Reported symptoms and patterns of language impairment in bilingual speakers with primary progressive aphasia: a retrospective study.
Jessica de Leon, Isabel Elaine Allen, Zachary Miller and 4 others
In bilingual patients with PPA, the less dominant language is the one that declines first and is least preserved.
In 93% of cases. Ask which language the patient uses less, not which one they learned first.
Key findings
1The non-dominant language was the first impacted in 93% of cases overall, regardless of whether it was the first or second language acquired. All participants except one with nfvPPA reported their less dominant language was affected first.
2When looking at first-acquired versus second-acquired language, 70% of participants reported symptoms first in L2, 13% in L1, and 17% reported both languages affected. In the lvPPA subgroup, every participant reported L2 as the first language impacted.
3In a minority of cases, the first reported symptom was unique to bilingual speakers, including difficulty with code switching (mixing two languages within a single word) and difficulty translating between languages.
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What it does not show
All findings are based on what the patient or caregiver remembered and reported to the neurologist — there was no objective language testing in both languages to confirm which language was actually more impaired. Every participant was evaluated in English only, so it is unknown whether the reported patterns would hold if testing had been done in the patient's other language. Subgroup sizes are small and unbalanced (22 nfvPPA, 31 svPPA, 16 lvPPA), so variant-specific patterns — especially the lvPPA finding that all 16 reported L2 first — rest on very few cases. The chart data spans more than 20 years, and bilingualism information was not collected in a consistent or systematic way across that period. This is a single tertiary-care centre in the United States; the language pairs and immigration histories may not generalise to other populations.
Declared interests
No potential conflict of interest was reported by the authors.
The easy way to misread this
Do not read the 93% figure as a rule you can apply to every bilingual PPA patient. It comes from subjective patient and caregiver reports in a retrospective chart review, all assessed in English only, with as few as 16 patients in one variant. It describes what people noticed, not what objective testing in both languages would show, and it cannot tell you which specific linguistic domains will be affected in which language.
Summarised by AI from the full paper, without a clinician reviewing it. Check it against the source before it changes what you do. Read it on PubMed →