BACKGROUND: and objectives. Several cognitive event-related potential (ERP) components such as mismatch negativity, P300, N400, and the late positive component (LPC) have been studied in aphasia. The aim of this study was to determine whether a modified semantic incongruity paradigm can serve as a more graded differentiation of ERP changes in patients with mild versus severe comprehension deficits. METHODS: A total of 20 aphasic patients with minor and severe comprehension deficits and 20 young and elder healthy controls were examined while reading 4-word sentences ending in a semantically congruent or noncongruent word. RESULTS: In contrast to young controls and to patients with mild comprehension deficits, aphasic patients with severe comprehension deficits exhibit an early positivity in the time window from 200 to 400 milliseconds and no N400 after the presentation of nonrecurrent semantically incongruent words. Patients with mild comprehension deficits were found to have an N400 with prolonged latency in comparison with the controls. An age effect in the control groups was detected as well. DISCUSSION: Semantic access and integration are performed differently in aphasic subjects with severe comprehension deficits. These differences in lexical-semantic processing must be taken into account in rehabilitation approaches that aim to improve comprehension deficits. Moreover, the findings may contribute to the design of therapy studies by employing a physiological measure that can discriminate among patients at baseline and at the end of an intervention.