Lesion-symptom Mapping of Acceptability Judgments in Chronic Poststroke Aphasia Reveals the Neurobiological Underpinnings of Receptive Syntax.

Disagreements persist regarding the neural basis of syntactic processing, which has been linked both to inferior frontal and posterior temporal regions of the brain. One focal point of the debate concerns the role of inferior frontal areas in receptive syntactic ability, which is mostly assessed using sentence comprehension involving complex syntactic structures, a task that is potentially confounded with working memory. Syntactic acceptability judgments may provide a better measure of receptive syntax by reducing the need to use high working memory load and complex sentences and by enabling assessment of various types of syntactic violations. We therefore tested the perception of grammatical violations by people with poststroke aphasia (n = 25), along with matched controls (n = 16), using English sentences involving errors in word order, agreement, or subcategorization. Lesion data were also collected. Control participants performed near ceiling in accuracy with higher discriminability of agreement and subcategorization violations than word order; aphasia participants were less able to discriminate violations, but, on average, paralleled control participants discriminability of types of violations. Lesion-symptom mapping showed a correlation between discriminability and posterior temporal regions, but not inferior frontal regions. We argue that these results diverge from models holding that frontal areas are amodal core regions in syntactic structure building and favor models that posit a core hierarchical system in posterior temporal regions.

The Wernicke conundrum revisited: evidence from connectome-based lesion-symptom mapping.

Wernicke's area has been assumed since the 1800s to be the primary region supporting word and sentence comprehension. However, in 2015 and 2019, Mesulam and colleagues raised what they termed the 'Wernicke conundrum', noting widespread variability in the anatomical definition of this area and presenting data from primary progressive aphasia that challenged this classical assumption. To resolve the conundrum, they posited a 'double disconnection' hypothesis: that word and sentence comprehension deficits in stroke-based aphasia result from disconnection of anterior temporal and inferior frontal regions from other parts of the brain due to white matter damage, rather than dysfunction of Wernicke's area itself. To test this hypothesis, we performed lesion-deficit correlations, including connectome-based lesion-symptom mapping, in four large, partially overlapping groups of English-speaking chronic left hemisphere stroke survivors. After removing variance due to object recognition and associative semantic processing, the same middle and posterior temporal lobe regions were implicated in both word comprehension deficits and complex non-canonical sentence comprehension deficits. Connectome lesion-symptom mapping revealed similar temporal-occipital white matter disconnections for impaired word and non-canonical sentence comprehension, including the temporal pole. We found an additional significant temporal-parietal disconnection for non-canonical sentence comprehension deficits, which may indicate a role for phonological working memory in processing complex syntax, but no significant frontal disconnections. Moreover, damage to these middle-posterior temporal lobe regions was associated with both word and non-canonical sentence comprehension deficits even when accounting for variance due to the strongest anterior temporal and inferior frontal white matter disconnections, respectively. Our results largely agree with the classical notion that Wernicke's area, defined here as middle superior temporal gyrus and middle-posterior superior temporal sulcus, supports both word and sentence comprehension, suggest a supporting role for temporal pole in both word and sentence comprehension, and speak against the hypothesis that comprehension deficits in Wernicke's aphasia result from double disconnection.

The Cortical Organization of Syntactic Processing Is Supramodal: Evidence from American Sign Language.

Areas within the left-lateralized neural network for language have been found to be sensitive to syntactic complexity in spoken and written language. Previous research has revealed that these areas are active for sign language as well, but whether these areas are specifically responsive to syntactic complexity in sign language independent of lexical processing has yet to be found. To investigate the question, we used fMRI to neuroimage deaf native signers' comprehension of 180 sign strings in American Sign Language (ASL) with a picture-probe recognition task. The ASL strings were all six signs in length but varied at three levels of syntactic complexity: sign lists, two-word sentences, and complex sentences. Syntactic complexity significantly affected comprehension and memory, both behaviorally and neurally, by facilitating accuracy and response time on the picture-probe recognition task and eliciting a left lateralized activation response pattern in anterior and posterior superior temporal sulcus (aSTS and pSTS). Minimal or absent syntactic structure reduced picture-probe recognition and elicited activation in bilateral pSTS and occipital-temporal cortex. These results provide evidence from a sign language, ASL, that the combinatorial processing of anterior STS and pSTS is supramodal in nature. The results further suggest that the neurolinguistic processing of ASL is characterized by overlapping and separable neural systems for syntactic and lexical processing.

Functional differentiation in the language network revealed by lesion-symptom mapping.

Theories of language organization in the brain commonly posit that different regions underlie distinct linguistic mechanisms. However, such theories have been criticized on the grounds that many neuroimaging studies of language processing find similar effects across regions. Moreover, condition by region interaction effects, which provide the strongest evidence of functional differentiation between regions, have rarely been offered in support of these theories. Here we address this by using lesion-symptom mapping in three large, partially-overlapping groups of aphasia patients with left hemisphere brain damage due to stroke (N = 121, N = 92, N = 218). We identified multiple measure by region interaction effects, associating damage to the posterior middle temporal gyrus with syntactic comprehension deficits, damage to posterior inferior frontal gyrus with expressive agrammatism, and damage to inferior angular gyrus with semantic category word fluency deficits. Our results are inconsistent with recent hypotheses that regions of the language network are undifferentiated with respect to high-level linguistic processing.

A double dissociation between plural and possessive "s": Evidence from the Morphosyntactic Generation test.

People with aphasia demonstrate impaired production of bound inflectional morphemes, such as noun plurals and possession. They often show greater difficulty in marking possession versus plurality. Using a new tool for eliciting language, the Morphosyntactic Generation test, we assessed people with primary progressive aphasia and those in the acute and chronic phase following left hemisphere stroke. Clinical profiles were associated with different strengths and weaknesses in language production. Performance of the plural was stronger than possessive in group analyses. However, some individuals demonstrated the inverse pattern of performance. These participants provide counter-evidence to the theory that difficulty with marking possessives is purely the result of their greater cognitive-linguistic complexity and support a functional double dissociation between possessives and plurals. The deficits resulted from morphosyntactic impairment. Future work is needed to understand why plural and possessive markers were differently sensitive to neurological disorders of language.

The Cortical Organization of Syntax.

Syntax, the structure of sentences, enables humans to express an infinite range of meanings through finite means. The neurobiology of syntax has been intensely studied but with little consensus. Two main candidate regions have been identified: the posterior inferior frontal gyrus (pIFG) and the posterior middle temporal gyrus (pMTG). Integrating research in linguistics, psycholinguistics, and neuroscience, we propose a neuroanatomical framework for syntax that attributes distinct syntactic computations to these regions in a unified model. The key theoretical advances are adopting a modern lexicalized view of syntax in which the lexicon and syntactic rules are intertwined, and recognizing a computational asymmetry in the role of syntax during comprehension and production. Our model postulates a hierarchical lexical-syntactic function to the pMTG, which interconnects previously identified speech perception and conceptual-semantic systems in the temporal and inferior parietal lobes, crucial for both sentence production and comprehension. These relational hierarchies are transformed via the pIFG into morpho-syntactic sequences, primarily tied to production. We show how this architecture provides a better account of the full range of data and is consistent with recent proposals regarding the organization of phonological processes in the brain.

The temporal dynamics of structure and content in sentence comprehension: Evidence from fMRI-constrained MEG.

Humans have a striking capacity to combine words into sentences that express new meanings. Previous research has identified key brain regions involved in this capacity, but little is known about the time course of activity in these regions, as hemodynamic methods such as fMRI provide little insight into temporal dynamics of neural activation. We performed an MEG experiment to elucidate the temporal dynamics of structure and content processing within four brain regions implicated by fMRI data from the same experiment: the temporo-parietal junction (TPJ), the posterior temporal lobe (PTL), the anterior temporal lobe (ATL), and the anterior inferior frontal gyrus (IFG). The TPJ showed increased activity for both structure and content near the end of the sentence, consistent with a role in incremental interpretation of event semantics. The PTL, a region not often associated with core aspects of syntax, showed a strong early effect of structure, consistent with predictive parsing models, and both structural and semantic context effects on function words. These results provide converging evidence that the PTL plays an important role in lexicalized syntactic processing. The ATL and IFG, regions traditionally associated with syntax, showed minimal effects of sentence structure. The ATL, PTL and IFG all showed effects of semantic content: increased activation for real words relative to nonwords. Our fMRI-guided MEG investigation therefore helps identify syntactic and semantic aspects of sentence comprehension in the brain in both spatial and temporal dimensions.

Phonological Feature Repetition Suppression in the Left Inferior Frontal Gyrus.

Models of speech production posit a role for the motor system, predominantly the posterior inferior frontal gyrus, in encoding complex phonological representations for speech production, at the phonemic, syllable, and word levels [Roelofs, A. A dorsal-pathway account of aphasic language production: The WEAVER++/ARC model. Cortex, 59(Suppl. C), 33-48, 2014; Hickok, G. Computational neuroanatomy of speech production. Nature Reviews Neuroscience, 13, 135-145, 2012; Guenther, F. H. Cortical interactions underlying the production of speech sounds. Journal of Communication Disorders, 39, 350-365, 2006]. However, phonological theory posits subphonemic units of representation, namely phonological features [Chomsky, N., & Halle, M. The sound pattern of English, 1968; Jakobson, R., Fant, G., & Halle, M. Preliminaries to speech analysis. The distinctive features and their correlates. Cambridge, MA: MIT Press, 1951], that specify independent articulatory parameters of speech sounds, such as place and manner of articulation. Therefore, motor brain systems may also incorporate phonological features into speech production planning units. Here, we add support for such a role with an fMRI experiment of word sequence production using a phonemic similarity manipulation. We adapted and modified the experimental paradigm of Oppenheim and Dell [Oppenheim, G. M., & Dell, G. S. Inner speech slips exhibit lexical bias, but not the phonemic similarity effect. Cognition, 106, 528-537, 2008; Oppenheim, G. M., & Dell, G. S. Motor movement matters: The flexible abstractness of inner speech. Memory & Cognition, 38, 1147-1160, 2010]. Participants silently articulated words cued by sequential visual presentation that varied in degree of phonological feature overlap in consonant onset position: high overlap (two shared phonological features; e.g., /r/ and /l/) or low overlap (one shared phonological feature, e.g., /r/ and /b/). We found a significant repetition suppression effect in the left posterior inferior frontal gyrus, with increased activation for phonologically dissimilar words compared with similar words. These results suggest that phonemes, particularly phonological features, are part of the planning units of the motor speech system.

Perception drives production across sensory modalities: A network for sensorimotor integration of visual speech.

Sensory information is critical for movement control, both for defining the targets of actions and providing feedback during planning or ongoing movements. This holds for speech motor control as well, where both auditory and somatosensory information have been shown to play a key role. Recent clinical research demonstrates that individuals with severe speech production deficits can show a dramatic improvement in fluency during online mimicking of an audiovisual speech signal suggesting the existence of a visuomotor pathway for speech motor control. Here we used fMRI in healthy individuals to identify this new visuomotor circuit for speech production. Participants were asked to perceive and covertly rehearse nonsense syllable sequences presented auditorily, visually, or audiovisually. The motor act of rehearsal, which is prima facie the same whether or not it is cued with a visible talker, produced different patterns of sensorimotor activation when cued by visual or audiovisual speech (relative to auditory speech). In particular, a network of brain regions including the left posterior middle temporal gyrus and several frontoparietal sensorimotor areas activated more strongly during rehearsal cued by a visible talker versus rehearsal cued by auditory speech alone. Some of these brain regions responded exclusively to rehearsal cued by visual or audiovisual speech. This result has significant implications for models of speech motor control, for the treatment of speech output disorders, and for models of the role of speech gesture imitation in development.

Audiovisual speech integration does not rely on the motor system: evidence from articulatory suppression, the McGurk effect, and fMRI.

Visual speech influences the perception of heard speech. A classic example of this is the McGurk effect, whereby an auditory /pa/ overlaid onto a visual /ka/ induces the fusion percept of /ta/. Recent behavioral and neuroimaging research has highlighted the importance of both articulatory representations and motor speech regions of the brain, particularly Broca's area, in audiovisual (AV) speech integration. Alternatively, AV speech integration may be accomplished by the sensory system through multisensory integration in the posterior STS. We assessed the claims regarding the involvement of the motor system in AV integration in two experiments: (i) examining the effect of articulatory suppression on the McGurk effect and (ii) determining if motor speech regions show an AV integration profile. The hypothesis regarding experiment (i) is that if the motor system plays a role in McGurk fusion, distracting the motor system through articulatory suppression should result in a reduction of McGurk fusion. The results of experiment (i) showed that articulatory suppression results in no such reduction, suggesting that the motor system is not responsible for the McGurk effect. The hypothesis of experiment (ii) was that if the brain activation to AV speech in motor regions (such as Broca's area) reflects AV integration, the profile of activity should reflect AV integration: AV > AO (auditory only) and AV > VO (visual only). The results of experiment (ii) demonstrate that motor speech regions do not show this integration profile, whereas the posterior STS does. Instead, activity in motor regions is task dependent. The combined results suggest that AV speech integration does not rely on the motor system.

Cortical networks responsive to phrase structure and subject island violations.

In principle, functional neuroimaging provides uniquely informative data in addressing linguistic questions, because it can indicate distinct processes that are not apparent from behavioral data alone. This could involve adjudicating the source of unacceptability via the different patterns of elicited brain responses to different ungrammatical sentence types. However, it is difficult to interpret brain activations to syntactic violations. Such responses could reflect processes that have nothing intrinsically related to linguistic representations, such as domain-general executive function abilities. In order to facilitate the potential use of functional neuroimaging methods to identify the source of different syntactic violations, we conducted an fMRI experiment to identify the brain activation maps associated with two distinct syntactic violation types: phrase structure (created by inverting the order of two adjacent words within a sentence) and subject islands (created by extracting a wh-phrase out of an embedded subject). The comparison of these violations to control sentences surprisingly showed no indication of a generalized violation response, with almost completely divergent activation patterns. Phrase structure violations seemingly activated regions previously implicated in verbal working memory and structural complexity in sentence processing, whereas the subject islands appeared to activate regions previously implicated in conceptual-semantic processing, broadly defined. We review our findings in the context of previous research on syntactic and semantic violations using event-related potentials. We suggest that functional neuroimaging is a potentially fruitful technique in unpacking the distinct sets of cognitive processes elicited by theoretically-relevant syntactic violations, when interpreted with care and paired with appropriate control conditions.

Mary has a little chair: Eliciting noun-modifier phrases in individuals with acute post-stroke aphasia.

Background: Aphasia assessment primarily examines an individual's syntax, nouns, and verbs. However, modifiers, such as adjectives and number words, and bound morphemes can be the subject of considerable difficulty for individuals with aphasia. The Morphosyntactic Generation (MorGen) targets nouns, modifiers, and bound inflectional morphemes in two-word phrases among people with aphasia. Aims: The purpose of this work is to provide the first report of the MorGen in hyperacute-acute aphasia. In doing so, we aim to (1) examine the MorGen's concurrent validity with common assessments of aphasia; (2) describe performance in modifiers by people with acute aphasia; and (3) associate MorGen performance with extent of lesioned vascular territories in acute stroke. Methods & Procedures: 62 adult English speakers within the first 14 days of left hemisphere ischemic stroke and 61 healthy control participants completed the MorGen. In addition to receiving the MorGen, participants with stroke received the Western Aphasia Battery (WAB), Boston Naming Test, and Hopkins Action Naming Assessment. Clinical MRIs were analyzed for the extent of lesion in the vascular territory of the left anterior, medial, and posterior cerebral artery, as well as the left posterior choroidal and thalamoperforator arteries. Outcomes & Results: Aim 1: Performance on the MorGen demonstrated consistently high, significant correlations with that on the WAB, Boston Naming Test, and Hopkins Action Naming Assessment. Aim 2: Individuals who had a stroke but were within functional limits (WFL) on the WAB performed significantly worse than healthy controls on the MorGen, driven by differences in adjective performance. When controlling for aphasia severity, those with fluent aphasia performed significantly better in their production of nouns, plurals, number, size, and color than those who had non-fluent aphasia, but both groups were similarly inclined to omit genitive marking. Aim 3: Lesions in the territory of the temporal branch of the posterior cerebral artery were associated with poorer performance in nouns, size, and color. Lesions in the territory of the anterior cerebral artery were associated with poorer performance in numbers. Conclusions: This work highlights the value of the MorGen as a tool for post-stroke language evaluation that complements the skills captured in more widely-used assessments such as the WAB and BNT.

Verbal working memory and syntactic comprehension segregate into the dorsal and ventral streams.

Syntactic processing and verbal working memory are both essential components to sentence comprehension. Nonetheless, the separability of these systems in the brain remains unclear. To address this issue, we performed causal-inference analyses based on lesion and connectome network mapping using MRI and behavioral testing in 103 individuals with chronic post-stroke aphasia. We employed a rhyme judgment task with heavy working memory load without articulatory confounds, controlling for the overall ability to match auditory words to pictures and to perform a metalinguistic rhyme judgment, isolating the effect of working memory load. We assessed noncanonical sentence comprehension, isolating syntactic processing by incorporating residual rhyme judgment performance as a covariate for working memory load. Voxel-based lesion analyses and structural connectome-based lesion symptom mapping controlling for total lesion volume were performed, with permutation testing to correct for multiple comparisons (4,000 permutations). We observed that effects of working memory load localized to dorsal stream damage: posterior temporal-parietal lesions and frontal-parietal white matter disconnections. These effects were differentiated from syntactic comprehension deficits, which were primarily associated with ventral stream damage: lesions to temporal lobe and temporal-parietal white matter disconnections, particularly when incorporating the residual measure of working memory load as a covariate. Our results support the conclusion that working memory and syntactic processing are associated with distinct brain networks, largely loading onto dorsal and ventral streams, respectively.

Lexico-semantics obscures lexical syntax.

A recently emerging generalization about language and the brain is that brain regions implicated in language that show syntax-related activations (e.g., increased activation for more complex sentence structures) also tend to show word-related activations, such as increased activation to reading real words (e.g. RAIN) relative to pseudowords (e.g. PHREZ) (Fedorenko et al., 2016). Fedorenko et al., (2020) generalize as follows: "…syntactic/combinatorial processing is not separable from lexico-semantic processing at the level of brain regions-or even voxel subsets-within the language network". Based on this generalization, Fedorenko et al. have made the conclusion "…that a cognitive architecture whereby syntactic processing is not separable from the processing of individual word meanings is most likely", arguing against "syntax-centric" views of language as promulgated by Chomsky and others. However, the notion of "lexico-semantics" articulated here obscures the fact that words are both syntactic and semantic entities. Because of this, any functional neuroimaging experiment that manipulates lexicality will almost assuredly tax both syntactic and semantic resources, and is therefore inadequate for isolating conceptual-semantic processing in the brain in exclusion to syntax. In addition, Fedorenko et al. do not satisfactorily account for robust lesion data that shows clear functional-anatomical dissociations within the language network. Finally, a "syntax-centric" view of language is perfectly compatible with Fedorenko et al.'s conclusions about syntax-selectivity in the brain because of the multiple potential mappings between linguistic theory and neurobiology beyond individual brain regions.

Grammatical Parallelism in Aphasia: A Lesion-Symptom Mapping Study.

Sentence structure, or syntax, is potentially a uniquely creative aspect of the human mind. Neuropsychological experiments in the 1970s suggested parallel syntactic production and comprehension deficits in agrammatic Broca's aphasia, thought to result from damage to syntactic mechanisms in Broca's area in the left frontal lobe. This hypothesis was sometimes termed overarching agrammatism, converging with developments in linguistic theory concerning central syntactic mechanisms supporting language production and comprehension. However, the evidence supporting an association among receptive syntactic deficits, expressive agrammatism, and damage to frontal cortex is equivocal. In addition, the relationship among a distinct grammatical production deficit in aphasia, paragrammatism, and receptive syntax has not been assessed. We used lesion-symptom mapping in three partially overlapping groups of left-hemisphere stroke patients to investigate these issues: grammatical production deficits in a primary group of 53 subjects and syntactic comprehension in larger sample sizes (N = 130, 218) that overlapped with the primary group. Paragrammatic production deficits were significantly associated with multiple analyses of syntactic comprehension, particularly when incorporating lesion volume as a covariate, but agrammatic production deficits were not. The lesion correlates of impaired performance of syntactic comprehension were significantly associated with damage to temporal lobe regions, which were also implicated in paragrammatism, but not with the inferior and middle frontal regions implicated in expressive agrammatism. Our results provide strong evidence against the overarching agrammatism hypothesis. By contrast, our results suggest the possibility of an alternative grammatical parallelism hypothesis rooted in paragrammatism and a central syntactic system in the posterior temporal lobe.

Hierarchical organization of human auditory cortex: evidence from acoustic invariance in the response to intelligible speech.

Hierarchical organization of human auditory cortex has been inferred from functional imaging observations that core regions respond to simple stimuli (tones) whereas downstream regions are selectively responsive to more complex stimuli (band-pass noise, speech). It is assumed that core regions code low-level features, which are combined at higher levels in the auditory system to yield more abstract neural codes. However, this hypothesis has not been critically evaluated in the auditory domain. We assessed sensitivity to acoustic variation within intelligible versus unintelligible speech using functional magnetic resonance imaging and a multivariate pattern analysis. Core auditory regions on the dorsal plane of the superior temporal gyrus exhibited high levels of sensitivity to acoustic features, whereas downstream auditory regions in both anterior superior temporal sulcus and posterior superior temporal sulcus (pSTS) bilaterally showed greater sensitivity to whether speech was intelligible or not and less sensitivity to acoustic variation (acoustic invariance). Acoustic invariance was most pronounced in more pSTS regions of both hemispheres, which we argue support phonological level representations. This finding provides direct evidence for a hierarchical organization of human auditory cortex and clarifies the cortical pathways supporting the processing of intelligible speech.

One cat, Two cats, Red cat, Blue cats: Eliciting morphemes from individuals with primary progressive aphasia.

BACKGROUND: Progressive neurodegenerative impairment with central language features, primary progressive aphasia (PPA), can be further distinguished for many individuals into one of three variants: semantic, non-fluent/agrammatic, and logopenic variant PPA. Variants differ in their relative preservation and deficits of language skills, particularly in word finding and grammar. The majority of elicited language assessments used in this population focus on single noun and verb production, while modifiers and inflectional morphemes are far less commonly examined. AIMS: The purpose of the present study is to determine whether there was an interaction between PPA variant and production of high-frequency nouns, proper names, modifiers, and bound inflectional morphemes to better understand how the variants differ. METHODS & PROCEDURES: Forty-six people with PPA and 47 individuals with no known neurological diagnoses completed a morphosyntactic generation assessment designed to target differential production of high-frequency nouns, proper names, modifiers (number, size, color), and bound inflectional morphemes (plural -s and possessive 's), the Morphosyntactic Generation test (MorGen). Performance is averaged for each of the seven morphosyntactic targets independently, resulting in seven separate performance scores. OUTCOMES & RESULTS: Individuals with PPA performed significantly more poorly than controls on the assessed morphemes in a repeated-measures analysis of variance, as well as on each morpheme considered independently via t-test.In a multivariable analysis of variance among PPA variants, the interaction of morpheme and PPA variant was significant, suggesting different variants produced the morphemes with a significantly different pattern of success. When morphemes were considered independently, only production of colour resulted in a significant difference between variants, driven by the performance of individuals with nfavPPA, who performed near-ceiling. When MorGen performance was used to predict PPA variant in a multinomial logistic regression the model was significant, with age, plural -s, noun, and number contributing significantly to the prediction. In a discriminate function analysis, classification of cases was best for agrammatic variant with 70% accuracy. CONCLUSIONS: Individuals with PPA, particularly semantic and logopenic variants, demonstrated difficulty on the MorGen compared to controls. The MorGen proved useful in predicting PPA variant. These findings highlight the potential benefit of examining a broader range of morphemes, particularly bound morphemes and modifiers, in addition to the more frequently investigated classes of nouns and verbs when understanding PPA.

Syntax-Sensitive Regions of the Posterior Inferior Frontal Gyrus and the Posterior Temporal Lobe Are Differentially Recruited by Production and Perception.

Matchin and Hickok (2020) proposed that the left posterior inferior frontal gyrus (PIFG) and the left posterior temporal lobe (PTL) both play a role in syntactic processing, broadly construed, attributing distinct functions to these regions with respect to production and perception. Consistent with this hypothesis, functional dissociations between these regions have been demonstrated with respect to lesion-symptom mapping in aphasia. However, neuroimaging studies of syntactic comprehension typically show similar activations in these regions. In order to identify whether these regions show distinct activation patterns with respect to syntactic perception and production, we performed an fMRI study contrasting the subvocal articulation and perception of structured jabberwocky phrases (syntactic), sequences of real words (lexical), and sequences of pseudowords (phonological). We defined two sets of language-selective regions of interest (ROIs) in individual subjects for the PIFG and the PTL using the contrasts [syntactic > lexical] and [syntactic > phonological]. We found robust significant interactions of comprehension and production between these 2 regions at the syntactic level, for both sets of language-selective ROIs. This suggests a core difference in the function of these regions with respect to production and perception, consistent with the lesion literature.

Agrammatism and Paragrammatism: A Cortical Double Dissociation Revealed by Lesion-Symptom Mapping.

The fundamental distinction of grammatical deficits in aphasia, agrammatism and paragrammatism, was made over a century ago. However, the extent to which the agrammatism/paragrammatism distinction exists independently of differences in speech fluency has not clearly been investigated. Despite much research on agrammatism, the lesion correlates of paragrammatism are essentially unknown. Lesion-symptom mapping was used to investigate the degree to which the lesion correlates of agrammatism and paragrammatism overlap or dissociate. Four expert raters assessed videos of 53 right-handed patients with aphasia following chronic left-hemisphere stroke retelling the Cinderella story. Consensus discussion determined each subject's classification with respect to grammatical deficits as Agrammatic, Paragrammatic, Both, or No Grammatical Deficit. Each subject's lesion was manually drawn on a high-resolution MRI and warped to standard space for group analyses. Lesion-symptom mapping analyses were performed in NiiStat including lesion volume as a covariate. Secondary analyses included speech rate (words per minute) as an additional covariate. Region of interest analyses identified a double dissociation between these syndromes: damage to Broca's area was significantly associated with agrammatism, p = 0.001 (but not paragrammatism, p = 0.930), while damage to the left posterior superior and middle temporal gyri was significantly associated with paragrammatism, p < 0.001 (but not agrammatism, p = 0.873). The same results obtained when regressing out the effect of speech rate, and nonoverlapping lesion distributions between the syndromes were confirmed by uncorrected whole brain analyses. Our results support a fundamental distinction between agrammatism and paragrammatism.