Mapping language and non-language cognitive deficits in post-stroke anomic aphasia

While language impairment is the defining symptom of aphasia, the co-occurrence of non-language cognitive deficits and their importance in predicting rehabilitation and recovery outcomes is well documented. Despite this, people with aphasia (PWA) are rarely tested on assessments of higher order cognitive functions, making it difficult for studies to associate these functions with a consistent lesion correlate. Contrary to classic models of speech and language, cumulative evidence shows that Brocas area and surrounding regions in the left inferior frontal cortex (LIFC) are involved in, but not specific to, speech production - suggesting that these regions may be involved in higher-level cognitive functions that support language production. A better understanding of language processing in the context of other domain general cognitive functions is essential for improving aphasia treatments. This study aimed to explore the brain-behaviour relationships between tests of individual cognitive skill and language abilities in people with post-stroke aphasia, with a focus on language production deficits and their associated lesion correlates. We predicted our analysis would reveal a latent (non-language specific) cognitive component, that would be driven by damage to LIFC. We analysed the behavioural and neural correlates of an extensive battery of language and non-language cognitive tests in a sample of thirty-six adults with long-term speech production deficits from post-stroke aphasia. All participants were anomic, with relatively intact speech comprehension and no apraxia of speech. The behavioural variables were analysed using Principal Component Analysis and their neural correlates were estimated using Voxel-Based Correlational Morphology. A significant number of anomic adults showed impaired performance on tests of non-language specific cognitive function. The variance underlying behavioural performance was best captured by four orthogonal components, two higher-order cognitive components (executive functions and verbal working memory) and two linguistic processing components (phonology and semantics). Brain-behaviour relationships revealed separable neural correlates for each component in line with previous studies and an executive functions correlate in the left inferior frontal cortex (LIFC). Our findings suggest that in adults with chronic post-stroke language production deficits (anomia), higher-level cognitive functions explain more of the variance in language function than classical models of the condition imply. Additionally, lesions to the LIFC, including Brocas area, were associated with executive (dys)function, independent of language abilities, suggesting that lesions to this area are associated with non-language specific higher-level cognitive functions that support speech production. These findings support contemporary models of speech production that place language processing within the context of domain-general perception, action and conceptual knowledge.