Phonological Processing as a Marker of Latent Cognitive Vulnerability: A Pre- and Post-Stroke Case Study in a Patient without Aphasia

Authors

  • Emanuela Shtika Sofia University “St. Kliment Ohridski”
  • Katerina Shtereva Sofia University St. Kliment Ohridski

DOI:

https://doi.org/10.60059/SPL.2024.2.42-56

Keywords:

phonological processing, ischemic stroke, subclinical vulnerability, cognitive reserve, right hemisphere lesion, neurovascular risk

Abstract

This study presents a case of a patient whose phonological processing was assessed before and after an ischemic stroke in the right posterior cerebral artery, without clinical signs of aphasia. Using a standardized assessment tool, a marked decline was observed in tasks involving repetition, blending, and segmentation of sound units, particularly when processing pseudowords,while automated processes such as oral reading and auditory phonological processing remained relatively preserved. The findings indicate that even lesions outside the classical language areas can lead to selective language-cognitive impairments. The study supports the concept of the network-based and bilateral organization of language functions and highlights the potential of phonological tasks as a sensitive tool for early detection of latent cognitive- linguistic vulnerability and increased neurovascular risk.

Author Biographies

  • Emanuela Shtika, Sofia University “St. Kliment Ohridski”

    Assistant Professor, PhD.

    Faculty of Educational Studies and the Arts, Department of Logopedics.

    Research interests: aphasiology; phonological processing and its interaction with oral and written language; prognostic factors for language recovery after stroke; speech-language assessment and therapy in aphasia; primary progressive aphasia.

    Publications: author and co-author of over 10 scientific publications in reputable national and international editions.

    Email: ehmarinova@uni-sofia.bg

     

  • Katerina Shtereva, Sofia University St. Kliment Ohridski

    Associate Professor, PhD.

    Faculty of Educational Studies and the Arts, Department of Logopedics.

    Research interests: language and cognitive development in childhood; phonological awareness and rapid naming; reading and related cognitive processes; assessment and therapy of language and communication disorders in children and adults; communication disorders in autism spectrum disorders; aphasiology and contemporary approaches in speech-language therapy; impact of digital technologies on early language development.      

    Publications: аuthor and co-author of over 80 scientific publications, including monographs, book chapters, and articles in indexed journals.

    Email: kshtereva@uni-sofia.bg

References

Asenova, I. (2009). Nevropsihologia. Blagoevgrad: Sanin – N i N. [Асенова, И. (2009). Невропсихология. Благоевград: Санин – Н и Н.]

Balestrini, S., Perozzi, C., Altamura, C., Vernieri, F., Luzzi, S., Bartolini, M., Provinciali, L. & Silvestrini, M. (2013). Severe carotid stenosis and impaired cerebral hemodynamics can influence cognitive deterioration. Neurology, 80 (23), 2145–2150. https://doi.org/10.1212/WNL.0b013e318295d71a

Berthier, M. L., Dávila, G., García-Casares, N., Green, C., Juárez, R., Ruiz-Cruces, R. & Barbancho, M. A. (2010). Atypical conduction aphasia and the right hemisphere: Cross-hemispheric plasticity of phonology in a developmentally dyslexic and dysgraphic patient with early left frontal damage. Neurocase, 17 (2), 93–111. https://doi.org/10.1080/13554794.2010.498380

Boyadzhiev, T. & Tilkov, D. (1999). Fonetika na balgarskia knizhoven ezik. Veliko Tarnovo: Abagar. [Бояджиев, Т. & Тилков, Д. (1999). Фонетика на българския книжовен език. Велико Търново: Абагар.]

Debette, S. & Markus, H. S. (2010). The clinical importance of white matter hyperintensities on brain magnetic resonance imaging: Systematic review and meta-analysis. BMJ, 341, c3666. https://doi.org/10.1136/bmj.c3666

Delano-Wood, L., Abeles, N., Sacco, J. M., Wierenga, C. E., Horne, N. R. & Bozoki, A. (2008). Regional white matter pathology in mild cognitive impairment: Differential influence of lesion type on neuropsychological functioning. Stroke, 39 (3), 794–799. https://doi.org/10.1161/STROKEAHA.107.502534

Dimitrova-Kirilova, V. M. (2023). Profesionalna predispozitsia pri asimptomni insulti (Disertatsionen trud, Meditsinski universitet „Prof. d-r Paraskev Stoyanov“ – Varna). [Димитрова-Кирилова, В. М. (2023). Професионална предиспозиция при асимптомни инсулти (Дисертационен труд, Медицински университет „Проф. д-р Параскев Стоянов“ – Варна).] https://repository.mu-varna.bg/bitstream/handle/nls/3121/THESIS_Vladina%20Dimitrova-Kirilova_2023.pdf?sequence=2

Gottesman, R. F. & Hillis, A. E. (2010). Predictors and assessment of cognitive dysfunction resulting from ischaemic stroke. The Lancet Neurology, 9 (9), 895–905. https://doi.org/10.1016/S1474-4422(10)70164-2

Hartwigsen, G., Price, C. J., Baumgaertner, A., Geiss, G., Koehnke, M., Ulmer, S. & Siebner, H. R. (2010). The right posterior inferior frontal gyrus contributes to phonological word decisions in the healthy brain: Evidence from dual-site TMS. Neuropsychologia, 48 (10), 3155–3163. https://doi.org/10.1016/j.neuropsychologia.2010.06.032

Johnston, S. C., O'Meara, E. S., Manolio, T. A., Lefkowitz, D., O'Leary, D. H., Goldstein, S., Carlson, M. C., Fried, L. P. & Longstreth, W. T., Jr. (2004). Cognitive impairment and decline are associated with carotid artery disease in patients without clinically evident cerebrovascular disease. Annals of Internal Medicine, 140 (4), 237–247. https://doi.org/10.7326/0003-4819-140-4-200402170-00005

Kendall, D., del Toro, C., Nadeau, S., Johnson, J., Rosenbek, J. & Velozo, C. (2010, June). The development of a standardized assessment of phonology in aphasia. Paper presented at the Clinical Aphasiology Conference, Isle of Palm, SC.

Kendall, D. L. & Nadeau, S. E. (2016). The Phonomotor Approach to Treating Phonological-Based Language Deficits in People With Aphasia. Topics in Language Disorders, 36 (2), 109–122. https://doi.org/10.1097/TLD.0000000000000086

Lee, M., Saver, J. L., Hong, K. S., Wu, Y. L., Liu, H. C., Rao, N. M. & Ovbiagele, B. (2014). Cognitive impairment and risk of future stroke: A systematic review and meta-analysis. CMAJ, 186 (14), E536–E546. https://doi.org/10.1503/cmaj.140147

Marinova, E. & Shtereva, K. (2023). Predstavyane na model za izsledvane na fonologiyata pri afazia, adaptiran za balgarskia ezik. Balgarski ezik i literatura, 65 (3), 276–289. [Маринова, E. & Щерева, K. (2023). Представяне на модел за изследване на фонологията при афазия, адаптиран за българския език. Български език и литература, 65 (3), 276–289.] https://doi.org/10.53656/bel2023-3-4mk

Martin, N. & Saffran, E. M. (1997). Language and auditory-verbal short-term memory impairments: Evidence for common underlying processes. Cognitive Neuropsychology, 14 (5), 641–682. https://doi.org/10.1080/026432997381402

Martinić-Popović, I., Lovrencić-Huzjan, A. & Demarin, V. (2009). Assessment of subtle cognitive impairment in stroke-free patients with carotid disease. Acta clinica Croatica, 48 (3), 231–240.

Mathiesen, E. B., Waterloo, K., Joakimsen, O., Bakke, S. J., Jacobsen, E. A. & Bønaa, K. H. (2004). Reduced neuropsychological test performance in asymptomatic carotid stenosis: The Tromsø Study. Neurology, 62 (5), 695–701. https://doi.org/10.1212/01.wnl.0000113759.80877.1f

Mele, F., Cova, I., Nicotra, A., Maestri, G., Salvadori, E., Cucumo, V., Masserini, F., Martelli, M., Pomati, S., Bertora, P. & Pantoni, L. (2024). Prestroke Cognitive Impairment: Frequency and Association With Premorbid Neuropsychiatric, Functional, and Neuroimaging Features. Stroke, 55 (7), 1869–1876. https://doi.org/10.1161/STROKEAHA.123.045344

Nadeau, S. E. (2001). Phonology: A review and proposals from a connectionist perspective. Brain and Language, 79 (3), 511–579. https://doi.org/10.1006/brln.2001.2566

Noonan, K. A., Jefferies, E., Visser, M. & Lambon Ralph, M. A. (2013). Going beyond inferior prefrontal involvement in semantic control: Evidence for the additional contribution of dorsal angular gyrus and posterior middle temporal cortex. Journal of Cognitive Neuroscience, 25 (11), 1824–1850. https://doi.org/10.1162/jocn_a_00442

Robson, H., Griffiths, T. D., Grube, M. & Woollams, A. M. (2019). Auditory, phonological, and semantic factors in the recovery from Wernicke's aphasia poststroke: Predictive value and implications for rehabilitation. Neurorehabilitation and Neural Repair, 33 (10), 800–812. https://doi.org/10.1177/1545968319868709

Schellhorn, T., Zucknick, M., Askim, T., Munthe-Kaas, R., Ihle-Hansen, H., Seljeseth, Y. M., Knapskog, A. B., Næss, H., Ellekjær, H., Thingstad, P., Wyller, T. B., Saltvedt, I. & Beyer, M. K. (2021). Pre-stroke cognitive impairment is associated with vascular imaging pathology: A prospective observational study. BMC Geriatrics, 21 (1), 362. https://doi.org/10.1186/s12877-021-02327-2

Shtereva, K. (2012). Fonologichnoto osaznavane na detsata. Sofia: Glossa Terapi. [Щерева, К. (2012). Фонологичното осъзнаване на децата. София: ГЛОССА ТЕРАПИ.] ISBN 978-954-92903-1-8

Shtereva, K., Hadzhiyska, B., Totev, T. & Slavcheva-Mihaylova, M. (2020). Application of the Wuggy Method for Generation of Pseudo-Words in the Bulgarian Language. Knowledge International Journal, 43 (6), 1219–1226.

Sinanović, O., Mrkonjić, Z., Zukić, S., Vidović, M. & Imamović, K. (2011). Post-stroke language disorders. Acta Clinica Croatica, 50 (1), 79–94. PMID: 22034787

Shtika, E. (2024). Vliyanie na fonologichnata prerabotka varhu ustnia i pismenia ezik pri afazia [Avtoreferat na disertatsia za pridobivane na obrazovatelna i nauchna stepen „doktor“]. Sofiyski universitet „Sv. Kliment Ohridski“, Fakultet po nauki za obrazovanieto i izkustvata. [Щика, Е. (2024). Влияние на фонологичната преработка върху устния и писмения език при афазия [Автореферат на дисертация за придобиване на образователна и научна степен „доктор“]. Софийски университет „Св. Климент Охридски“, Факултет по науки за образованието и изкуствата.]

Shtika, E. & Shtereva, K. (2024). Vliyanie na fonologichnata prerabotka varhu ustnia ezik pri afazia. – In: M. Grinberg & K. Shtereva (Eds.), Senzornata prerabotka v konteksta na logopediyata – Sbornik dokladi ot mezhdunarodna konferentsia, Albena 2024, 41–50. Sofia: LTs Romel. [Щика, Е. & Щерева, К. (2024). Влияние на фонологичната преработка върху устния език при афазия. – В: М. Гринберг и К. Щерева (ред.), Сензорната преработка в контекста на логопедията – Сборник доклади от международна конференция, Албена 2024, 41–50. София: ЛЦ Ромел.] ISBN: 978-954-9458-33-6

Stoel-Gammon, C. & Stemberger, J. (1994). Consonant harmony and underspecification in child phonology. – In: M. Yavas (Ed.), First and Second Language Phonology, 63–80. Singular Publishing Group.

Tsenova, Ts. (2012). Logopedia. Opisanie, diagnostika i terapia na komunikativnite narushenia. Sofia: DiMaks. [Ценова, Ц. (2012). Логопедия. Описание, диагностика и терапия на комуникативните нарушения. София: ДиМакс.]

Tilkov, D. (1983). Izsledvania varhu balgarskia ezik. Sofia: Nauka i izkustvo. [Тилков, Д. (1983). Изследвания върху българския език. София: Наука и изкуство.]

van Dun, K., De Witte, E., Van Daele, W., Van Hecke, W., Manto, M. & Mariën, P. (2015). Atypical cerebral and cerebellar language organisation: A case study. Cerebellum & Ataxias, 2 (1), 18. https://doi.org/10.1186/s40673-015-0036-9

Vigneau, M., Beaucousin, V., Hervé, P. Y., Jobard, G., Petit, L., Crivello, F., Mellet, E., Zago, L., Mazoyer, B. & Tzourio-Mazoyer, N. (2011). What is right-hemisphere contribution to phonological, lexico-semantic, and sentence processing? Insights from a meta-analysis. NeuroImage, 54 (1), 577–593. https://doi.org/10.1016/j.neuroimage.2010.07.036

Woollams, A. M. (2013). Connectionist neuropsychology: Uncovering ultimate causes of acquired dyslexia. Philosophical Transactions of the Royal Society B: Biological Sciences, 369 (1634), 20120398. https://doi.org/10.1098/rstb.2012.0398

Xing, S., Lacey, E. H., Skipper-Kallal, L. M., Jiang, X., Harris-Love, M. L., Zeng, J. & Turkeltaub, P. E. (2018). Right hemisphere grey matter structure and language outcomes in chronic left hemisphere stroke. Brain, 141 (1), 326–341. https://doi.org/10.1093/brain/awx295

Yuan, B., Jin, Y., Zhang, Z., Song, Z. & Liu, Y. (2025). Identifying phonological and lexico-semantic dimensions in post-stroke subcortical aphasia: A data-driven approach. Frontiers in Neurology, 16, Article 1630365. https://doi.org/10.3389/fneur.2023.1630365

Zhang, M., Gao, J., Xie, B., Mak, H. K. F. & Cheung, R. T. F. (2021). Evaluation of the cognitive performance of hypertensive patients with silent cerebrovascular lesions. Journal of Visualized Experiments, (170), e61017. https://doi.org/10.3791/61017

Zhu, W., Huang, H., Yang, S., Luo, X., Zhu, W., Xu, S., Meng, Q., Zuo, C., Liu, Y., Wang, W. & Alzheimer’s Disease Neuroimaging Initiative. (2021). Cortical and subcortical grey matter abnormalities in white matter hyperintensities and subsequent cognitive impairment. Neuroscience Bulletin, 37 (6), 789–803. https://doi.org/10.1007/s12264-021-00657-0

Downloads

Published

2026-03-11