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Rapid Lexical Retrieval and Executive Functioning in Very Mild Aphasia
Alycia B Laks1,2, Andrew T DeMarco1,2, Sophie S Hurwitz1,2
1Center for Brain Plasticity and Recovery, Georgetown University Medical Center, Washington, DC.
American Journal of Speech-Language Pathology
|December 16, 2025
Summary
Individuals with very mild aphasia after stroke show impaired letter fluency due to difficulties in rapid lexical retrieval and switching. These findings highlight the importance of these cognitive domains in identifying subtle language deficits.
Area of Science:
- Neuroscience
- Psycholinguistics
- Clinical Linguistics
Background:
- Left-hemisphere stroke survivors may exhibit subtle language impairments not detected by standard assessments like the Western Aphasia Battery-Revised (WAB-R).
- These individuals, termed 'not aphasic by WAB-R' (NABW), may still experience self-reported aphasia.
- Letter fluency tasks have shown sensitivity to very mild aphasia in the NABW group, but the underlying cognitive domains are unclear.
Purpose of the Study:
- To investigate whether lexical retrieval or executive functioning (EF) domains drive impaired letter fluency in NABW individuals.
- To compare the diagnostic accuracy of specific lexical retrieval and EF measures against letter fluency tasks for identifying very mild aphasia.
Main Methods:
- Twenty-seven NABW individuals and 63 healthy controls completed letter fluency tasks, timed picture naming, and the Antelopes and Cantaloupes (A&C) executive function task.
- The A&C task assessed switching, semantic, and phonological control.
- Group differences were analyzed using Mann-Whitney U tests, correlations examined relationships between measures, and receiver operating characteristic (ROC) curve analysis determined diagnostic utility.
Main Results:
- Six measures showed group differences and correlated with letter fluency, including naming reaction times and A&C measures involving rapid lexical retrieval or switching with lexical retrieval.
- No single measure demonstrated higher sensitivity and specificity than letter fluency tasks in identifying very mild aphasia in the NABW group.
- Letter fluency tasks remained superior in distinguishing individuals with very mild aphasia.
Conclusions:
- Impaired letter fluency in NABW individuals appears to stem from deficits in rapid lexical retrieval and switching tasks that involve lexical retrieval.
- These findings underscore the role of lexical retrieval and executive control in subtle language impairments post-stroke.
- Letter fluency tasks are valuable tools for detecting very mild aphasia in stroke survivors.
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