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Damage to the anterior arcuate fasciculus predicts non-fluent speech production in aphasia
Open accessAbstract
Non-fluent aphasia implies a relatively straightforward neurological condition characterized by limited speech output. However, it is an umbrella term for different underlying impairments affecting speech production. Several studies have sought the critical lesion location that gives rise to non-fluent aphasia. The results have been mixed but typically implicate anterior cortical regions such as Broca's area, the left anterior insula, and deep white matter regions. To provide a clearer picture of cortical damage in non-fluent aphasia, the current study examined brain damage that negatively influences speech fluency in patients with aphasia. It controlled for some basic speech and language comprehension factors in order to better isolate the contribution of different mechanisms to fluency, or its lack. Cortical damage was related to overall speech fluency, as estimated by clinical judgements using the Western Aphasia Battery speech fluency scale, diadochokinetic rate, rudimentary auditory language comprehension, and executive functioning (scores on a matrix reasoning test) in 64 patients with chronic left hemisphere stroke. A region of interest analysis that included brain regions typically implicated in speech and language processing revealed that non-fluency in aphasia is primarily predicted by damage to the anterior segment of the left arcuate fasciculus. An improved prediction model also included the left uncinate fasciculus, a white matter tract connecting the middle and anterior temporal lobe with frontal lobe regions, including the pars triangularis. Models that controlled for diadochokinetic rate, picture-word recognition, or executive functioning also revealed a strong relationship between anterior segment involvement and speech fluency. Whole brain analyses corroborated the findings from the region of interest analyses. An additional exploratory analysis revealed that involvement of the uncinate fasciculus adjudicated between Broca's and global aphasia, the two most common kinds of non-fluent aphasia. In summary, the current results suggest that the anterior segment of the left arcuate fasciculus, a white matter tract that lies deep to posterior portions of Broca's area and the sensory-motor cortex, is a robust predictor of impaired speech fluency in aphasic patients, even when motor speech, lexical processing, and executive functioning are included as co-factors. Simply put, damage to those regions results in non-fluent aphasic speech; when they are undamaged, fluent aphasias result.
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“Damage to each of these white/grey matter regions has been associated with speech production impairments in prior lesion studies”
From Damage to Broca’s area does not contribute to long-term speech production outcome after stroke (2021) · cites this paper as Fridriksson et al., 2013
In the citing paper
“a previous well-powered lesion study was unable to establish a significant relationship between persistent speech production impairments and damage to either of these white matter tracts after controlling for damage to the anterior segment of the arcuate fasciculus (Fridriksson et al., 2013)”
From Damage to Broca’s area does not contribute to long-term speech production outcome after stroke (2021) · cites this paper as Fridriksson et al., 2013
In the citing paper
“These probability thresholds are within the range of those used in previous studies”
From Damage to Broca’s area does not contribute to long-term speech production outcome after stroke (2021) · cites this paper as Fridriksson et al., 2013
In the citing paper
“Our findings support prior conclusions that white matter, above the insula, in the vicinity of aAF is important for speech production (Fridriksson et al., 2013)”
From Damage to Broca’s area does not contribute to long-term speech production outcome after stroke (2021) · cites this paper as Fridriksson et al., 2013
In the citing paper
“persistent speech production impairments as a consequence of stroke damage to aAF have been reported in prior studies that did (Marchina et al., 2011) and did not collect (Fridriksson et al., 2013) DTI data to quantify structural abnormality in white matter pathways.”
From Damage to Broca’s area does not contribute to long-term speech production outcome after stroke (2021) · cites this paper as Fridriksson et al., 2013
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BBB-Permeable Near-Infrared Oxazine Fluorophores for White Matter Tract ImagingPreprint
Mengesha, B., Dai, M., Montaño, A. R., et al. (2026) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.64898/2026.05.22.727303
“…the brain is associated with negative patient outcomes, for example, damage to the arcuate fasciculus is associated with deficits in speech fluency 5 , injury to the uncinate fasciculus and left inferior longitudinal fasciculus is associated with impairments in name retrieval 6,7 , and injury to…”
Quantifier processing and semantic flexibility in patients with aphasia
Bender, B. (2026) · RWTH Publications (RWTH Aachen)
Nasiri, D., Consuegra, A., Wyss, C., Hostettler, L., Descombes, C., Wermelinger, J., Raabe, A., Schucht, P., & Seidel, K. (2026) · Brain and Spine · doi:10.1016/j.bas.2026.106254
“…within the language network, contributing to both the dorsal phonological and ventral semantic stream supporting functions beyond straightforward speech repetition (Bernal and Ardila, 2009; Catani and Mesulam, 2008; Fridriksson et al., 2013; Giampiccolo and Duffau, 2022; Ivanova et al., 2021).”
İnme Sonrası Üst Motor Nöron Dizartrisi Alt Tiplerinde Diadokokinetik Hız Ölçümleri
Kocaoğlu, S., & Özkan, E. T. (2026) · Dil Konuşma ve Yutma Araştırmaları Dergisi · doi:10.58563/dkyad.1906583.2026.2.3
The interacting language network: A framework for neuromodulation and clinical translation
Preisig, B. C., Proix, T., Borghesani, V., Brem, S., Marchesotti, S., & Guggisberg, A. G. (2026) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2026.106972
Metadata
- Authors
- Fridriksson, J., Guo, D., Fillmore, P., Holland, A., & Rorden, C.
- Affiliations
- University of South Carolina (US)
- University of Arizona (US)
- Venue
- Brain
- Publisher
- Oxford University Press (OUP)
- Published
- 2013-10-15
- Volume
- 136
- Issue
- 11
- Pages
- 3451-3460
- ISSN
- 0006-8950 (ISSN-L)
- 1460-2156
- PMC
- PMC3808690
- OpenAlex
- W2124041025
- Semantic Scholar
- 69f0e3ec6bfd102fd2bca9399f7f99f2b9535a96
- Cited by
- 172
- References
- 61
- Citations by year
- 2026: 10 · 2025: 11 · 2024: 13 · 2023: 14 · 2022: 22 · 2021: 16 · 2020: 18 · 2019: 14 · 2018: 12 · 2017: 14 · 2016: 9 · 2015: 11 · 2014: 7
- FWCI
- 4.94
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Brain (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute on Deafness and Other Communication Disorders (R01DC008355, R01DC009571, DC-009571, DC008355)
- Topics
- Life Sciences › Neuroscience › Cognitive Neuroscience › Neurobiology of Language and Bilingualism
- Life Sciences › Neuroscience › Cognitive Neuroscience › Hemispheric Asymmetry in Neuroscience
- Social Sciences › Psychology › Developmental and Educational Psychology › Language Development and Disorders
- Keywords
- non-fluent aphasia, arcuate fasciculus, uncinate fasciculus, speech fluency, left hemisphere stroke, Broca's area, white matter tracts, global aphasia, Broca's aphasia, executive function, diadochokinesis, auditory language comprehension
- MeSH terms
- Aged, Aphasia, Broca, Cerebral Cortex, Female, Humans, Language Tests, Magnetic Resonance Imaging, Male, Middle Aged, Neural Pathways, Neuropsychological Tests, Predictive Value of Tests, Cohort Studies, Cerebrum
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