Document Type

Article

Abstract

Aphasia severity after stroke varies widely and is not fully explained by lesion size or location. We propose that incorporating the brain’s sensorimotor-association (S-A) gradient, reflecting cortical hierarchy, offers a biologically grounded framework for predicting language outcomes. In 236 individuals with chronic left-hemisphere stroke, we examine whether the hierarchical position of lesions in language-specific (LS) and domain-general (DG) areas modulates aphasia severity. We parcellate lesions using a cortical atlas and weigh them by each region’s S-A rank. We apply hierarchical linear regression to test whether S-A ranking and its interaction with lesion volume improves prediction of Western Aphasia Battery-Revised Aphasia Quotient (WAB-R-AQ) scores. Across models, lesion volume in lower S-A regions is more detrimental than in higher-order areas. The LS-only model yields the highest explanatory power (adjusted R2 = 0.426). These findings reveal that cortical hierarchy shapes post-stroke language outcomes and should be considered in future models of aphasia recovery.

Digital Object Identifier (DOI)

https://doi.org/10.1038/s42003-025-09375-z

Rights

© The Author(s) 2026

This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s CreativeCommons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit https://creativecommons.org/licenses/by-nc/4.0/.

APA Citation

Rangus, I., Busby, N., Riccardi, N., Kristinsson, S., Wilmskoetter, J., den Ouden, D. B., Rorden, C., Newman-Norlund, R., Fridriksson, J., & Bonilha, L. (2026). Cortical hierarchy and aphasia severity: the sensorimotor–association gradient modulates lesion effects within language-specific networks. Communications Biology, 9.https://doi.org/10.1038/s42003-025-09375-z

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