A specific pattern of executive dysfunctions in transcortical motor aphasia

Abstract

Background: Recent studies imply that executive functions (EF) are closely related to our ability to comprehend and produce language. A number of findings suggest that functional communication and language recovery in aphasia depend not only on intact language abilities but on EF as well. Some patients with transcortical motor aphasia (TMA) show language deficits only in tasks in which conflicting representations must be resolved by executive processes. In line with these results, others have proposed that TMA should be referred to as “dysexecutive aphasia”. EF in aphasia have mostly been studied using neuropsychological tests, therefore there is a need for systematic experimental investigations of these skills.

Aims: 1. To investigate EF in TMA, and to test whether executive dysfunctions are specific to TMA. 2. To experimentally measure different components of EF: updating working memory representations and inhibition of prepotent responses.

Methods & Procedures: Five individuals with TMA, five patients with conduction aphasia and ten healthy controls participated. We designed four nonverbal tasks: to measure updating of working memory representations, we used a visual and an auditory n-back task. To assess inhibition of prepotent responses, we designed a Stop-signal and a nonverbal Stroop task. All tasks involved within-subject baseline conditions.

Outcomes & Results: We found certain EF deficits in both groups of individuals with aphasia as compared to healthy controls. Individuals with TMA showed impaired inhibition as indexed by the Stop-signal and the nonverbal Stroop tasks, as well as a deficit of updating of working memory representations as indexed by the auditory n-back task. Participants with conduction aphasia had difficulties in only one of the tasks measuring inhibition, but no clear evidence for impairment of updating of working memory representations was found.

Conclusions: Although the results show different patterns of EF deficits in the groups with aphasia, the findings clearly demonstrate that EF deficits are not specific to participants with TMA. Based on these results, and on earlier data highlighting the role of executive processes in functional communication and language recovery, we suggest that tests of EF should be an inherent part of clinical aphasia assessment.

Keywords:

• Executive functions
• Cognitive control
• Working memory
• Conduction aphasia
• n-back
• Aphasia assessment

We thank Klára Marton for discussions on the study and her comments on a previous version of the manuscript, and László Jenei for his help in analysing neurological data.