Bilinguals activate both languages when they intend to speak even one language alone (e.g., Kroll, Bobb, & Wodniekca, 2006). At the same time, they are able to select the language they intend to speak and switch back and forth between languages rapidly, with few production errors. Previous research utilizing behavioral (Linck, Kroll, & Sunderman, 2009) and neuroimaging techniques (ERPs and fMRI; Guo, Liu, Misra, & Kroll, 2011; Misra, Guo, Bobb, & Kroll, 2012) suggest that successful bilingual speech production is enabled by active inhibition of the language not in use. Results showing an asymmetric switching cost for the L1 compared to the L2 (with a larger cost -reflected in longer naming latencies-when switching from the L2 to the L1) have been taken as evidence that the L1 (usually the dominant language for bilinguals who learned their second language later in life) may need to be inhibited when speaking in the L2. However, there is still little research on the scope of this inhibitory process. The goal of this event-related functional magnetic resonance imaging study is to understand how the recruitment of neural areas implicated during bilingual language processing are shaped by the scope of language use. The results show that bilinguals engage a wide functional control network that is hierarchically engaged in local control for single lexical items, but extends further to the broader semantic level, and finally to the whole language. This functional network is modulated by proficiency in the L2.

Morphological brain changes as a consequence of new learning have been widely established. Learning a second language (L2) is one such experience that can lead to rapid structural neural changes. However, still relatively little is known about how levels of proficiency in the L2 and the age at which the L2 is learned influence brain neuroplasticity. The goal of this study is to provide novel evidence for the effect of bilingualism on white matter structure in relatively proficient but late L2 learners who acquired the second language after early childhood. Overall, the results demonstrate a significant effect on white matter fractional anisotropy (FA) as a function of L2 learning. Higher FA values were found in a broad white matter network including the anterior thalamic radiation (ATR), the inferior fronto-occipital fasciculus (IFOF), the Uncinate Fasciculus (UF), and the inferior longitudinal fasciculus (ILF). Moreover, FA values were correlated with age of L2 acquisition, suggesting that learning an L2, even past childhood, induces neural changes. Finally, these results provide some initial evidence that variability in the age of L2 acquisition has important consequences for neural plasticity.

Study objective

To assess the effect of armodafinil on task-related prefrontal cortex activation using functional magnetic resonance imaging (fMRI) in patients with obstructive sleep apnea (OSA) and excessive sleepiness despite continuous positive airway pressure (CPAP) therapy.

Methods

This 2-week, multicenter, prospective, randomized, double-blind, placebo-controlled, parallel-group study was conducted at five neuroimaging sites and four collaborating clinical study centers in the United States. Patients were 40 right-handed or ambidextrous men and women aged between 18 and 60 years, with OSA and persistent sleepiness, as determined by multiple sleep latency and Epworth Sleepiness Scale scores, despite effective, stable use of CPAP. Treatment was randomized (1:1) to once-daily armodafinil 200 mg or placebo. The primary efficacy outcome was a change from baseline at week 2 in the volume of activation meeting the predefined threshold in the dorsolateral prefrontal cortex during a 2-back working memory task. The key secondary measure was the change in task response latency.

Results

No significant differences were observed between treatment groups in the primary or key secondary outcomes. Armodafinil was generally well tolerated. The most common adverse events (occurring in more than one patient [5%]) were headache (19%), nasopharyngitis (14%), and diarrhea (10%).

Conclusions

Armodafinil did not improve fMRI-measured functional brain activation in CPAP-treated patients with OSA and excessive sleepiness.

Study registration

Double-Blind, Placebo-Controlled, Functional Neuroimaging Study of Armodafinil (200 mg/Day) on Prefrontal Cortical Activation in Patients With Residual Excessive Sleepiness Associated With Obstructive Sleep Apnea/Hypopnea.