Journal of Neurolinguistics 48 (2018) 1–3

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Journal of Neurolinguistics
journal homepage: www.elsevier.com/locate/jneuroling

Short-term and working memory deficits in aphasia: Current issues

T
in theory, evidence, and treatment
Irene Minkinaa, Christos Salisb, Nadine Martina,∗
a
Temple University, USA
b
Newcastle University, UK

ABS TRA CT

In this article, we introduce a special issue of the Journal of Neurolinguistics that focuses on
current research in short-term and working memory impairment in aphasia. The papers are
summarized briefly and discussed with respect to their individual and collective contributions to
our understanding of the role of short-term and working memory processes in language and its
impairment in aphasia. The timeliness of the special issue is noted, as it sets the stage for future
work in this area.

Over the last several decades, there has been a steady rise in investigations that seek to elucidate the role of verbal short-term
memory (STM) and working memory (WM) in language processing in clinical and non-clinical populations. A subset of these studies
aims to understand the breakdown of verbal STM/WM after left-sided, stroke-induced aphasia, and consequently, the ways in which
these processes support language production and comprehension.
Historically, models of the relationship of verbal STM/WM and language fall into two groups, those that view the two processes as
largely separable (Baddeley, 2003; Shallice & Warrington, 1977; Warrington & Shallice, 1969) and those that conceptualize language
and STM/WM as intrinsically tied processes (Cowan, 2008; Craik & Lockhart, 1972; Saffran, 1990). Recent aphasia literature supports
this notion (for reviews, see Minkina, Rosenberg, Kalinyak-Fliszar, & Martin, 2017; Salis, Kelly, & Code, 2015). We know that strong
positive correlations exist between verbal short-term memory (STM) span (a measure of the temporary storage component of WM)
and performance on a wide variety of language production and comprehension tasks. Numerous studies have also shown a nearly
ubiquitous reduction of verbal STM span in individuals with aphasia, but not in healthy controls or in brain damaged individuals
without aphasia, demonstrating the specificity of verbal STM/WM impairment. Additionally, extant research has shown that word
retrieval and verbal STM span length tend to recover together after left hemisphere damage (Martin, Saffran, & Dell, 1996).
Studies of qualitative aspects of span performance in aphasia also indicate a close relationship between language and verbal STM/
WM. The locus of participants' errors on STM/WM span tasks (e.g., whether they err on words at the beginning or end of a word
string) relates to their language impairment type (e.g., more phonologically-driven versus more semantically-driven impairment).
These patterns indicate that the relationship between verbal STM/WM and language stems not only from how severely these pro-
cesses are impaired, but also from shared resources that support the activation of semantic and phonological representations needed
to perform both language and verbal WM tasks. Together, these studies demonstrate the intricate relationship between STM/WM and
language processing, which necessitate the need for continuation of both theoretical and clinically-based research on this topic.
The articles in this special issue contribute to our understanding of the complex relationship between language and verbal STM/
WM in several ways. The first group of articles investigates effects of short-term and working memory on several domains of language

∗
Corresponding author. Department of Communication Sciences and Disorders, Temple University, Weiss Hall, Room 110 1701 N. 13th Street Philadelphia, PA,
19122 USA.
E-mail address: nmartin@temple.edu (N. Martin).

https://doi.org/10.1016/j.jneuroling.2018.07.001
Received 17 June 2018; Accepted 1 July 2018
Available online 07 July 2018
0911-6044/ © 2018 Elsevier Ltd. All rights reserved.
I. Minkina et al. Journal of Neurolinguistics 48 (2018) 1–3

processing, including sentence and discourse processing. These domains naturally recruit considerable WM resources, as it is ne-
cessary for interlocutors to hold on to previously spoken information as well as information they intend to produce later in the course
of a conversation. Thus, it is not surprising that a sizeable number of articles in this special issue focus on sentence and discourse
processing in aphasia.
Varkanitsa and Caplan (2018) contribute a systematic review of 26 studies that investigated the association between STM/WM
and sentence comprehension in individuals with aphasia, with the addition of a meta-analysis of relevant studies published between
1980 and 2017. Murray (2018) contributes an empirical study of sentence comprehension, where both participants with aphasia and
neurologically healthy adults complete a sentence judgment task in a variety of conditions that differentially tax working memory
load. Murray investigates whether these conditions differentially impact performance. Interactions between the different working
memory conditions and psycholinguistic variables of the sentence stimuli are also explored. Finally, the author investigates whether
performance on various STM/WM measures is associated with a dual-task sentence judgment condition. Zakariás, Salis, and
Wartenburger (2018) present new data from a treatment study of WM that aimed to improve WM as well as spoken sentence
comprehension and aspects of functional communication in three German-speaking people with aphasia. All participants showed
improvement on at least one measure of spoken sentence comprehension and everyday memory activities. Two of them also showed
improvement on measures of WM and functional communication. Additionally, the authors discuss the issue of self-reported moti-
vation of participants in computerized treatments.
Several other contributors tackle questions about the relationship between WM and sentence production, a relationship that has
not been systematically investigated to the same extent as sentence comprehension in aphasia. Sung, Eom, and Lee (2018) manipulate
WM load in sentence production by varying task type (syntactic priming versus sentence completion), sentence type, and canonicity.
They ask how these differing task demands affect performance and whether these sentence production tasks relate to WM capacity in
individuals with aphasia and neurologically healthy controls. Yan, Martin, and Slevc (2018) also address the issue of syntactic
priming in individuals with aphasia and neurologically healthy controls, investigating whether syntactic priming behavior in both
groups is related to their verbal STM abilities. Finally, Cahana-Amitay and Jenkins (2018) investigate the relationship between WM
and discourse productions in individuals with aphasia, and how this relationship may be impacted by aphasia type. These six papers
are both related and diverse in nature, sharing a common interest in the influence of WM on language processing, but spanning
multiple linguistic domains (syntax and discourse processing) and encompassing both comprehension and production modalities.
A second group of papers uses a variety of approaches to tackle the question of domain specificity of WM impairments in
individuals with aphasia. This issue has resulted in equivocal findings in previous investigations, with some studies demonstrating
WM-language relationships only with verbal but not nonverbal WM tasks (e.g., De Renzi & Nichelli, 1975), and others demonstrating
relationships between nonverbal tasks and language performance (e.g., Harnish & Lundine, 2015). Thus, the inclusion of a group of
papers dealing with this topic is timely and warranted.
Kasselimis et al. (2018) investigate the issue of modality-dependent and independent WM impairments in aphasia using both
behavioral and neuroimaging approaches by obtaining test scores for both verbal and spatial working memory tasks as well as
structural imaging data from 54 participants. These techniques allow the authors to investigate the prevalence of verbal and spatial
working memory deficits in their participants, as well as to examine correlations between participants' working memory impairments
and their lesion profiles. In a related endeavor, Christensen, Wright, and Ratiu (2018) investigate spatial and verbal WM abilities in
individuals with aphasia and neurologically healthy control participants. The use of a diverse set of tasks (verbal and spatial n-back,
flanker arrow task, and forward digit and spatial span) sets the authors' methods apart from those of many STM/WM investigations
relying solely on span tasks. Finally, Paulraj, Schendel, Curran, Dronkers, and Baldo (2018) examine the role of the left hemisphere in
spatial working memory. The authors compare spatial working memory abilities in a group of individuals with left hemisphere
damage with aphasia and a group of non-aphasic individuals with left hemisphere damage in order to determine the extent to which
verbal processing supports spatial memory. Additionally, the authors use voxel-based lesion symptom mapping to identify left
hemisphere regions that contribute to spatial WM. Together, these three articles tackle the issue of domain-general and domain-
specific WM impairments in aphasia through diverse behavioral and neuroimaging techniques, and make a critical contribution to a
controversial and equivocal topic in the aphasia literature.
A third group of clinically driven articles tackles assessment and treatment of verbal STM/WM in aphasia, a new field of inquiry
that has grown considerably as our understanding of the role of WM in language increases. In a question directly related to the
aforementioned group of articles, Harnish, Schwen Blackett, Zezinka, Lundine, and Pan (2018) investigate the extent to which both
verbal and spatial working memory measures predict treatment generalization after therapy for anomia in aphasia. Their in-
vestigation informs both treatment of word retrieval deficits in aphasia and theoretical issues encompassing domain-specificity of
WM. Majerus (2018) reviews extant working memory treatments for aphasia, focusing on both near-transfer and far-transfer
treatment effects, and makes methodological recommendations for future WM treatment studies in order to increase their treatment
specificity and theoretical rigor. Finally, three articles described below, use innovative STM/WM assessment techniques to explore
the relationship between STM/WM and language processing in individuals with aphasia.
While previous investigations of verbal STM and WM in aphasia have largely relied on forward and backward span tasks (re-
petition of words or digits immediately after presentation), the assessment papers in this issue present us with new, multidimensional,
and more sensitive ways of measuring STM/WM in aphasia. Salis, Martin, Meehan, and McCaffery's (2018) investigation goes beyond
standard accuracy-based WM measures (i.e., word/digit span length) to examine speech-timing characteristics (e.g., response and
pause durations) of individuals with aphasia during word span tasks. This intricate investigation is a valuable compliment to the
many studies utilizing accuracy-based measures to elucidate the role of STM/WM in language processing and its breakdown. Kim,
Suleman, and Hopper (2018) use pupillometry to measure cognitive effort during a short-term memory task in individuals with

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I. Minkina et al. Journal of Neurolinguistics 48 (2018) 1–3

aphasia and neurologically healthy controls. They compare the groups on both accuracy and cognitive effort measures to obtain a
more holistic measure of STM performance. Like Salis et al., Kim et al. argue for the importance of going beyond accuracy-based STM
measures in order to better understand the role of STM in aphasia. Finally, Martin, Minkina, Kohen, and Kalinyak-Fliszar (2018)
report on a battery of STM and WM tasks (The Temple Assessment of Language and Short-Term Memory in Aphasia), including data
from 39 individuals with aphasia and 16 neurologically healthy controls. Like the previous two papers in the WM assessment group,
Martin et al. argue for a holistic STM measurement approach, offering a diverse set of tasks that span multiple language domains (e.g.,
semantic and phonological) and unique approaches to varying working memory load (e.g., varying stimulus-response delay or
varying delay between two stimuli being compared).
Together, this group of papers is both theoretically and clinically significant, tackling a challenging, enduring and yet timely topic
from multiple angles and spanning a diverse set of established and novel methodologies. The included papers show how far we have
come in our conceptualization of the influence of cognitive processes on language production and comprehension. We hope that the
content of this special issue will ignite further inquiry into the role of STM and WM in language processing, and inspire additional
investigations of the influences of STM/WM breakdown on language processing difficulties in individuals with aphasia.

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