Early bilingualism as a protective factor against acute post-stroke aphasia

Abstract Background and aims Aphasia is among the most debilitating post-stroke deficits. Previous studies have suggested that bilingualism, the ability to use more than one language, may confer advantages in language recovery compared with monolingualism in patients with chronic stroke. Our aim was to determine whether early pre-scholar simultaneous bilingualism acts as a protective factor by examining language recovery within the first seven days after acute ischaemic stroke. Methods We retrospectively analyzed clinical and neuroimaging data from Italian monolingual and early bilingual (Slovenian- and Croatian-Italian) patients with anterior-circulation ischaemic stroke and aphasia who were consecutively admitted between January 2018 and April 2020. The two cohorts were compared, and a multivariate logistic regression model was used to identify variables associated with language improvement at 7 days, defined as a ≥ 1-point reduction or complete recovery. Results The two groups did not differ in demographic or clinical characteristics, type of acute treatment, or extent of the ischaemic lesion. Early bilingual patients exhibited significantly greater improvement in NIHSS language scores at day seven. In multivariate analysis, early bilingualism (p = 0.005) emerged as independent predictor of early language recovery, with consistent effect sizes across sensitivity analyses. Conclusions Early bilingualism (eBL) is an independent and robust predictor of aphasia recovery within the first seven days after stroke.