Acquired aphasics and dyslexics with even very profound word reading impairments have been shown to perform relatively well on the lexical decision task (e.g., Buchanan, Hildebrandt, & MacKinnon, 1999), but direct contrasts with unimpaired participant's data is often complicated by extremely long reaction times for patient data. The dissociation between lexical decision and word naming performance shown by these patients is of theoretical importance, and here we present an analysis of processing underlying the lexical decision task. We are able to determine what aspects of performance are affected by acquired aphasics in the lexical decision task. We fit lexical decision data from aphasic patients and from normal readers with a sequential sampling model (the diffusion model; Ratcliff, 1978; Ratcliff, Van Zandt, & McKoon, 1999) that simultaneously considers reaction time and accuracy. This model provides a powerful means of assessing processes involved in impaired and unimpaired lexical decision. Our results suggest that lexical decision may tap impairments at both a linguistic and a nonlinguistic level. These impairments combine to make patients produce the exaggerated lexical decision reaction times typical of neurolinguistic patients: we demonstrate that patients have compromised decision and nondecision processes but that the quality of the information upon which they base their decisions is not much different from that of unimpaired participants.