Clinical Manifestations

Abstract

BACKGROUND: The digit span task, a measure of auditory verbal short-term and working memory, is widely used globally. Emerging research has revealed variations in digit span performance across languages among young adults; however, studies focusing on older populations are scarce and typically involving limited languages. This study investigates digit span performance among older adults (40-90 year-old) across fourteen languages and explored the influence of lexical and numerical properties on cognitive assessment. METHOD: We examined digit span performance among cognitively normal participants (CN), individuals with mild cognitive impairment (MCI) and Alzheimer's disease (AD) across fourteen language cohorts totalling 3,681 participants: English (n = 446), Mandarin (n = 97), Cantonese (n = 65), Spanish (n = 218), Kannada (n = 69), Hindi (n = 72), Telugu (n = 69), Malayalam (n = 70), Bengali (n = 70), French (n = 299), Korean (n = 1098), Italian (n = 540), Arabic (n = 50), and Turkish (n = 518). First, we analyzed language differences in digit span performance among CN using ANOVA and general linear models. We then conducted Receiver operating characteristic (ROC) analyses to identify the optimal cutoff values for AD. Next, we computed the digit count, syllable count, and numerical magnitude (i.e. the average sum of the digits) of all digit stimuli in the English cohort and analyzed their effects via linear and ridge regression analyses. RESULT: The forward (FDS) and backward digit span (BDS) tests revealed significant differences among CN across the fourteen language cohorts even after adjusting for age and education (FDS:F=38.62, p <0.001; BDS:F=19.23, p <0.001). ROC analysis revealed varying optimal cutoff values across languages: English (FDS:6, BDS:4), Italian and Turkish (FDS:5, BDS:4), Mandarin (FDS:7, BDS:5), Cantonese (FDS:7, BDS:4), and French (FDS:6, BDS:3). Further analysis indicated that the interaction between digit and syllable counts significantly impacted FDS accuracy in English speakers (linear:p=0.00035; ridge:p< 0.000001), with no significant effect from digit count alone after adjusting for interaction. Conversely, BDS performance showed a significant negative influence from digit count (p = 0.00858), with numerical magnitude and syllable count nearing significance (p = 0.083 and p = 0.066, respectively). CONCLUSION: Variations in digit span performance across languages illustrate the role of linguistic and numerical factors in cognitive assessments, even with tests targeting non-language domains using digit stimuli. These findings underscore the critical value of language diversity in cognitive research. © 2025 The Alzheimer's Association. Alzheimer's & Dementia published by Wiley Periodicals LLC on behalf of Alzheimer's Association.