Livingston, G. et al. Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission. Lancet 404, 572–628 (2024).
Google Scholar
Santamaria-Garcia, H. et al. Factors associated with healthy aging in Latin American populations. Nat. Med. 29, 2248–2258 (2023).
Google Scholar
GBD 2021 Forecasting Collaborators Burden of disease scenarios for 204 countries and territories, 2022-2050: a forecasting analysis for the Global Burden of Disease Study 2021. Lancet 403, 2204–2256 (2024).
Google Scholar
Fang, M. et al. Lifetime risk and projected burden of dementia. Nat. Med. 31, 772–776 (2025).
Google Scholar
Hernández, H. et al. The exposome of healthy and accelerated aging across 40 countries. Nat. Med. 31, 3089–3100 (2025).
Bialystok, E. Bilingualism: pathway to cognitive reserve. Trends Cogn. Sci. 25, 355–364 (2021).
Google Scholar
Venugopal, A. et al. Protective effect of bilingualism on aging, MCI, and dementia: a community-based study. Alzheimer’s Dement. 20, 2620–2631 (2024).
Google Scholar
Craik, F. I., Bialystok, E. & Freedman, M. Delaying the onset of Alzheimer disease: bilingualism as a form of cognitive reserve. Neurology 75, 1726–1729 (2010).
Google Scholar
Alladi, S. et al. Bilingualism delays age at onset of dementia, independent of education and immigration status. Neurology 81, 1938–1944 (2013).
Google Scholar
Perani, D. et al. The impact of bilingualism on brain reserve and metabolic connectivity in Alzheimer’s dementia. Proc. Natl Acad. Sci. USA 114, 1690–1695 (2017).
Google Scholar
Abutalebi, J. et al. Bilingualism protects anterior temporal lobe integrity in aging. Neurobiol. Aging 35, 2126–2133 (2014).
Google Scholar
Anderson, J. A. E. et al. Effects of bilingualism on white matter integrity in older adults. NeuroImage 167, 143–150 (2018).
Google Scholar
Voits, T. et al. Degree of multilingual engagement modulates resting state oscillatory activity across the lifespan. Neurobiol. Aging 140, 70–80 (2024).
Google Scholar
Stevens, W. D., Khan, N., Anderson, J. A. E., Grady, C. L. & Bialystok, E. A neural mechanism of cognitive reserve: the case of bilingualism. NeuroImage 281, 120365 (2023).
Google Scholar
Mukadam, N., Sommerlad, A. & Livingston, G. The relationship of bilingualism compared to monolingualism to the risk of cognitive decline or dementia: a systematic review and meta-analysis. J. Alzheimer’s Dis. 58, 45–54 (2017).
Google Scholar
Brini, S. et al. Bilingualism is associated with a delayed onset of dementia but not with a lower risk of developing it: a systematic review with meta-analyses. Neuropsychol. Rev. 30, 1–24 (2020).
Google Scholar
Ibanez, A. et al. Neuroecological links of the exposome and One Health. Neuron 112, 1905–1910 (2024).
Google Scholar
Fuller, R. et al. Pollution and health: a progress update. Lancet Planet Health 6, e535–e547 (2022).
Google Scholar
Sheridan, M. A. Measuring the impact of structural inequality on the structure of the brain. Proc. Natl Acad. Sci. USA 120, e2306076120 (2023).
Google Scholar
Zugman, A. et al. Country-level gender inequality is associated with structural differences in the brains of women and men. Proc. Natl Acad. Sci. USA 120, e2218782120 (2023).
Google Scholar
Van Bavel, J. J., Gadarian, S. K., Knowles, E. & Ruggeri, K. Political polarization and health. Nat. Med. 30, 3085–3093 (2024).
Google Scholar
Lorenz-Spreen, P., Oswald, L., Lewandowsky, S. & Hertwig, R. A systematic review of worldwide causal and correlational evidence on digital media and democracy. Nat. Hum. Behav. 7, 74–101 (2023).
Google Scholar
Gonzalez-Gomez, R. et al. Qualitative and quantitative educational disparities and brain signatures in healthy aging and dementia across global settings. EClinicalMedicine 82, 103187 (2025).
Google Scholar
Hatzenbuehler, M. L., McLaughlin, K. A., Weissman, D. G. & Cikara, M. A research agenda for understanding how social inequality is linked to brain structure and function. Nat. Hum. Behav. 8, 20–31 (2024).
Google Scholar
Legaz, A., Baez, S. & Ibañez, A. Unequal burdens: How structural socioeconomic inequality shapes brain health in aging and dementia. Neuroscience 569, 245–247 (2025).
Google Scholar
Baez, S. et al. Structural inequality and temporal brain dynamics across diverse samples. Clin. Transl. Med 14, e70032 (2024).
Google Scholar
Legaz, A. et al. Structural inequality linked to brain volume and network dynamics in aging and dementia across the Americas. Nat. Aging 5, 259–274 (2025).
Google Scholar
Moguilner, S. et al. Brain clocks capture diversity and disparities in aging and dementia across geographically diverse populations. Nat. Med. 30, 3646–3657 (2024).
Google Scholar
Ibanez, A. et al. Healthy aging meta-analyses and scoping review of risk factors across Latin America reveal large heterogeneity and weak predictive models. Nat. aging 4, 1153–1165 (2024).
Google Scholar
Tian, Y. E. et al. Heterogeneous aging across multiple organ systems and prediction of chronic disease and mortality. Nat. Med. 29, 1221–1231 (2023).
Google Scholar
Smith, S. M., Vidaurre, D., Alfaro-Almagro, F., Nichols, T. E. & Miller, K. L. Estimation of brain age delta from brain imaging. NeuroImage 200, 528–539 (2019).
Google Scholar
SHARE-ERIC. Survey of Health, Ageing and Retirement in Europe (SHARE) Wave 1. Release version: 9.0.0. SHARE-ERIC (2024).
SHARE-ERIC. Survey of Health, Ageing and Retirement in Europe (SHARE) Wave 2. Release version: 9.0.0. SHARE-ERIC (2024).
Börsch-Supan, A. et al. Data resource profile: the Survey of Health Ageing and Retirement in Europe (SHARE). Int. J. Epidemiol. 42, 992–1001 (2013).
Google Scholar
Bergmann, M., Kneip, T., De Luca, G. & Scherpenzeel, A. Survey participation in the Survey of Health, Ageing and Retirement in Europe (SHARE), Wave 1–7. Based on Release 7.0.0. SHARE Working Paper Series 41–2019 (MEA, Max Planck Institute for Social Law and Social Policy. 2019).
Chen, Y. E. A. Defining brain health: a concept analysis. Int. J. Geriatr. Psychiatry (2021).
Google Scholar
World Health Organization. World Report on Ageing and Health (Geneva, 2015).
Thierry, G. & Wu, Y. J. Brain potentials reveal unconscious translation during foreign-language comprehension. Proc. Natl Acad. Sci. USA 104, 12530–12535 (2007).
Google Scholar
Villameriel, S., Costello, B., Giezen, M. & Carreiras, M. Cross-modal and cross-language activation in bilinguals reveals lexical competition even when words or signs are unheard or unseen. Proc. Natl Acad. Sci. USA 119, e2203906119 (2022).
Google Scholar
Rothman, J. Harnessing the bilingual descent down the mountain of life: charting novel paths for Cognitive and Brain Reserves research. Biling. Lang. Cogn. 28, 793–801 (2024).
Google Scholar
Li, P., Legault, J. & Litcofsky, K. A. Neuroplasticity as a function of second language learning: anatomical changes in the human brain. Cortex 58, 301–324 (2014).
Google Scholar
Mechelli, A. et al. Neurolinguistics: structural plasticity in the bilingual brain. Nature 431, 757 (2004).
Google Scholar
Pliatsikas, C. Understanding structural plasticity in the bilingual brain: the Dynamic Restructuring Model. Biling. Lang. Cogn. 23, 459–471 (2020).
Google Scholar
Amoruso, L. et al. Decoding bilingualism from resting-state oscillatory network organization. Ann. N. Y. Acad. Sci. 1534, 106–117 (2024).
Google Scholar
Voits, T., Pliatsikas, C., Robson, H. & Rothman, J. Beyond Alzheimer’s disease: can bilingualism be a more generalized protective factor in neurodegeneration?. Neuropsychologia 147, 107593 (2020).
Google Scholar
Orcutt, M. et al. Lancet migration: global collaboration to advance migration health. Lancet 395, 317–319 (2020).
Google Scholar
Boyle, P. A. et al. The “cognitive clock”: a novel indicator of brain health. Alzheimers Dement. 17, 1923–1937 (2021).
Google Scholar
Yu, L. et al. Predicting age at Alzheimer’s dementia onset with the cognitive clock. Alzheimers Dement. 19, 3555–3562 (2023).
Google Scholar
DeLuca, V., Rothman, J., Bialystok, E. & Pliatsikas, C. Redefining bilingualism as a spectrum of experiences that differentially affects brain structure and function. Proc. Natl Acad. Sci. USA 116, 7565–7574 (2019).
Google Scholar
Titone, D. A. & Tiv, M. Rethinking multilingual experience through a Systems Framework of Bilingualism. Biling. Lang. Cogn. 26, 1–16 (2023).
Google Scholar
Baez, S. et al. Structural inequality and temporal brain dynamics across diverse samples. Clin. Transl. Med. 14, e70032 (2024).
Google Scholar
Ruiz-Adame, M., Ibanez, A., Mollayeva, T. & Trepel, D. Association between neuroticism and dementia on healthcare use: a multi-level analysis across 27 countries from The Survey of Health, Ageing and Retirement in Europe (SHARE). J. Alzheimer’s Dis. 95, 181–193 (2023).
Google Scholar
Chen, H., Cohen, P. & Chen, S. How big is a big odds ratio? Interpreting the magnitudes of odds ratios in epidemiological studies. Commun. Stat.—Simul. Comput. 39, 860–864 (2010).
Google Scholar
Lakens, D. Sample size justification. Collabra. Psychol. 8, 33267 (2022).
Google Scholar
Eurostat. EU key indicators (Statistical Office of the European Union Luxembourg, 2025).
Gong, J. et al. Sex differences in dementia risk and risk factors: Individual-participant data analysis using 21 cohorts across six continents from the COSMIC consortium. Alzheimers Dement. 19, 3365–3378 (2023).
Google Scholar
GBD 2019 Dementia Forecasting Collaborators Estimation of the global prevalence of dementia in 2019 and forecasted prevalence in 2050: an analysis for the Global Burden of Disease Study 2019. Lancet Public Health 7, e105–e125 (2022).
Google Scholar
Friedman, J. Greedy function approximation: a gradient boosting machine. Ann. Stat. 29, 1189–1232 (2001).
Google Scholar
Fittipaldi, S. et al. Heterogeneous factors influence social cognition across diverse settings in brain health and age-related diseases. Nat. Ment. Health 2, 63–75 (2024).
Google Scholar
Andrade, C. Understanding relative risk, odds ratio, and related terms: as simple as it can get. J. Clin. Psychiatry 76, e857–e861 (2015).
Google Scholar
Rajkomar, A., Dean, J. & Kohane, I. Machine learning in medicine. N. Engl. J. Med. 380, 1347–1358 (2019).
Google Scholar
Gamallo, P., Pichel, J. R. & Alegria, I. From language identification to language distance. Phys. A Stat. Mech. Appl. 484, 152–162 (2017).
Google Scholar
Paul, P., Pennell, M. L. & Lemeshow, S. Standardizing the power of the Hosmer–Lemeshow goodness of fit test in large data sets. Stat. Med. 32, 67–80 (2013).
Google Scholar
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