Lesion correlates of conversational speech production deficits.

We assess brain areas involved in speech production using a recently developed lesion-symptom mapping method (voxel-based lesion-symptom mapping, VLSM) with 50 aphasic patients with left-hemisphere lesions. Conversational speech was collected through a standardized biographical interview, and used to determine mean length of utterance in morphemes (MLU), type token ratio (TTR) and overall tokens spoken for each patient. These metrics are used as indicators of grammatical complexity, semantic variation, and amount of speech, respectively. VLSM analysis revealed that damage to the anterior insula was predictive of low scores on MLU and tokens, consistent with prior findings of the role of this region in speech production [Dronkers, N. F. (1996). A new brain region for coordinating speech articulation. Nature, 384(6605), 159-161]. Additionally, the inferior frontal gyrus, sensorimotor and anterior temporal areas were also associated with lower scores on both of these measures. Overall, token and MLU maps were highly similar, suggesting an overlap between grammatical language networks and overall fluency. TTR maps also shared some portions of this network, but damage to posterior temporal regions also reduced scores on this measure. These results represent the first voxel-based lesion analysis of speech production performance in aphasic patients.