Extra-Linguistic Cognitive Functions Involved in the Token Test: Results from a Cohort of Non-Aphasic Stroke Patients with Right Hemisphere Lesion

Abstract

Background: The Token Test (TT) is widely used to examine comprehension disorders in aphasic patients, but abilities other than language may affect a patient’s performance. This study aims to explore the correlation between the TT subtest performances and the performances in extra-linguistic cognitive areas in a cohort of patients from the Intensive Rehabilitation Post-Stroke (RIPS) study with a first, right hemisphere stroke and without aphasia, prospectively enrolled at admission to intensive inpatient post-acute rehabilitation. Methods: The patients were administered the TT (50-item version), the forward and backward digit span (DST), and the Montreal Cognitive Assessment (MoCA). Spearman’s partial correlations adjusted by age were used to evaluate the association between the number of errors in the TT and the other tests’ corrected scores. Results: Of the 37 patients enrolled in this study, 29.7% made 3–11 errors on the TT, 27.0% more than 11 errors, mostly in parts IV and V. The forward and backward digit span scores showed correlations with errors in part V of the TT (r = −0.408, p = 0.013; r = −0.307, p = 0.027). The errors in part IV of the TT presented a correlation with a forward digit span too (r = −0.394, p = 0.017). With respect to MoCA domains, executive functioning, and orientation were related to the TT part V errors (r = −0.468, p = 0.007; r = −0.499, p = 0.003). The orientation also correlated with the TT part III (r = −0.504, p = 0.002). Conclusion: Our findings show that the TT performances in patients with right hemisphere stroke and without aphasia are related to impairments in auditory–verbal span/auditory working memory mostly for TT scores on subpart V as measured by the DST and to executive function and orientation, as measured by the MoCA subtests.

Differential contribution of language and executive functioning to verbal fluency performance in glioma patients

“…The Token Test assesses language comprehension and determines the presence and severity of aphasia. However, it is not a pure measure of language, since executive functioning processes such as working memory also contribute to test performance (Basagni et al., 2022). This result seems to indicate that working memory is more involved in letter fluency than in category fluency.…”

Cognitive training incorporating temporal information processing improves linguistic and non-linguistic functions in people with aphasia

“…Additionally, Oron et al 61 documented a link between millisecond TIP and sentence comprehension. They emphasised that decoding the meaning of complex sentences requires high working memory load 40 , 62 , 63 . This is also in line with studies showing the amelioration of sentence comprehension following working memory training in PWA 41 , 42 , 44 .…”

The Telephone Language Screener (TLS): standardization of a novel telephone-based screening test for language impairment

“…Third, as is the case for the Token Test from which it takes inspiration, the CML too taps into multiple, extra-linguistic cognitive functions [ 78 ]. Indeed, the performance on the Token Test not only depends on the integrity of the morpho-syntactic component, but also on phonological working memory/verbal short-term memory and executive functions [ 79 ]. Hence, CML scores need to be interpreted along with the performance on the BDS-T/-WM: in the presence of a defective performance on both the CML and the BDS-T/-WM, examiners should not confidently conclude on the presence of morpho-syntactic deficits.…”