Words fail: Lesion-symptom mapping of errors of omission in post-stroke aphasia

Impaired object naming is a core deficit in post-stroke aphasia, which can manifest as errors of commission – producing an incorrect word or a non-word – or as errors of omission – failing to attempt to name the object. Detailed behavioural, computational, and neurological investigations of errors of commission have played a key role in the development of neurocognitive models of word production. In contrast, the neurocognitive basis of omission errors is radically underspecified despite being a prevalent phenomenon in aphasia and other populations. The prevalence of omission errors makes their neurocognitive basis important for characterizing an individual's deficits and, ideally, for personalizing treatment and evaluating treatment outcomes. This study leveraged established relationships between lesion location and errors of commission to investigate omission errors in picture naming. Omission error rates from the Philadelphia Naming Test for 123 individuals with post-stroke aphasia were analysed using support vector regression lesion-symptom mapping. Omission errors were most strongly associated with left frontal and mid-anterior temporal lobe lesions. Computational model analysis further showed that omission errors were positively associated with impaired semantically driven lexical retrieval rather than phonological retrieval. These results suggest that errors of omission in aphasia predominantly arise from lexical–semantic deficits in word retrieval and selection from a competitor set.