Editing Aphasia (section)

=== Cognitive deficits ===
While aphasia has traditionally been described in terms of language deficits, there is increasing evidence that many people with aphasia commonly experience co-occurring non-linguistic [[cognitive deficit]]s in areas such as attention, memory, executive functions and learning.<ref>{{cite journal |last1=Helm-Estabrooks |first1=Nancy |date=March–April 2002 |title=Cognition and aphasia: a discussion and a study |url=https://www.sciencedirect.com/science/article/abs/pii/S0021992402000631 |journal=Journal of Communication Disorders |volume=35 |issue=2 |pages=171–186 |doi=10.1016/S0021-9924(02)00063-1 |pmid=12036150 |access-date=15 October 2021}}</ref><ref>{{cite journal |last1=Vallila-Rohter |first1=Sofia |last2=Kiran |first2=Swathi |date=January 2013 |title=Non-linguistic learning and aphasia: Evidence from a paired associate and feedback-based task |journal=Neuropsychologia |volume=51 |issue=1 |pages=79–90 |doi=10.1016/j.neuropsychologia.2012.10.024 |pmc=3626426 |pmid=23127795}}</ref><ref name=":1">{{Cite journal |last=Murray |first=Laura L. |name-list-style=vanc |date=May 2012 |title=Attention and Other Cognitive Deficits in Aphasia: Presence and Relation to Language and Communication Measures |url=http://aphasiology.pitt.edu/2222/1/38-45-1-RV.pdf |url-status=live |journal=American Journal of Speech-Language Pathology |language=en |volume=21 |issue=2 |pages=S51–64 |doi=10.1044/1058-0360(2012/11-0067) |issn=1058-0360 |pmid=22230179 |archive-url=https://ghostarchive.org/archive/20221009/http://aphasiology.pitt.edu/2222/1/38-45-1-RV.pdf |archive-date=2022-10-09}}</ref> By some accounts, cognitive deficits, such as attention and working memory constitute the underlying cause of language impairment in people with aphasia.<ref>{{cite journal |vauthors=Hula WD, McNeil MR |date=August 2008 |title=Models of attention and dual-task performance as explanatory constructs in aphasia |journal=Seminars in Speech and Language |volume=29 |issue=3 |pages=169–187; quiz C 3–4 |doi=10.1055/s-0028-1082882 |pmid=18720315 |s2cid=260319083}}</ref> Others suggest that cognitive deficits often co-occur, but are comparable to cognitive deficits in stroke patients without aphasia and reflect general brain dysfunction following injury.<ref>{{cite journal |vauthors=Fonseca J, Raposo A, Martins IP |date=March 2018 |title=Cognitive performance and aphasia recovery |journal=Topics in Stroke Rehabilitation |volume=25 |issue=2 |pages=131–136 |doi=10.1080/10749357.2017.1390904 |pmid=29072540 |s2cid=3884877}}</ref> Whilst it has been shown that cognitive neural networks support language reorganisation after stroke,<ref name=":16">{{Cite journal |last1=Brownsett |first1=Sonia |last2=Wise |first2=Richard |name-list-style=vanc |date=2014-10-24 |title=Cognitive control and its impact on recovery from aphasic stroke |journal=Brain |volume=137 |issue=1 |pages=242–54 |doi=10.1093/brain/awt289 |s2cid=151445078|doi-access=free |pmid=24163248 |pmc=3891442 }}</ref>
The degree to which deficits in attention and other cognitive domains underlie language deficits in aphasia is still unclear.<ref name=":2">{{Cite journal |last1=Villard |first1=Sarah |last2=Kira n |first2=Swathi |name-list-style=vanc |date=2017-10-03 |title=To what extent does attention underlie language in aphasia? |journal=Aphasiology |volume=31 |issue=10 |pages=1226–1245 |doi=10.1080/02687038.2016.1242711 |s2cid=151445078}}</ref>

In particular, people with aphasia often demonstrate short-term and working memory deficits.<ref name=":1" /> These deficits can occur in both the verbal domain<ref>{{cite journal |vauthors=Martin N, Ayala J |date=June 2004 |title=Measurements of auditory-verbal STM span in aphasia: effects of item, task, and lexical impairment |journal=Brain and Language |volume=89 |issue=3 |pages=464–483 |doi=10.1016/j.bandl.2003.12.004 |pmid=15120538 |s2cid=11497057}}</ref><ref>{{cite journal |vauthors=Laures-Gore J, Marshall RS, Verner E |date=January 2011 |title=Performance of Individuals with Left-Hemisphere Stroke and Aphasia and Individuals with Right Brain Damage on Forward and Backward Digit Span Tasks |journal=Aphasiology |volume=25 |issue=1 |pages=43–56 |doi=10.1080/02687031003714426 |pmc=3090622 |pmid=21572584}}</ref> as well as the visuospatial domain.<ref>{{cite journal |vauthors=Kasselimis DS, Simos PG, Economou A, Peppas C, Evdokimidis I, Potagas C |date=August 2013 |title=Are memory deficits dependent on the presence of aphasia in left brain damaged patients? |journal=Neuropsychologia |volume=51 |issue=9 |pages=1773–1776 |doi=10.1016/j.neuropsychologia.2013.06.003 |pmid=23770384 |s2cid=14620782 |doi-access=free}}</ref> Furthermore, these deficits are often associated with performance on language specific tasks such as naming, lexical processing, and sentence comprehension, and discourse production.<ref name=":3">{{cite journal |vauthors=Wall KJ, Cumming TB, Copland DA |date=2017-05-05 |title=Determining the Association between Language and Cognitive Tests in Poststroke Aphasia |journal=Frontiers in Neurology |volume=8 |pages=149 |doi=10.3389/fneur.2017.00149 |pmc=5418218 |pmid=28529495 |doi-access=free}}</ref><ref name=":1" /><ref>{{cite journal |last1=Cahana-Amitay |first1=Dalia |last2=Jenkins |first2=Theodore |name-list-style=vanc |date=November 2018 |title=Working memory and discourse production in people with aphasia 6 |journal=Journal of Neurolinguistics |language=en |volume=48 |pages=90–103 |doi=10.1016/j.jneuroling.2018.04.007 |s2cid=53183275}}</ref><ref>{{cite journal |vauthors=Minkina I, Martin N, Spencer KA, Kendall DL |date=March 2018 |title=Links Between Short-Term Memory and Word Retrieval in Aphasia |journal=American Journal of Speech-Language Pathology |volume=27 |issue=1S |pages=379–391 |doi=10.1044/2017_AJSLP-16-0194 |pmc=6111490 |pmid=29497750}}</ref> Other studies have found that most, but not all people with aphasia demonstrate performance deficits on tasks of attention, and their performance on these tasks correlate with language performance and cognitive ability in other domains.<ref name=":1" /> Even patients with mild aphasia, who score near the ceiling on tests of language often demonstrate slower response times and interference effects in non-verbal attention abilities.<ref>{{Cite journal |vauthors=Hunting-Pompon R, Kendall D, Bacon Moore A |date=June 2011 |title=Examining attention and cognitive processing in participants with self-reported mild anomia |journal=Aphasiology |volume=25 |issue=6–7 |pages=800–812 |doi=10.1080/02687038.2010.542562 |s2cid=145763896}}</ref>

In addition to deficits in short-term memory, working memory, and attention, people with aphasia can also demonstrate deficits in executive function.<ref>{{cite journal |vauthors=Murray LL, Ramage AE |date=2000 |title=Assessing the executive function abilities of adults with neurogenic communication disorders |journal=Seminars in Speech and Language |volume=21 |issue=2 |pages=153–167; quiz 168 |doi=10.1055/s-2000-7562 |pmid=10879547 |s2cid=260320569}}</ref> For instance, people with aphasia may demonstrate deficits in initiation, planning, self-monitoring, and cognitive flexibility.<ref>{{Cite journal |last=Murray |first=Laura L. |name-list-style=vanc |date=2017-07-03 |title=Design fluency subsequent to onset of aphasia: a distinct pattern of executive function difficulties? |journal=Aphasiology |language=en |volume=31 |issue=7 |pages=793–818 |doi=10.1080/02687038.2016.1261248 |issn=0268-7038 |s2cid=151808957}}</ref> Other studies have found that people with aphasia demonstrate reduced speed and efficiency during completion of executive function assessments.<ref>{{Cite journal |last=Purdy |first=Mary |name-list-style=vanc |date=April 2002 |title=Executive function ability in persons with aphasia |journal=Aphasiology |language=en |volume=16 |issue=4–6 |pages=549–557 |doi=10.1080/02687030244000176 |issn=0268-7038 |s2cid=144618814}}</ref>

Regardless of their role in the underlying nature of aphasia, cognitive deficits have a clear role in the study and rehabilitation of aphasia. For instance, the severity of cognitive deficits in people with aphasia has been associated with lower quality of life, even more so than the severity of language deficits.<ref>{{Cite journal |vauthors=Nicholas M, Hunsaker E, Guarino AJ |date=2017-06-03 |title=The relation between language, non-verbal cognition and quality of life in people with aphasia |journal=Aphasiology |volume=31 |issue=6 |pages=688–702 |doi=10.1080/02687038.2015.1076927 |s2cid=146960778}}</ref> Furthermore, cognitive deficits may influence the learning process of rehabilitation<ref>{{cite journal |last1=Vallila-Rohter |first1=Sofia |date=January 2017 |title=Considering Learning Ability in Language Rehabilitation Plans |url=https://pubs.asha.org/doi/abs/10.1044/persp2.SIG2.23 |journal=Perspectives of the ASHA Special Interest Groups |volume=2 |issue=2 |pages=23–30 |doi=10.1044/persp2.SIG2.23 |access-date=15 October 2021}}</ref><ref>{{cite journal |last1=Middleton |first1=Erica L. |last2=Schwartz |first2=MyrnaF. |last3=Rawson |first3=Katherine A. |last4=Traut |first4=Hilary |last5=Verkuilen |first5=Jay |date=October 2016 |title=Towards a Theory of Learning for Naming Rehabilitation: Retrieval Practice and Spacing Effects |journal=Journal of Speech, Language, and Hearing Research |volume=59 |issue=5 |pages=1111–1122 |doi=10.1044/2016_JSLHR-L-15-0303 |pmc=5345556 |pmid=27716858}}</ref> and language treatment outcomes in aphasia.<ref>{{cite journal |vauthors=Dignam J, Copland D, O'Brien K, Burfein P, Khan A, Rodriguez AD |date=February 2017 |title=Influence of Cognitive Ability on Therapy Outcomes for Anomia in Adults With Chronic Poststroke Aphasia |url=https://espace.library.uq.edu.au/view/UQ:505087/UQ505087_OA.pdf |journal=Journal of Speech, Language, and Hearing Research |volume=60 |issue=2 |pages=406–421 |doi=10.1044/2016_JSLHR-L-15-0384 |pmid=28199471}}</ref><ref>{{cite journal |vauthors=Lambon Ralph MA, Snell C, Fillingham JK, Conroy P, Sage K |date=April 2010 |title=Predicting the outcome of anomia therapy for people with aphasia post CVA: both language and cognitive status are key predictors |journal=Neuropsychological Rehabilitation |volume=20 |issue=2 |pages=289–305 |doi=10.1080/09602010903237875 |pmid=20077315 |s2cid=23062509}}</ref> Non-linguistic cognitive deficits have also been the target of interventions directed at improving language ability, though outcomes are not definitive.<ref>{{cite journal |vauthors=Murray LL, Keeton RJ, Karcher L |date=January 2006 |title=Treating attention in mild aphasia: evaluation of attention process training-II |journal=Journal of Communication Disorders |volume=39 |issue=1 |pages=37–61 |doi=10.1016/j.jcomdis.2005.06.001 |pmid=16039661}}</ref> While some studies have demonstrated language improvement secondary to cognitively-focused treatment,<ref>{{cite journal |vauthors=Peach RK, Beck KM, Gorman M, Fisher C |date=August 2019 |title=Clinical Outcomes Following Language-Specific Attention Treatment Versus Direct Attention Training for Aphasia: A Comparative Effectiveness Study |journal=Journal of Speech, Language, and Hearing Research |volume=62 |issue=8 |pages=2785–2811 |doi=10.1044/2019_JSLHR-L-18-0504 |pmid=31348732 |s2cid=198934220}}</ref> others have found little evidence that the treatment of cognitive deficits in people with aphasia has an influence on language outcomes.<ref>{{cite journal |display-authors=6 |vauthors=Nouwens F, de Lau LM, Visch-Brink EG, van de Sandt-Koenderman WM, Lingsma HF, Goosen S, Blom DM, Koudstaal PJ, Dippel DW |date=June 2017 |title=Efficacy of early cognitive-linguistic treatment for aphasia due to stroke: A randomised controlled trial (Rotterdam Aphasia Therapy Study-3) |journal=European Stroke Journal |volume=2 |issue=2 |pages=126–136 |doi=10.1177/2396987317698327 |pmc=5992741 |pmid=29900407}}</ref>

One important caveat in the measurement and treatment of cognitive deficits in people with aphasia is the degree to which assessments of cognition rely on language abilities for successful performance.<ref>{{cite journal |vauthors=Mayer JF, Murray LL |date=September 2012 |title=Measuring working memory deficits in aphasia |journal=Journal of Communication Disorders |volume=45 |issue=5 |pages=325–339 |doi=10.1016/j.jcomdis.2012.06.002 |pmid=22771135}}</ref> Most studies have attempted to circumvent this challenge by utilizing non-verbal cognitive assessments to evaluate cognitive ability in people with aphasia. However, the degree to which these tasks are truly "non-verbal" and not mediated by language is unclear.<ref name=":2" /> For instance, Wall et al.<ref name=":3" /> found that language and non-linguistic performance was related, except when non-linguistic performance was measured by "real life" cognitive tasks.