Automated language impairment screening in acute stroke using connected speech

Connected speech is essential for everyday communication, but clinical constraints and patient fatigue limit detailed evaluation in acute stroke (<1-week post-stroke). Bedside assessments may sample discourse but rarely quantify language impairment (LI) in connected speech, leaving patient communication poorly characterized. We analyzed brief story retellings from 86 patients with left-hemisphere stroke (~4 days post-stroke; 63 classified with LI using composite clinical and naming criteria). From transcripts generated with automatic speech recognition, we derived discrete linguistic features and embeddings with Large Language Models (LLMs). An ensemble of embedding-based classifiers distinguished patients with and without LI with 90% balanced accuracy (79% sensitivity, 100% specificity), outperforming independent embedding and discrete-linguistic-based classifiers, showing distinct LLMs contributed complementary information. Adding the discrete-linguistic-based classifier to the ensemble did not improve balanced accuracy but modestly increased sensitivity at the expense of specificity. We provide proof of concept for a fast, largely automated discourse screener of acute LI.