Detecting post-stroke aphasia using EEG-based neural envelope tracking of natural speech

[Objective]. After a stroke, one-third of patients suffer from aphasia, a language disorder that impairs communication ability. The standard behavioral tests used to diagnose aphasia are time-consuming and have low ecological validity. Neural tracking of the speech envelope is a promising tool for investigating brain responses to natural speech. The speech envelope is crucial for speech understanding, encompassing cues for processing linguistic units. In this study, we aimed to test the potential of the neural envelope tracking technique for detecting language impairments in individuals with aphasia (IWA). [Approach]. We recorded EEG from 27 IWA in the chronic phase after stroke and 22 controls while they listened to a story. We quantified neural envelope tracking in a broadband frequency range as well as in the delta, theta, alpha, beta, and gamma frequency bands using mutual information analysis. Besides group differences in neural tracking measures, we also tested its suitability for detecting aphasia using a Support Vector Machine (SVM) classifier. We further investigated the required recording length for the SVM to detect aphasia and to obtain reliable outcomes. [Results]. IWA displayed decreased neural envelope tracking compared to controls in the broad, delta, theta, and gamma band. Neural tracking in these frequency bands effectively captured aphasia at the individual level (SVM accuracy 84%, AUC 88%). High-accuracy and reliable detection could be obtained with 5-7 minutes of recording time. [Significance]. Our study shows that neural tracking of speech is an effective biomarker for aphasia. We demonstrated its potential as a diagnostic tool with high reliability, individual-level detection of aphasia, and time-efficient assessment. This work represents a significant step towards more automatic, objective, and ecologically valid assessments of language impairments in aphasia.