A novel anatomo-functional aphasia screening (D-AFAS) for patients with left-hemispheric brain lesions ​

Language arises from distributed cortical regions interconnected by white-matter pathways. We aimed to develop an anatomo-functional language assessment for perioperative clinical evaluation. The Dresden Anatomo-Functional Aphasia Screening (D-AFAS) is a time-efficient language assessment comprising 43 subtests that was assessed in 79 patients with left-hemispheric lesions involving the language network. Subtest performance was analyzed in relation to cortical lobe involvement and disruption of major language-related white-matter tracts using diffusion tensor imaging tractography. Primarily expressive subtests such as phonemic fluency, tongue twisters, nonword spelling, and working memory sequences were most vulnerable, whereas predominantly receptive subtests such as phonological and semantic judgment, picture recognition, and word reading were relatively preserved. At the tract level, the lowest AFAS total scores were observed with involvement of the arcuate fasciculus and inferior fronto-occipital fasciculus. Inferior and middle longitudinal fasciculi showed intermediate effects with selective disorders in naming, semantic-driven tasks and reading. The uncinate fasciculus and frontal aslant tract were associated with more selective deficits like reduced performance in speech initiation and sentence construction in FAT- and unique-naming disorders in UF-involvement. Parietal and insular lesion involvement was linked to greater overall language impairment than frontal or temporal lesions. Comparing all multimodal subtests, linear regression analyses demonstrated strongest associations between AFAS total score and picture description and picture naming. Overall, these findings emphasize the dominant contribution of major white-matter pathways to language function and support the D-AFAS as a structured framework for perioperative network-level language assessment.