Differential impairments in irony comprehension in brain-damaged individuals: Insight from contextual processing, theory of mind and executive functions

<b>Objective</b>: The comprehension of irony can be affected after brain injuries. The cognitive mechanisms accounting for such disorders remain yet unclear. The heterogeneity of cognitive profiles of brain-damaged individuals and the use of independent tests to measure the links between these mechanisms and the comprehension of irony might contribute to this lack of clarity. The present study aimed to further explore the underlying mechanisms of irony understanding disorders (i.e., context processing, executive functions (EF), and theory of mind (ToM)) in patients with brain lesions. <br> <b>Method</b>: We used a paradigm manipulating these mechanisms within an irony task to identify different patterns of pragmatic performance associated with cognitive profiles. We administered this task and standard neuropsychological tests assessing EF, and ToM to thirty acquired brain injured (ABI) and thirty healthy control (HC) participants. <br> <b>Results</b>: A cluster analysis revealed that two-thirds of the ABI participants (3 sub-groups out of 4) presented atypical pragmatic and neuropsychological patterns. The most severe disturbances in understanding irony, characterized by insensitivity to the context, were associated with a joint impairment on ToM and EF in one subgroup. In the two other context-sensitive subgroups, an isolated deficit in EF co-occurred with difficulties dealing with literal or ironic statements when the EF demand of the irony task was increased. However, the effect of this EF demand could be negated by the presence of markers helping the comprehension of irony. <br> <b>Conclusions</b>: These results have important clinical implications for the evaluation and therapy of pragmatic disorders in ABI individuals.