Asyntactic comprehension, working memory, and acute ischemia in Broca's area versus angular gyrus

We evaluated sentence comprehension of variety of sentence constructions and components of short-term memory (STM) in 53 individuals with acute ischemic stroke, to test some current hypotheses about the role of Broca's area in these tasks. We found that some patients show structure-specific, task-independent deficits in sentence comprehension, with chance level of accuracy on passive reversible sentences, more impaired comprehension of object-cleft than subject-cleft sentences, and more impaired comprehension of reversible than irreversible sentences in both sentence-picture matching and enactment tasks. In a dichotomous analysis, this pattern of "asyntactic comprehension" was associated with dysfunctional tissue in left angular gyrus, rather than dysfunctional tissue in Broca's area as previously proposed. Tissue dysfunction in left Brodmann area (BA) 44, part of Broca's area, was associated with phonological STM impairment defined by forward digit span≤4. Verbal working memory (VWM) defined by backward digit span≤2 was associated with tissue dysfunction left premotor cortex (BA 6). In a continuous analysis, patients with acute ischemia in left BA 44 were impaired in phonological STM. Patients with ischemia in left BA 45 and BA 6 were impaired in passive, reversible sentences, STM, and VWM. Patients with ischemia in left BA 39 were impaired in passive reversible sentences, object-cleft sentences, STM, and VWM. Therefore, various components of working memory seem to depend on a network of brain regions that include left angular gyrus and posterior frontal cortex (BA 6, 44, 45); left BA 45 and angular gyrus (BA 39) may have additional roles in comprehension of syntax such as thematic role checking.