Conference Program

This talk will attempt to bring together some of the implications of research and evidence presented at this conference. This will be contextualized drawing on relevant existing population representative and derived studies and broader multidisciplinary sources. In particular, there will be a focus on changing life expectancies, Sustainable Development Goals, and rapidly rising concern about our ability to address our own species impact on climate and environmental integrity. An ageing focus throws up a different perspective on there, including how we review and assess the evidence base to address current challenges and future scenarios.

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This talk will discuss some of the main challenges associated with cognitive assessment in older multilingual and multicultural populations based on international research and current evidence. This will mainly draw on the increasing cultural neuropsychology and neuroscience literature and will be contextualized drawing on relevant population data and studies from the Greater Bay Area and/or China when possible. In particular, there will be a focus on cultural, linguistic and educational influences on cognitive test performance and how these have been addressed in newly developed cross-cultural cognitive instruments. Use of cognitive instruments appropriate for older people from diverse language, education and literacy backgrounds is important to address current challenges in early dementia diagnosis and epidemiological research at the global level.

How does our experience with language impact human brain organization? In this presentation, I show how three decades of work capitalising on the rich linguistic environment of Montreal has allowed us to gain insights about brain organization for language in healthy participants and in clinical domains. The talk will focus on research combining behavioral methods with functional neuroimaging (PET, task-based fMRI, resting-state fMRI) under different language learning scenarios, to investigate how neural organization is influenced by the age of acquisition, proficiency in the language, and the distinctive characteristics of languages. I will discuss the use of anatomical techniques such as voxel-based morphometry-VBM, cortical thickness measures, diffusion tensor tractography to enhance our understanding of neural plasticity in the healthy human brain and in patients with brain lesions. I also show how we are developing newer tools using speech samples and machine learning methods to address the interaction between basic science and the clinic, with a focus on diagnosis in patients with neurodegenerative disorders.

Bilingualism may protect against cognitive aging, but bilinguals can differ on various characteristics (e.g., frequency of bilingual language use, degree of proficiency). Most studies on the effect of bilingualism on dementia risk examine group differences between bilinguals and monolinguals, treating bilinguals as a monolithic group. In addition, there is inconsistent accounting for environmental and sociocultural factors (i.e., immigrant status) that influence the ability or opportunity to become bilingual. The current presentation will discuss implications of diverse linguistic characteristics of bilinguals (i.e., frequency of bilingual language use) on the contributions of bilingualism to cognitive reserve. Lastly, we will provide a framework on how to incorporate bilingualism using a lifecourse approach to address appropriate sociocultural confounds in cognitive aging research.

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The concept of cognitive reserve was introduced to account for the observation of individual discrepancies between severity of brain pathology and the level of cognitive/functional impairment, and provides a strong foundation for the current focus on modifiable risk factors as a strategy for brain health promotion. Physical activity, diet, cognitive training and social engagement are areas allowing the possibility to act positively on the reserve by means of active intervention. Even modest effects of increased reserve on the age of onset or the rate of cognitive decline would have an enormous positive impact global brain health at the population level.

Dementia is a common condition among older adults, with higher prevalence in several LMIC, probably due to low education and to poor control of cardiovascular risk factors. Multi-domain non-pharmacological interventions are a key strategy to prevent dementia or to postpone the emergence of symptoms. The impact of these interventions may be greater in most LMIC, given the high prevalence and burden of modifiable risk factors. Importantly, several measures have low cost and may be implemented at the primary care level.

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It is by now well recognized that a problem of accelerating urgency that the world is facing is the set of devastating diseases that ageing brings.  An integrated response to these diseases is to understand the endogenous and exogenous factors which drive biological ageing, with the aim of slowing the process, or even stopping or reversing it.  Systematic research on ageing, involving many disciplines, began in mid-20th century (Medawar, Williams, etc.)  Progress at the molecular level in recent years is represented in: defining hallmarks of biological ageing (Lopez-otin), developing the epigenetic clock (Horvath), and efforts to recover epigenetic information to regain functions (Sinclair).  Research is also progressing along the neuropsychological front.  I will briefly review efforts by our team in investigating the neuropsychological bases of cognitive decline, as detected via linguistic experiments.

Person-centered care can be better achieved in a dementia-friendly community. This presentation reviews dementia friendliness with reference of Global Dementia Observatory by World Health Organization. Three actions areas will be highlighted to discuss gaps and strategies to build resilience, including 1) dementia awareness and friendliness; 2) risk reduction; and 3) support for carers of people with dementia. Only by increased public awareness to minize negative steoretype, efforts to reduce risk factors from a life course perspective, and engaged support to carers could contribute to resilience to better response to dementia-related challenges for an all inclusive society.

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