Abstract
Objective
Early identification of cognitive symptoms pathognomonic of Alzheimer’s disease (AD) in highly educated bilingual adults remains challenging. We present a clinical case illustrating the application of an SRN model in a 70-year-old highly educated, balanced bilingual Latina eventually diagnosed with moderate-severe stages of AD following an event of severe confusion and disorientation.
Method
An SRN model was applied to promote equitable care through evidence-based consideration of cognitive aging-reserve and its putative manifestation in neurodegenerative disorders. The patient underwent a neuropsychological assessment and structural/functional neuroimaging. Her educational background, linguistic proficiencies, acculturation level, social/behavioral comportment, and limitations in available neuropsychological tools/norms were integrated to reflect the complexity in conducting a reliable bilingual assessment and formulating differential diagnoses.
Results
The SRN model guided clinical decision-making to determine the appropriate target language for bilingual assessment, and to identify reliable normative anchors of impairment relative to premorbid estimates, resulting in incorporation of validated Spanish measures/norms. Neuroimaging revealed bilateral parietal-temporal hypometabolism, which was generally consistent with neuropsychological findings, and the patient was diagnosed with major neurocognitive disorder due to AD.
Conclusions
Given the advanced nature of this patient’s cognitive decline by the time of assessment, it was hypothesized that the combination of bilingualism and high education further masked the precipitous decline atypically observed in AD individuals with high cognitive reserve. Cognitive reserve theories, nonetheless, continue to be anchored strictly within a monocultural-monolingual framework. This complex case, therefore, highlights the urgent need to incorporate bilingualism in current models of cognitive reserve to boost sensitivity in detecting early expression of bilingual AD.