Semantic flow and its relation to controlled semantic retrieval deficits in the narrative production of people with aphasia.

Aphasia has had a profound influence on our understanding of how language is instantiated within the human brain. Historically, aphasia has yielded an in vivo model for elucidating the effects of impaired lexical-semantic access on language comprehension and production. Aphasiology has focused intensively on single word dissociations. Yet, less is known about the integrity of combinatorial semantic processes required to construct well-formed narratives. Here we addressed the question of how controlled lexical-semantic retrieval deficits (a hallmark of aphasia) might compound over the course of longer narratives. We specifically examined word-by-word flow of taxonomic vs. thematic semantic distance in the storytelling narratives of individuals with chronic post-stroke aphasia (n = 259) relative to age-matched controls (n = 203). We first parsed raw transcribed narratives into content words and computed inter-word semantic distances for every running pair of words in each narrative (N = 232,490 word transitions). The narratives of people with aphasia showed significant reductions in taxonomic and thematic semantic distance relative to controls. Both distance metrics were strongly predictive of offline measures of semantic impairment and aphasia severity. Since individuals with aphasia often exhibit perseverative language output (i.e., repetitions), we performed additional analyses with repetitions excluded. When repetitions were excluded, group differences in semantic distances persisted and thematic distance was still predictive of semantic impairment, although some findings changed. These results demonstrate the cumulative impact of deficits in controlled word retrieval over the course of narrative production. We discuss the nature of semantic flow between words as a novel metric of characterizing discourse and elucidating the nature of lexical-semantic access impairment in aphasia at multiword levels.