Original research| Volume 100, ISSUE 7, P1251-1258, July 2019

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Nonlinguistic Cognitive Factors Predict Treatment-Induced Recovery in Chronic Poststroke Aphasia

Published:January 09, 2019DOI:



      To determine if pretreatment nonlinguistic cognition predicted language treatment outcomes and if so, which specific nonlinguistic cognitive subskills predicted naming therapy outcomes.




      Research clinic.


      Study 1 included data from 67 persons with aphasia who underwent language treatment and a pretreatment cognitive-linguistic assessment battery (N=67). Study 2 included data from 27 study 1 participants who completed additional pretreatment nonlinguistic cognitive assessments.


      120-minute sessions of sentence comprehension (n=26) or naming treatment (n=41) 2 times per week for up to 10-12 weeks.

      Main Outcome Measures

      Proportion of potential maximal gain (PMG) (assessed immediately after treatment [10-12wk]; formula=mean posttreatment score–mean pretreatment score/total number of trained items–mean pretreatment score) and proportion of potential maximal gain maintained (PMGM) (assessed 12wk after posttreatment [22-24wk]; formula=mean maintenance score–mean pretreatment score/total number of trained items–mean pretreatment score) as outcome variables; and pretreatment assessment scores as predictor variables.


      In study 1, 37% of participants demonstrated nonlinguistic cognitive deficits. Principal component analyses reduced assessment data to 2 components: linguistic and nonlinguistic cognition. Backward elimination regression revealed that higher linguistic and nonlinguistic cognitive function significantly predicted higher PMG after language therapy. In study 2, principal component analysis of only the nonlinguistic cognitive measures identified 3 components: executive function, verbal short-term memory, and visual short-term memory. Controlling for pretreatment apraxia of speech and auditory comprehension deficits, regression analyses revealed that higher executive function and visual short-term memory significantly predicted higher PMG and PMGM after naming therapy.


      Pretreatment nonlinguistic cognitive function significantly influenced language treatment outcomes and maintenance of therapy gains.


      List of abbreviations:

      PMG (potential maximal gain), PMGM (potential maximal gain maintained), SE (standard error)
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        • Dickey L.
        • Kagan A.
        • Lindsay M.P.
        • Fang J.
        • Rowland A.
        • Black S.
        Incidence and profile of inpatient stroke-induced aphasia in Ontario, Canada.
        Arch Phys Med Rehabil. 2010; 91: 196-202
        • Peach R.K.
        Cognitive approaches to aphasia treatment: application of the cognition of language to aphasia intervention.
        Semin Speech Lang. 2017; 38: 3-4
        • McNeil M.R.
        • Odell K.
        • Tseng C.H.
        Toward the integration of resource allocation into a general theory of aphasia.
        Clin Aphasiology. 1991; 20: 21-39
        • Villard S.
        • Kiran S.
        Between-session intra-individual variability in sustained, selective, and integrational non-linguistic attention in aphasia.
        Neuropsychologia. 2015; 66: 204-212
        • Lang C.J.
        • Quitz A.
        Verbal and nonverbal memory impairment in aphasia.
        J Neurol. 2012; 259: 1655-1661
        • Seniów J.
        • Litwin M.
        • Leśniak M.
        The relationship between non-linguistic cognitive deficits and language recovery in patients with aphasia.
        J Neurol Sci. 2009; 283: 91-94
        • Purdy M.
        Executive function ability in persons with aphasia.
        Aphasiology. 2002; 16: 549-557
        • Kertesz A.
        • McCabe P.
        Intelligence and aphasia: performance of aphasics on Raven’s coloured progressive matrices (RCPM).
        Brain Lang. 1975; 2: 387-395
        • Brady M.C.
        • Kelly H.
        • Godwin J.
        • Enderby P.
        • Campbell P.
        Speech and language therapy for aphasia following stroke.
        Cochrane Database Syst Rev. 2016; : CD000425
        • Bonini M.V.
        • Radanovic M.
        Cognitive deficits in post-stroke aphasia.
        Arq Neuropsiquiatr. 2015; 73: 840-847
        • El Hachioui H.
        • Visch-Brink E.G.
        • Lingsma H.F.
        • et al.
        Nonlinguistic cognitive impairment in poststroke aphasia: a prospective study.
        Neurorehabil Neural Repair. 2014; 28: 273-281
        • Code C.
        • Torney A.
        • Gildea-Howardine E.
        • Willmes K.
        Outcome of a one-month therapy intensive for chronic aphasia: variable individual responses.
        Semin Speech Lang. 2010; 31: 21-33
        • Lambon Ralph M.A.
        • Snell C.
        • Fillingham J.K.
        • Conroy P.
        • Sage K.
        Predicting the outcome of anomia therapy for people with aphasia post CVA: both language and cognitive status are key predictors.
        Neuropsychol Rehabil. 2010; 20: 289-305
        • Dignam J.
        • Copland D.
        • O’Brien K.
        • Burfein P.
        • Khan A.
        • Rodriguez A.D.
        Influence of cognitive ability on therapy outcomes for anomia in adults with chronic poststroke aphasia.
        J Speech Lang Hear Res. 2017; 60: 406-421
        • Fillingham J.K.
        • Sage K.
        • Lambon Ralph M.A.
        The treatment of anomia using errorless learning.
        Neuropsychol Rehabil. 2006; 16: 129-154
        • Kristensen L.F.
        • Steensig I.
        • Pedersen A.D.
        • Pedersen A.R.
        • Nielsen J.F.
        Constraint-induced aphasia therapy in subacute neurorehabilitation.
        Aphasiology. 2015; 29: 1152-1163
        • Purdy M.
        • Koch A.
        Prediction of strategy usage by adults with aphasia.
        Aphasiology. 2006; 20: 337-348
        • Goldenberg G.
        • Dettmers H.
        • Grothe C.
        • Spatt J.
        Influence of linguistic and non-linguistic capacities on spontaneous recovery of aphasia and on success of language therapy.
        Aphasiology. 1994; 8: 443-456
        • Yeung O.
        • Law S.P.
        Executive functions and aphasia treatment outcomes: data from an ortho-phonological cueing therapy for anomia in Chinese.
        Int J Speech Lang Pathol. 2010; 12: 529-544
        • Kertesz A.
        Western Aphasia Battery (Revised).
        PsychCorp, San Antonio2007
        • Goodglass H.
        • Kaplan E.F.
        • Weintraub S.
        The Revised Boston Naming Test.
        Lea & Febiger, Philadelphia2001
        • Helm-Estabrooks N.
        Cognitive linguistic quick test: examiner’s manual.
        Psychological Corporation, San Antonio2001
        • Howard D.
        • Patterson K.
        The pyramids and palm trees test: a test of semantic access from words and pictures.
        Thames Valley Test Company, 1992
        • Wechsler D.
        Wechsler Adult Intelligence Scale–Fourth Edition (WAIS-IV).
        Pearson Education, 2008
        • Baddeley A.D.
        • Emslie H.
        • Nimmo-Smith I.
        The Doors and People Test.
        Thames Valley Test Company, Bury St. Edmunds, UK1994
        • Kessels R.P.
        • Van Zandvoort M.J.
        • Postma A.
        • Kappelle L.J.
        • De Haan E.H.
        The Corsi block-tapping task: standardization and normative data.
        Appl Neuropsychol. 2000; 7: 252-258
        • Martin N.
        • Minkina I.
        • Kohen F.P.
        • Kalinyak-Fliszar M.
        Assessment of linguistic and verbal short-term memory components of language abilities in aphasia.
        J Neurolinguistics. 2018; 48: 199-225
        • Dabul B.L.
        Apraxia Battery for Adults, Second Edition.
        Pro-Ed, Austin2000
        • Wall K.J.
        • Cumming T.B.
        • Copland D.A.
        Determining the association between language and cognitive tests in poststroke aphasia.
        Front Neurol. 2017; 8: 149
        • Lezak M.D.
        Neuropsychological assessment.
        3rd ed. Oxford University Press, New York1995
        • Murray L.
        • Salis C.
        • Martin N.
        • Dralle J.
        The use of standardised short-term and working memory tests in aphasia research: a systematic review.
        Neuropsychol Rehabil. 2018; 28: 309-351
        • Mayer J.F.
        • Mitchinson S.I.
        • Murray L.L.
        Addressing concomitant executive dysfunction and aphasia: previous approaches and the new brain budget protocol.
        Aphasiology. 2016; 31: 837-860
        • Des Roches C.A.
        • Balachandran I.
        • Ascenso E.M.
        • Tripodis Y.
        • Kiran S.
        Effectiveness of an impairment-based individualized rehabilitation program using an iPad-based software platform.
        Front Hum Neurosci. 2015; 8: 1015