Language comprehension in chronic aphasia relies on the language network, not the Multiple Demand network

Comprehension in chronic aphasia relies on the language network, not the Multiple Demand network | medRxiv Skip to main content Home About Submit ALERTS / RSS Search for this keyword Advanced Search Comprehension in chronic aphasia relies on the language network, not the Multiple Demand network View ORCID Profile Anne Billot , View ORCID Profile Maria Varkanitsa , Niharika Jhingan , Nicole Carvalho , Isaac Falconer , Hannah Small , Rachel Ryskin , Idan Blank , View ORCID Profile Evelina Fedorenko , Swathi Kiran doi: https://doi.org/10.64898/2026.03.16.26348460 Anne Billot 1 Massachusetts General Hospital, Department of Neurology , Boston, MA 02114, USA 2 Harvard Medical School , Boston, MA 02115, USA Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Anne Billot For correspondence: abillot{at}fas.harvard.edu kirans{at}bu.edu evelina9{at}mit.edu Maria Varkanitsa 3 Department of Speech, Language, and Hearing Sciences, Boston University , Boston, MA 02115, USA 4 Center for Brain Recovery, Boston University , Boston, MA 02115, USA Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Maria Varkanitsa Niharika Jhingan 5 Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology , Cambridge, MA 02139, USA 6 McGovern Institute for Brain Research, Massachusetts Institute of Technology , Cambridge, MA 02139, USA Find this author on Google Scholar Find this author on PubMed Search for this author on this site Nicole Carvalho 3 Department of Speech, Language, and Hearing Sciences, Boston University , Boston, MA 02115, USA Find this author on Google Scholar Find this author on PubMed Search for this author on this site Isaac Falconer 7 School of Medicine, Boston University , Boston, MA 02115, USA Find this author on Google Scholar Find this author on PubMed Search for this author on this site Hannah Small 8 Department of Cognitive Science, Johns Hopkins University , Baltimore, MD 21218, USA Find this author on Google Scholar Find this author on PubMed Search for this author on this site Rachel Ryskin 9 Department of Cognitive & Information Sciences, University of California Merced , Merced, CA 95343, USA Find this author on Google Scholar Find this author on PubMed Search for this author on this site Idan Blank 10 Department of Psychology and Department of Linguistics, University of California Los Angeles , Los Angeles, CA 90095, USA Find this author on Google Scholar Find this author on PubMed Search for this author on this site Evelina Fedorenko 5 Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology , Cambridge, MA 02139, USA 6 McGovern Institute for Brain Research, Massachusetts Institute of Technology , Cambridge, MA 02139, USA 11 Program in Speech and Hearing Bioscience and Technology, Harvard University , Boston, MA 02114, USA Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Evelina Fedorenko Swathi Kiran 3 Department of Speech, Language, and Hearing Sciences, Boston University , Boston, MA 02115, USA 4 Center for Brain Recovery, Boston University , Boston, MA 02115, USA Find this author on Google Scholar Find this author on PubMed Search for this author on this site For correspondence: abillot{at}fas.harvard.edu kirans{at}bu.edu evelina9{at}mit.edu Abstract Full Text Info/History Metrics Data/Code Preview PDF Abstract Post-stroke aphasia recovery has been proposed to be supported by two broad mechanisms: i) reorganization within the remaining components of the language network; and ii) recruitment of brain areas outside of the premorbid language network to assume language function post stroke. A key candidate for such network reorganization is the multiple demand (MD) network, which supports executive functions and is recruited for a wide range of cognitive tasks. A prominent hypothesis suggests that, when specialized language resources are no longer sufficient, this network supports linguistic processing while retaining its domain-general role. In this cross-sectional study, we used precision functional MRI to evaluate these two hypotheses in 37 individuals with chronic post-stroke aphasia, along with 38 age-matched controls. Language and MD networks were identified within individuals using functional localizer tasks. Participants with aphasia completed extensive behavioral assessments that evaluated linguistic and general cognitive skills. We examined responses during language processing in each of the two networks and related activity and functional connectivity measures from the two networks to linguistic ability. Our results do not support the hypothesis that language comprehension in chronic aphasia recruits parts of the MD network. First, the language and the MD networks remain robustly dissociated: the language network responds selectively to language across modalities, and no MD region shows increased responses to language comprehension in aphasia relative to controls. Second, functional connectivity analyses reveal no increased integration between the two networks during language comprehension. Third, linguistic ability is associated with the strength of activity within the language network, but not the MD network. Although we cannot rule out a role for the MD network in aphasia recovery during the acute or subacute phases, or in more severely impaired patients, it appears that during the chronic phase, language comprehension relies on the same specialized network as in healthy controls. Competing Interest Statement Swathi Kiran is an advisor and owns stock in Constant Therapy Health, a digital therapy company, but there is no scientific overlap with the work reported in this paper. Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: All participants gave written informed consent in accordance with the requirements of MIT Committee on the Use of Humans as Experimental Subjects (COUHES) and the Institutional Review Board of Boston University. The Massachusetts Institute of Technology Committee on the Use of Humans as Experimental Subjects (COUHES) and the Institutional Review Board (IRB) of Boston University approved the conduct of the study. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Footnotes ↵ † co-senior authors. This version of the manuscript has been revised to update the following: (1) the statistical models, which now include by-participant random slopes, with corrections for multiple comparisons applied consistently across analyses; (2) the brain-behavior analyses, restricted to participants whose behavioral testing was completed within 9 months of scanning (n = 33), with an updated neural principal component analysis, elastic net results and partial regression plots (Fig. 5); (3) new lateralization and spatial-overlap results; (4) a more complete description of the behavioral assessments and of the exploratory lesion-location analyses; and (5) corresponding revisions to the Results, Discussion, figures and supplementary material. The main conclusions are unchanged. Data Availability The data that support the findings of this study will be available on ResearchBox. Funder Information Declared National Institute on Deafness and Other Communication Disorders, https://ror.org/04mhx6838 , R01DC016950 Copyright The copyright holder for this preprint is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. It is made available under a CC-BY-NC-ND 4.0 International license . Back to top Previous Next Posted October 26, 2026. Download PDF Data/Code Email Thank you for your interest in spreading the word about medRxiv. NOTE: Your email address is requested solely to identify you as the sender of this article. Your Email * Your Name * Send To * Enter multiple addresses on separate lines or separate them with commas. You are going to email the following Comprehension in chronic aphasia relies on the language network, not the Multiple Demand network Message Subject (Your Name) has forwarded a page to you from medRxiv Message Body (Your Name) thought you would like to see this page from the medRxiv website. Your Personal Message CAPTCHA This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. Share Comprehension in chronic aphasia relies on the language network, not the Multiple Demand network Anne Billot , Maria Varkanitsa , Niharika Jhingan , Nicole Carvalho , Isaac Falconer , Hannah Small , Rachel Ryskin , Idan Blank , Evelina Fedorenko , Swathi Kiran medRxiv 2026.03.16.26348460; doi: https://doi.org/10.64898/2026.03.16.26348460 Share This Article: Copy Citation Tools Comprehension in chronic aphasia relies on the language network, not the Multiple Demand network Anne Billot , Maria Varkanitsa , Niharika Jhingan , Nicole Carvalho , Isaac Falconer , Hannah Small , Rachel Ryskin , Idan Blank , Evelina Fedorenko , Swathi Kiran medRxiv 2026.03.16.26348460; doi: https://doi.org/10.64898/2026.03.16.26348460 Citation Manager Formats BibTeX Bookends EasyBib EndNote (tagged) EndNote 8 (xml) Medlars Mendeley Papers RefWorks Tagged Ref Manager RIS Zotero Tweet Widget Facebook Like Google Plus One Subject Area Neurology Subject Areas All Articles Addiction Medicine (637) Allergy and Immunology (917) Anesthesia (348) Cardiovascular Medicine (4974) Dentistry and Oral Medicine (493) Dermatology (426) Emergency Medicine (674) Endocrinology (including Diabetes Mellitus and Metabolic Disease) (1682) Epidemiology (16207) Forensic Medicine (36) Gastroenterology (1238) Genetic and Genomic Medicine (7250) Geriatric Medicine (751) Health Economics (1092) Health Informatics (5262) Health Policy (1463) Health Systems and Quality Improvement (1825) Hematology (599) HIV/AIDS (1375) Infectious Diseases (except HIV/AIDS) (16466) Intensive Care and Critical Care Medicine (1199) Medical Education (696) Medical Ethics (156) Nephrology (747) Neurology (7552) Nursing (377) Nutrition (1120) Obstetrics and Gynecology (1293) Occupational and Environmental Health (1038) Oncology (3730) Ophthalmology (1087) Orthopedics (406) Otolaryngology (463) Pain Medicine (499) Palliative Medicine (143) Pathology (720) Pediatrics (1852) Pharmacology and Therapeutics (752) Primary Care Research (784) Psychiatry and Clinical Psychology (6099) Public and Global Health (9957) Radiology and Imaging (2515) Rehabilitation Medicine and Physical Therapy (1506) Respiratory Medicine (1264) Rheumatology (657) Sexual and Reproductive Health (799) Sports Medicine (595) Surgery (799) Toxicology (109) Transplantation (318) Urology (307)

Related documents

• Cortical Hierarchy and Aphasia Severity: The Sensorimotor–Association Gradient Modulates Lesion Effects Within Language-Specific Networks#295930
• Understanding and Improving Language Performance in Post-Stroke Aphasia with Machine Learning, Brain Networks, and Transcranial Magnetic Stimulation#929183
• Computerised Therapy in Chronic Stroke#979693
• A Combined Speech-Language and Counseling Intervention for Primary Progressive Aphasia: Acceptability, Feasibility, and Preliminary Outcomes.#288640
• Communication makes intensive language therapy more efficient: a randomized controlled trial in chronic post-stroke aphasia.#395817