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Lexical Decision Task for Studying Written Word Recognition in Adults with and without Dementia or Mild Cognitive Impairment

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Phonemic Fluency and Rhyme Production in People with Aphasic Word Retrieval Disorders: Sub-Lexical Written Language

Anja Wunderlich¹

¹FH Gesundheit - University of Applied Sciences Tyrol, Innsbruck, Austria.

International Journal of Language & Communication Disorders

|November 12, 2025

Summary

Written language skills, specifically reading and writing nonwords, significantly impact phonemic fluency and rhyme production in people with aphasia (PWA). Category fluency, however, relies more on spoken word retrieval abilities.

Keywords:

aphasia impact of written language lexical fluency rhyme production word retrieval

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Area of Science:

Neurolinguistics
Cognitive Psychology
Speech and Language Pathology

Background:

Word retrieval in communication is typically semantically driven.
Phonemic fluency and rhyme production rely on word form retrieval, unlike category fluency.
Previous studies link written language deficits to poorer phonemic fluency, but this is less explored in people with aphasia (PWA).

Purpose of the Study:

To investigate how written language skills, word retrieval, aphasia severity, and executive function affect phonemic fluency, rhyme production, and category fluency in PWA.
To test the hypothesis that phonemic fluency and rhyme production are linked to written language skills, while category fluency is not.
To explore the impact of word retrieval, aphasia severity, and executive functions on all three fluency tasks.

Main Methods:

19 PWA with post-semantic word retrieval disorders were assessed.
Tasks included phonemic fluency, rhyme production, category fluency, nonword and irregular word reading/writing, oral naming (Boston Naming Test), Token Test, and executive function tasks (spatial 2-back, antisaccade).
Hierarchical regression analyses were used to analyze the data.

Main Results:

Reading and writing of nonwords (sub-lexical skills) were the strongest predictors for both phonemic fluency and rhyme production.
Oral naming performance (word retrieval) was the strongest predictor for category fluency.
Aphasia severity and executive functions showed potential impacts across tasks, though specific results varied.

Conclusions:

Sub-lexical written language abilities are significantly associated with phonemic fluency and rhyme production in PWA.
Phonemic fluency and rhyme production may not be suitable for assessing or treating word retrieval disorders in PWA with acquired dyslexia/dysgraphia.
Category fluency, linked to spoken word retrieval, may be more appropriate for evaluating word retrieval deficits in this population.