{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,4,6]],"date-time":"2026-04-06T12:44:31Z","timestamp":1775479471638,"version":"3.50.1"},"posted":{"date-parts":[[2026,4,2]]},"group-title":"Neurology","reference-count":41,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T00:00:00Z","timestamp":1775088000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2026,4,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                <jats:sec>\n                  <jats:title>INTRODUCTION<\/jats:title>\n                  <jats:p>Bilingualism is a proposed cognitive reserve factor that delays symptom onset in Alzheimer\u2019s disease (AD), though current evidence lacks biomarker confirmation. This retrospective study examined bilingualism\u2019s association with symptom onset across AD clinical stages, including biomarker-confirmed cases.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>METHODS<\/jats:title>\n                  <jats:p>Participants from the Sant Pau Memory Unit spanning amnestic mild cognitive impairment (MCI), amnestic dementia, and biomarker-confirmed AD were analyzed, with balanced representation of active and passive Spanish-Catalan bilinguals. Linear regression models evaluated associations between bilingualism and reported age at symptom onset, controlling for education, sex, and disease severity.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>\n                    Active bilingualism was associated with delayed symptom onset in amnestic MCI (2.21 years), amnestic dementia (1.42 years), and biomarker-confirmed AD (1.45 years;\n                    <jats:italic>p<\/jats:italic>\n                    s &lt; .05). Higher education was associated with earlier onset, likely representing healthcare seeking behavior.\n                  <\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>DISCUSSION<\/jats:title>\n                  <jats:p>Bilingualism protects against earlier symptom manifestation in MCI and AD, supporting bilingualism as a contributor to cognitive reserve.<\/jats:p>\n                <\/jats:sec>","DOI":"10.64898\/2026.03.31.26349879","type":"posted-content","created":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T18:00:13Z","timestamp":1775152813000},"source":"Crossref","is-referenced-by-count":0,"title":["Evidence for bilingualism as a cognitive reserve factor in biomarker-confirmed Alzheimer\u2019s disease"],"prefix":"10.64898","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5287-3012","authenticated-orcid":false,"given":"Stephanie M.","family":"Grasso","sequence":"first","affiliation":[{"name":"Department of Speech, Language, 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Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elena","family":"Vera-Campuzano","sequence":"additional","affiliation":[{"name":"Sant Pau Memory Unit, IR SANT PAU, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain"},{"name":"Institut de Neuroci\u00e8ncies, Universitat Aut\u00f2noma de Barcelona, Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Judit","family":"Selma-Gonz\u00e1lez","sequence":"additional","affiliation":[{"name":"Sant Pau Memory Unit, IR SANT PAU, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain"},{"name":"Institut de Neuroci\u00e8ncies, Universitat Aut\u00f2noma de Barcelona, Barcelona, 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