Multilevel auditory and cognitive processing in post-stroke aphasia: associations with language performance using ABR, LLR, and P300: a cross-sectional observational study
Keywords:
Aphasia, Stroke, Evoked Potentials, Auditory, Evoked Potentials, Auditory, Brain Stem, Event-Related Potentials, P300, Post-Stroke Aphasia, Auditory Processing, Late Latency Responses, Cognitive Processing Speed, Language Performance, Speech and Language TherapyAbstract
BACKGROUND: Aphasia following stroke is primarily characterized by language impairment; however, accumulating evidence suggests that deficits in auditory and cognitive processing may also contribute to impaired language function. Auditory evoked potentials provide objective markers of neural processing across subcortical, cortical, and cognitive levels and may help clarify the neurophysiological mechanisms underlying post-stroke aphasia.
OBJECTIVES: To investigate multilevel auditory processing and its relationship with language performance in individuals with post-stroke aphasia using Auditory Brainstem Responses (ABR), Late Latency Responses (LLR), and P300 potentials.
DESIGN AND SETTING: Cross-sectional observational study conducted at a university hospital in Türkiye.
METHODS: Twenty-nine individuals with post-stroke aphasia and 33 age-matched healthy controls were included. Language performance was assessed using the Aphasia Language Assessment Test and a standardized naming task. Auditory processing was evaluated using ABR, LLR (P1, N1, P2, N2), and P300 potentials recorded according to standard electrophysiological protocols. Group comparisons were performed for latency and amplitude measures, and correlation analyses were conducted to examine associations between electrophysiological parameters and language performance.
RESULTS: Compared with healthy controls, individuals with aphasia demonstrated significantly prolonged latencies in ABR waves and interpeak intervals, as well as in all LLR and P300 components (p < 0.05). No significant group differences were observed in amplitude measures. Naming performance was significantly lower in the aphasia group. Although correlations between language performance and electrophysiological measures did not reach statistical significance, moderate negative trends were observed between naming scores and N2 and P300 latencies.
CONCLUSION: Post-stroke aphasia is associated with delayed auditory processing across subcortical, cortical, and cognitive levels, reflecting generalized slowing rather than reduced neural recruitment. Latency-based auditory evoked potential measures may complement behavioral language assessments and support a multilevel auditory–cognitive framework for aphasia evaluation and rehabilitation.
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1. Engelter ST, Gostynski M, Papa S, et al. Epidemiology of aphasia attributable to first ischemic stroke: incidence, severity, fluency, etiology, and thrombolysis. Stroke. 2006 Jun;37(6):1379–84. https://doi.org/10.1161/01.STR.0000221815.64093.8c.
2. Shah-Basak P, Boukrina O, Li XR, Jebahi F, Kielar A. Targeted neurorehabilitation strategies in post-stroke aphasia. Restorative Neurology and Neuroscience. 08 2023 Dec;41(3–4):129–91. https://doi.org/10.3233/RNN-231344.
3. Meechan RJH, McCann CM, Purdy SC. The electrophysiology of aphasia: A scoping review. Clinical Neurophysiology. 2021 Dec;132(12):3025–34. https://doi.org/10.1016/j.clinph.2021.08.023.
4. Kertesz A. Western Aphasia Battery—Revised (WAB-R) [Database record] [Internet]. APA PsycTests; 2006. [cited 2026 May 14]. https://doi.org/10.1037/t15168-000.
5. Polich J. Updating P300: An integrative theory of P3a and P3b. Clinical Neurophysiology. 2007 Oct;118(10):2128–48. https://doi.org/10.1016/j.clinph.2007.04.019.
6. Mourad S, Abd Al-Ghaffar M, Bassiony MAA, Fawzi G. Value of complex evoked auditory brainstem response in patients with post-stroke aphasia (prospective study). Egyptian Journal of Ear, Nose, Throat and Allied Sciences. 2017 Nov;18(3):217–21. https://doi.org/10.1016/j.ejenta.2017.05.006.
7. Fonseca J, Ferreira JJ, Pavão Martins I. Cognitive performance in aphasia due to stroke: a systematic review. International Journal on Disability and Human Development. 24 2017 Jan;16(2). https://doi.org/10.1515/ijdhd-2016-0011.
8. Rojas Sosa MC, Fraire Martínez MI, Olvera Gómez JL, Jáuregui-Renaud K. Early auditory middle latency evoked potentials correlates with recovery from aphasia after stroke. Clinical Neurophysiology. 2009 Jan;120(1):136–9. https://doi.org/10.1016/j.clinph.2008.10.011.
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