Lifelong exposure to multilingualism: new evidence to support cognitive reserve hypothesis
Investigate the protective effect of multilingualism on cognition in seniors. As part of the MemoVie study conducted on 232 non-demented volunteers aged 65 and more, neurogeriatric and neuropsychological evaluations were performed. Participants were classified as presenting either cognitive impairme...
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| creator | Perquin, Magali Vaillant, Michel Schuller, Anne-Marie Pastore, Jessica Dartigues, Jean-François Lair, Marie-Lise Diederich, Nico |
| description | Investigate the protective effect of multilingualism on cognition in seniors.
As part of the MemoVie study conducted on 232 non-demented volunteers aged 65 and more, neurogeriatric and neuropsychological evaluations were performed. Participants were classified as presenting either cognitive impairment without dementia (CIND) or being free of any cognitive impairment (CIND-free). Language practices, socio-demographic data and lifestyle habits were recorded. In this retrospective nested case-control design, we used as proxies of multilingualism: number of languages practiced, age of acquisition and duration of practice, emphasizing the temporal pattern of acquisition, and the resulting practice of several languages sequentially or concomitantly during various periods of life. This special angle on the matter offered to our work a dimension particularly original and innovative.
44 subjects (19%) had CIND, the others were cognitively normal. All practiced from 2 to 7 languages. When compared with bilinguals, participants who practiced more than 2 languages presented a lower risk of CIND, after adjustment for education and age (odds ratio (OR) = 0.30, 95% confidence limits (95%CL) = [0.10-0.92]). Progressing from 2 to 3 languages, instead of staying bilingual, was associated with a 7-fold protection against CIND (OR = 0.14, 95%CL = [0.04-0.45], p = 0.0010). A one year delay to reach multilingualism (3 languages practiced being the threshold) multiplied the risk of CIND by 1.022 (OR = 1.022, 95%CL = [1.01-1.04], p = 0.0044). Also noteworthy, just as for multilingualism, an impact of cognitively stimulating activities on the occurrence of CIND was found as well (OR = 0.979, 95%CL = [0.961-0.998], p = 0.033).
The study did not show independence of multilingualism and CIND. Rather it seems to show a strong association toward a protection against CIND. Practicing multilingualism from early life on, and/or learning it at a fast pace is even more efficient. This protection might be related to the enhancement of cognitive reserve and brain plasticity, thereby preserving brain functions from alterations during aging. |
| doi_str_mv | 10.1371/journal.pone.0062030 |
| format | Article |
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As part of the MemoVie study conducted on 232 non-demented volunteers aged 65 and more, neurogeriatric and neuropsychological evaluations were performed. Participants were classified as presenting either cognitive impairment without dementia (CIND) or being free of any cognitive impairment (CIND-free). Language practices, socio-demographic data and lifestyle habits were recorded. In this retrospective nested case-control design, we used as proxies of multilingualism: number of languages practiced, age of acquisition and duration of practice, emphasizing the temporal pattern of acquisition, and the resulting practice of several languages sequentially or concomitantly during various periods of life. This special angle on the matter offered to our work a dimension particularly original and innovative.
44 subjects (19%) had CIND, the others were cognitively normal. All practiced from 2 to 7 languages. When compared with bilinguals, participants who practiced more than 2 languages presented a lower risk of CIND, after adjustment for education and age (odds ratio (OR) = 0.30, 95% confidence limits (95%CL) = [0.10-0.92]). Progressing from 2 to 3 languages, instead of staying bilingual, was associated with a 7-fold protection against CIND (OR = 0.14, 95%CL = [0.04-0.45], p = 0.0010). A one year delay to reach multilingualism (3 languages practiced being the threshold) multiplied the risk of CIND by 1.022 (OR = 1.022, 95%CL = [1.01-1.04], p = 0.0044). Also noteworthy, just as for multilingualism, an impact of cognitively stimulating activities on the occurrence of CIND was found as well (OR = 0.979, 95%CL = [0.961-0.998], p = 0.033).
The study did not show independence of multilingualism and CIND. Rather it seems to show a strong association toward a protection against CIND. Practicing multilingualism from early life on, and/or learning it at a fast pace is even more efficient. This protection might be related to the enhancement of cognitive reserve and brain plasticity, thereby preserving brain functions from alterations during aging.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0062030</identifier><identifier>PMID: 23646113</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Aged ; Aged, 80 and over ; Aging ; Alzheimer Disease - prevention & control ; Alzheimer's disease ; Bilingualism ; Biology ; Brain ; Cognition ; Cognition Disorders - prevention & control ; Cognitive ability ; Cognitive Reserve ; Confidence limits ; Confounding Factors (Epidemiology) ; Dementia ; Dementia - prevention & control ; Dementia disorders ; Demographics ; Education ; Habits ; Humans ; Hypotheses ; Impairment ; Languages ; Leisure ; Medical screening ; Medicine ; Multilingualism ; Neuropsychological Tests ; Odds Ratio ; Retrospective Studies ; Risk Factors ; Social and Behavioral Sciences ; Studies</subject><ispartof>PloS one, 2013-04, Vol.8 (4), p.e62030-e62030</ispartof><rights>2013 Perquin et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License: https://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2013 Perquin et al 2013 Perquin et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c592t-f3c715d200797035d7bc47561af8273ec85995473da54e910a35ac7e4f66b48f3</citedby><cites>FETCH-LOGICAL-c592t-f3c715d200797035d7bc47561af8273ec85995473da54e910a35ac7e4f66b48f3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3640029/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3640029/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2096,2915,23845,27901,27902,53766,53768,79342,79343</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23646113$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Perquin, Magali</creatorcontrib><creatorcontrib>Vaillant, Michel</creatorcontrib><creatorcontrib>Schuller, Anne-Marie</creatorcontrib><creatorcontrib>Pastore, Jessica</creatorcontrib><creatorcontrib>Dartigues, Jean-François</creatorcontrib><creatorcontrib>Lair, Marie-Lise</creatorcontrib><creatorcontrib>Diederich, Nico</creatorcontrib><creatorcontrib>MemoVie Group</creatorcontrib><creatorcontrib>on behalf of the MemoVie Group</creatorcontrib><title>Lifelong exposure to multilingualism: new evidence to support cognitive reserve hypothesis</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Investigate the protective effect of multilingualism on cognition in seniors.
As part of the MemoVie study conducted on 232 non-demented volunteers aged 65 and more, neurogeriatric and neuropsychological evaluations were performed. Participants were classified as presenting either cognitive impairment without dementia (CIND) or being free of any cognitive impairment (CIND-free). Language practices, socio-demographic data and lifestyle habits were recorded. In this retrospective nested case-control design, we used as proxies of multilingualism: number of languages practiced, age of acquisition and duration of practice, emphasizing the temporal pattern of acquisition, and the resulting practice of several languages sequentially or concomitantly during various periods of life. This special angle on the matter offered to our work a dimension particularly original and innovative.
44 subjects (19%) had CIND, the others were cognitively normal. All practiced from 2 to 7 languages. When compared with bilinguals, participants who practiced more than 2 languages presented a lower risk of CIND, after adjustment for education and age (odds ratio (OR) = 0.30, 95% confidence limits (95%CL) = [0.10-0.92]). Progressing from 2 to 3 languages, instead of staying bilingual, was associated with a 7-fold protection against CIND (OR = 0.14, 95%CL = [0.04-0.45], p = 0.0010). A one year delay to reach multilingualism (3 languages practiced being the threshold) multiplied the risk of CIND by 1.022 (OR = 1.022, 95%CL = [1.01-1.04], p = 0.0044). Also noteworthy, just as for multilingualism, an impact of cognitively stimulating activities on the occurrence of CIND was found as well (OR = 0.979, 95%CL = [0.961-0.998], p = 0.033).
The study did not show independence of multilingualism and CIND. Rather it seems to show a strong association toward a protection against CIND. Practicing multilingualism from early life on, and/or learning it at a fast pace is even more efficient. This protection might be related to the enhancement of cognitive reserve and brain plasticity, thereby preserving brain functions from alterations during aging.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Aging</subject><subject>Alzheimer Disease - prevention & control</subject><subject>Alzheimer's disease</subject><subject>Bilingualism</subject><subject>Biology</subject><subject>Brain</subject><subject>Cognition</subject><subject>Cognition Disorders - prevention & control</subject><subject>Cognitive ability</subject><subject>Cognitive Reserve</subject><subject>Confidence limits</subject><subject>Confounding Factors (Epidemiology)</subject><subject>Dementia</subject><subject>Dementia - prevention & control</subject><subject>Dementia disorders</subject><subject>Demographics</subject><subject>Education</subject><subject>Habits</subject><subject>Humans</subject><subject>Hypotheses</subject><subject>Impairment</subject><subject>Languages</subject><subject>Leisure</subject><subject>Medical screening</subject><subject>Medicine</subject><subject>Multilingualism</subject><subject>Neuropsychological Tests</subject><subject>Odds Ratio</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Social and Behavioral Sciences</subject><subject>Studies</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><sourceid>DOA</sourceid><recordid>eNptUk1v1DAQjRCIlsI_QBCJSy-7jO3YjjkgoapApZW4wIWL5XUmWa-8drCThf57srtp1SJO44_33rwZvaJ4TWBJmCTvt3FMwfhlHwMuAQQFBk-Kc6IYXRwuTx-cz4oXOW8BOKuFeF6cUSYqQQg7L36uXIs-hq7EP33MY8JyiOVu9IPzLnSj8S7vPpQBf5e4dw0GewTkse9jGkobu-AGt8cyYcY01c1tH4cNZpdfFs9a4zO-mutF8ePz9ferr4vVty83V59WC8sVHRYts5LwhgJIJYHxRq5tJbkgpq2pZGhrrhSvJGsMr1ARMIwbK7FqhVhXdcsuircn3d7HrOe1ZE3YpKIqSdmEuDkhmmi2uk9uZ9Ktjsbp40NMnTZpcNajFooaEIopaFnFDTWcmsa068kfh0bUk9bHudu43mFjMQzJ-Eeij3-C2-gu7vW0cgCqJoHLWSDFXyPmQe9ctui9CRjHo28FissaJui7f6D_n646oWyKOSds780Q0Ieo3LH0ISp6jspEe_NwkHvSXTbYXwvUvXY</recordid><startdate>20130430</startdate><enddate>20130430</enddate><creator>Perquin, Magali</creator><creator>Vaillant, Michel</creator><creator>Schuller, Anne-Marie</creator><creator>Pastore, Jessica</creator><creator>Dartigues, Jean-François</creator><creator>Lair, Marie-Lise</creator><creator>Diederich, Nico</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QG</scope><scope>7QL</scope><scope>7QO</scope><scope>7RV</scope><scope>7SN</scope><scope>7SS</scope><scope>7T5</scope><scope>7TG</scope><scope>7TM</scope><scope>7U9</scope><scope>7X2</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABJCF</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>D1I</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB.</scope><scope>KB0</scope><scope>KL.</scope><scope>L6V</scope><scope>LK8</scope><scope>M0K</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>M7S</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PATMY</scope><scope>PDBOC</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PTHSS</scope><scope>PYCSY</scope><scope>RC3</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope></search><sort><creationdate>20130430</creationdate><title>Lifelong exposure to multilingualism: new evidence to support cognitive reserve hypothesis</title><author>Perquin, Magali ; Vaillant, Michel ; Schuller, Anne-Marie ; Pastore, Jessica ; Dartigues, Jean-François ; Lair, Marie-Lise ; Diederich, Nico</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c592t-f3c715d200797035d7bc47561af8273ec85995473da54e910a35ac7e4f66b48f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Aging</topic><topic>Alzheimer Disease - prevention & control</topic><topic>Alzheimer's disease</topic><topic>Bilingualism</topic><topic>Biology</topic><topic>Brain</topic><topic>Cognition</topic><topic>Cognition Disorders - prevention & control</topic><topic>Cognitive ability</topic><topic>Cognitive Reserve</topic><topic>Confidence limits</topic><topic>Confounding Factors (Epidemiology)</topic><topic>Dementia</topic><topic>Dementia - prevention & control</topic><topic>Dementia disorders</topic><topic>Demographics</topic><topic>Education</topic><topic>Habits</topic><topic>Humans</topic><topic>Hypotheses</topic><topic>Impairment</topic><topic>Languages</topic><topic>Leisure</topic><topic>Medical screening</topic><topic>Medicine</topic><topic>Multilingualism</topic><topic>Neuropsychological Tests</topic><topic>Odds Ratio</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Social and Behavioral Sciences</topic><topic>Studies</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Perquin, Magali</creatorcontrib><creatorcontrib>Vaillant, Michel</creatorcontrib><creatorcontrib>Schuller, Anne-Marie</creatorcontrib><creatorcontrib>Pastore, Jessica</creatorcontrib><creatorcontrib>Dartigues, Jean-François</creatorcontrib><creatorcontrib>Lair, Marie-Lise</creatorcontrib><creatorcontrib>Diederich, Nico</creatorcontrib><creatorcontrib>MemoVie Group</creatorcontrib><creatorcontrib>on behalf of the MemoVie Group</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Animal Behavior Abstracts</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Biotechnology Research Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Ecology Abstracts</collection><collection>Entomology Abstracts (Full archive)</collection><collection>Immunology Abstracts</collection><collection>Meteorological & Geoastrophysical Abstracts</collection><collection>Nucleic Acids Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Agricultural Science Collection</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Technology Research Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Technology Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Materials Science & Engineering Collection</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest One Sustainability</collection><collection>ProQuest Central UK/Ireland</collection><collection>Advanced Technologies & Aerospace Collection</collection><collection>Agricultural & Environmental Science Collection</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Technology Collection</collection><collection>Natural Science Collection</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Materials Science Collection</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Materials Science Database</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Meteorological & Geoastrophysical Abstracts - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Perquin, Magali</au><au>Vaillant, Michel</au><au>Schuller, Anne-Marie</au><au>Pastore, Jessica</au><au>Dartigues, Jean-François</au><au>Lair, Marie-Lise</au><au>Diederich, Nico</au><aucorp>MemoVie Group</aucorp><aucorp>on behalf of the MemoVie Group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Lifelong exposure to multilingualism: new evidence to support cognitive reserve hypothesis</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2013-04-30</date><risdate>2013</risdate><volume>8</volume><issue>4</issue><spage>e62030</spage><epage>e62030</epage><pages>e62030-e62030</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Investigate the protective effect of multilingualism on cognition in seniors.
As part of the MemoVie study conducted on 232 non-demented volunteers aged 65 and more, neurogeriatric and neuropsychological evaluations were performed. Participants were classified as presenting either cognitive impairment without dementia (CIND) or being free of any cognitive impairment (CIND-free). Language practices, socio-demographic data and lifestyle habits were recorded. In this retrospective nested case-control design, we used as proxies of multilingualism: number of languages practiced, age of acquisition and duration of practice, emphasizing the temporal pattern of acquisition, and the resulting practice of several languages sequentially or concomitantly during various periods of life. This special angle on the matter offered to our work a dimension particularly original and innovative.
44 subjects (19%) had CIND, the others were cognitively normal. All practiced from 2 to 7 languages. When compared with bilinguals, participants who practiced more than 2 languages presented a lower risk of CIND, after adjustment for education and age (odds ratio (OR) = 0.30, 95% confidence limits (95%CL) = [0.10-0.92]). Progressing from 2 to 3 languages, instead of staying bilingual, was associated with a 7-fold protection against CIND (OR = 0.14, 95%CL = [0.04-0.45], p = 0.0010). A one year delay to reach multilingualism (3 languages practiced being the threshold) multiplied the risk of CIND by 1.022 (OR = 1.022, 95%CL = [1.01-1.04], p = 0.0044). Also noteworthy, just as for multilingualism, an impact of cognitively stimulating activities on the occurrence of CIND was found as well (OR = 0.979, 95%CL = [0.961-0.998], p = 0.033).
The study did not show independence of multilingualism and CIND. Rather it seems to show a strong association toward a protection against CIND. Practicing multilingualism from early life on, and/or learning it at a fast pace is even more efficient. This protection might be related to the enhancement of cognitive reserve and brain plasticity, thereby preserving brain functions from alterations during aging.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>23646113</pmid><doi>10.1371/journal.pone.0062030</doi><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
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| issn | 1932-6203 1932-6203 |
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| subjects | Aged Aged, 80 and over Aging Alzheimer Disease - prevention & control Alzheimer's disease Bilingualism Biology Brain Cognition Cognition Disorders - prevention & control Cognitive ability Cognitive Reserve Confidence limits Confounding Factors (Epidemiology) Dementia Dementia - prevention & control Dementia disorders Demographics Education Habits Humans Hypotheses Impairment Languages Leisure Medical screening Medicine Multilingualism Neuropsychological Tests Odds Ratio Retrospective Studies Risk Factors Social and Behavioral Sciences Studies |
| title | Lifelong exposure to multilingualism: new evidence to support cognitive reserve hypothesis |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-08T07%3A51%3A58IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Lifelong%20exposure%20to%20multilingualism:%20new%20evidence%20to%20support%20cognitive%20reserve%20hypothesis&rft.jtitle=PloS%20one&rft.au=Perquin,%20Magali&rft.aucorp=MemoVie%20Group&rft.date=2013-04-30&rft.volume=8&rft.issue=4&rft.spage=e62030&rft.epage=e62030&rft.pages=e62030-e62030&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0062030&rft_dat=%3Cproquest_plos_%3E1349095780%3C/proquest_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1347594723&rft_id=info:pmid/23646113&rft_doaj_id=oai_doaj_org_article_692a069390f345a2a52adafbd2050d68&rfr_iscdi=true |