCI, and Alzheimer’s disease. Arch Clin Neuropsychol2023; 38: 525–536.
52.
McDonnellMDillLPanosS, et al.Verbal fluency as a screening tool for mild cognitive impairment. Int Psychogeriatrics2020; 32: 1055–1062.
53.
WhitfordVTitoneD. The effects of word frequency and word predictability during first-and second-language paragraph Reading in bilingual older and younger adults. Psychol Aging2017; 32: 158.
54.
GaleTMIrvineKLawsKR, et al.The naming profile in Alzheimer patients parallels that of elderly controls. J Clin Exp Neuropsychol2009; 31: 565–574.
55.
SilveriMCCappaAMariottiP, et al.Naming in patients with Alzheimer’s disease: influence of age of acquisition and categorical effects. J Clin Exp Neuropsychol2002; 24: 755–764.
56.
BaileyLMLockaryKHigbyE. Cross-linguistic influence in the bilingual lexicon: evidence for ubiquitous facilitation and context-dependent interference effects on lexical processing. Biling Lang Cogn2024; 27: 495–514.
57.
CostaACaramazzaASebastian-GallesN. The cognate facilitation effect: implications for models of lexical access. J Exp Psychol Learn Mem Cogn2000; 26: 1283.
58.
MartinCDNozariN. Language control in bilingual production: insights from error rate and error type in sentence production. Biling Lang Cogn2021; 24: 374–388.
59.
LiCGollanTH. Cognates facilitate switches and then confusion: contrasting effects of cascade versus feedback on language selection. J Exp Psychol Learn Mem Cogn2018; 44: 974.
60.
CuetosFGonzalez-NostiMMartínezC. The picture-naming task in the analysis of cognitive deterioration in Alzheimer’s disease. Aphasiology2005; 19: 545–557.
61.
CatricalàEDella RosaPAPlebaniV, et al.Semantic feature degradation and naming performance. Evidence from neurodegenerative disorders. Brain Lang2015; 147: 58–65.
62.
GallantMLavoieMHudonC, et al.Analysis of naming errors in healthy aging, mild cognitive impairment, and Alzheimer’s disease. Can J Speech Lang Pathol Audiol2019; 43: 95–108.
63.
MooijmanSSchoonenRGoralM, et al.Why do bilingual speakers with aphasia alternate between languages? A study into their experiences and mixing patterns. Aphasiology2026; 40: 493–520.
64.
AlbertMSDeKoskySTDicksonD, et al.The diagnosis of mild cognitive impairment due to Alzheimer’s disease: recommendations from the National Institute on Aging-Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s disease. Alzheimers Dement2011; 7: 270–279.
65.
McKhannGMKnopmanDSChertkowH, et al.The diagnosis of dementia due to Alzheimer’s disease: recommendations from the National Institute on Aging-Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s disease. Alzheimers Dement2011; 7: 263–269.
66.
CalabriaMPérez PérezJMartínez-HortaS, et al.Language reconfiguration in bilinguals: a study with Huntington’s disease patients. Linguist Approaches Biling2021; 11: 459–483.
67.
FolsteinMFFolsteinSEMcHughPR. Mini-mental state: apractical method for grading the mental state of patients for clinicians. J Psychiatr Res1975; 12: 189–198.
68.
TamayoFCasals-CollMSánchez-BenavidesG, et al.Spanish normative studies in a young adult population (NEURONORMA young adults project): guidelines for the span verbal, span visuo-spatial, Letter-Number Sequencing, Trail Making Test and Symbol Digit Modalities Test. Neurol (English Ed)2012; 27: 319–329.
69.
MorrisJCHeymanAMohsRC, et al.The consortium to establish a registry for Alzheimer’s disease (CERAD): i. Clinical and neuropsychological assessment of Alzheimer’s disease. Neurology1989; 39: 1159–1165.
70.
SnodgrassJGVanderwartM. A standardized set of 260 pictures: norms for name agreement, image agreement, familiarity, and visual complexity. J Exp Psychol Hum Learn Mem1980; 6: 174.
71.
BatesED’AmicoSJacobsenT, et al.Timed picture naming in seven languages. Psychon Bull Rev2003; 10: 344–380.
72.
GuaschMBoadaRFerréP, et al.NIM: a web-based Swiss army knife to select stimuli for psycholinguistic studies. Behav Res Methods2013; 45: 765–771.
73.
ForsterKIForsterJC. DMDX: a Windows display program with millisecond accuracy. Behav Res Methods Instrum Comput2003; 35: 116–124.
74.
ProtopapasA. Checkvocal: a program to facilitate checking the accuracy and response time of vocal responses from DMDX. Behav Res Methods2007; 39: 859–862.
75.
BatesDMaechlerMBolkerB, et al.Package ‘lme4’. Convergence2015; 12: 2.
76.
SchwartzMF. Theoretical analysis of word production deficits in adult aphasia. Philos Trans R Soc B Biol Sci2014; 369: 20120390.
77.
Forbes-McKayKEVenneriA. Detecting subtle spontaneous language decline in early Alzheimer’s disease with a picture description task. Neurol Sci2005; 26: 243–254.
78.
Arce RenteríaMCasallettoKTomS, et al.The contributions of active Spanish-English bilingualism to cognitive reserve among older Hispanic adults living in California. Arch Clin Neuropsychol2019; 34: 1235.
79.
Trudeau-MeisnerMJohnsBTTalerV. Contextual diversity and picture naming: The role of aging and bilingualism. Biling Lang CognEpub ahead of print 24 June 2025: 1–17. DOI: 10.1017/S1366728925100229
80.
SvennevigJHansenPSimonsenHG, et al.Code-switching in multilinguals with dementia: patterns across speech contexts. Clin Linguist Phon2019; 33: 1009–1030.
81.
CalabriaMHernándezMCattaneoG, et al.Active bilingualism delays the onset of mild cognitive impairment. Neuropsychologia2020; 146: 107528.
82.
CargneluttiETomasinoBFabbroF. Effects of linguistic distance on second language brain activations in bilinguals: an exploratory coordinate-based meta-analysis. Front Hum Neurosci2022; 15: 744489.
83.
KhachatryanEVanhoofGBeyensH, et al.Language processing in bilingual aphasia: a new insight into the problem. WIREs Cogn Sci2016; 7: 180–196.
84.
KuzminaEGoralMNorvikM, et al.What influences language impairment in bilingual aphasia? A meta-analytic review. Front Psychol2019; 10: 445.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
