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We investigated whether language usage was related to the volume of white matter lesions in a cohort of middle-aged to older adults with different multilingual characteristics, including monolingualism in daily life (use of one language), bilingualism (use of two languages), and multilingualism (active use of 3 languages, i.e., Catalan, Spanish, English). We also explored cognitive status and cognitive change over a 2-year follow-up period linked to possible associations between language usage and white matter status to provide insights into the theory of cognitive reserve (CR).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>All participants (N\u2005=\u2005397, age range: 45\u201369, 50.1% female) underwent cognitive and structural magnetic resonance imaging assessments at baseline, and 306 of them completed additional cognitive and neuroimaging assessments 2 years later. Active use of languages was computed at baseline with the Shannon Entropy equation, which measured the frequency of use of each language in 4 different contexts: home, work, friends, and family. The volume of white matter hypointensities (WM-hypo) was determined using FreeSurfer.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>There was a positive correlation between Entropy values and WM-hypo. Compared to monolinguals, participants using 3 languages daily presented equivalent cognitive function and increased white matter lesions, both at baseline and follow-up examinations.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>Among middle-aged participants with equivalent cognitive levels, active multilingualism was associated with greater white matter deterioration, suggesting increased CR.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/geronb\/gbaf064","type":"journal-article","created":{"date-parts":[[2025,4,8]],"date-time":"2025-04-08T11:05:35Z","timestamp":1744110335000},"source":"Crossref","is-referenced-by-count":4,"title":["Use of Multiple Languages Provides Cognitive Reserve Amidst Age-Related White Matter 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