Title: Neuropsychological Functions of the prefrontal cortex
1Neuropsychological Functions of the prefrontal
cortex
2Overview
- Prefrontal executive function
- Regional prefrontal syndromes
- Neuropsychological assessment of prefrontal
syndromes
3The prefrontal lobe as the seat of the highest
human mentality
- Phylogenetic perspective
- Ontogenetic perspective
- Anatomical perspective
- Neuropsychological perspective
4Phylogenetic perspective Species differences in
prefrontal cortex
5Ontogenetic perspectiveLate maturation of
prefrontal cortex
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6Anatomical perspective Extensive prefrontal
lobe connections
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7Neuropsychological perspectivePhineas Gage
(accident in 1848)
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8Prefrontal function Early descriptions
- Personality (Harlow, 1868)
- Abstract attitude (Goldstein, 1927)
- Mental set (Jacobsen, 1935)
- Self-regulation (Luria, 1962)
- Concept formation (Milner, 1964)
9Prefrontal function Recent descriptions
- Supervisory mental process
- Cognitive flexibility
- Meta-cognition
- Goal-directed behavior
- Executive function
10An example of an executive
11A model of prefrontal executive function
Memory
Executive Function
Language
Spatial Pr
Attention
12The regional prefrontal syndromes(Cummings, 1985)
Dorsolateral
Orbitofrontal
Mesial frontal
13Core hypotheses
Anatomical area Function Syndrometype
Dorsolateral Cognition Disorganized
Orbitofrontal Emotion Disinhibited
Mesial frontal Motivation Apathetic
14Dorsolateral syndrome(Disorganized type)
- Poor judgment
- Concrete thinking
- Lack of insight
- Poor planning
- cognitive inflexibility
15Orbitofrontal syndrome (Disinhibited type)
- Social misbehavior
- Poor impulse control
- Emotional lability
- Hypersexuality
- Stimulus-driven behavior
16Mesial frontal syndrome (Apathetic type)
- Poor initiative
- Diminished verbal output motor behavior
- Akinetic mutism
- Urinary incontinence
17Neuropsychological assessment of prefrontal
syndromes Overview
- WAIS Poor sensitivity
- MMPI Poor response validity
- Specialized tests are needed
- EXIT (EXecutive Intelligence Test)
- (Kim, 2001)
18EXIT (EXecutive Intelligence Test)
- Norm 1619, 2024, 2534, 3544, 4554,
5564 yrs - Adm time 25 minutes
- Score EIQ (Executive IQ)
- Subtests Stroop test
- Verbal fluency Design fluency
- Rey AVLT
19Stroop test
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20Verbal fluency
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21Design fluency
22Rey AVLT
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23Core features of EXIT as a psychometric
instrument
- Multi-task approach
- Unstructured testing
- Use of control tests
- Qualitative scoring
- Normative M100, SD15
24The rationale for prefrontal pathology in
schizophrenia
- Disorganized thinking, speech, behavior
- Disordered dopamine systems
- Prefrontal metabolic deficit
25A validity study of EXIT
- Sample Schizophrenic pts n45
- Normal controls n27
- Measure WAIS VIQ, PIQ, FIQ
- EXIT EIQ
- Hypothesis Largest group-difference in EIQ
26Schizophrenic pts vs Normal controls
27Case 1 Frontal head injury
- Male, 29 yrs
- Policeman
- Car accident 6 months ago
- Personality deteriorationDisorganized
behavior
28Case 2 Parkinsons disease
- Female, 63 yrs
- Housewife
- Parkinson-like symptom onset 3.5 yrs ago
- Progressive deterioration
29Case 3 Korsakoffs disease
- Female, 39 yrs
- Housewife
- Heavy alcohol ingestion during last 4 yrs
- Physical weaknessMental confusion
30Case 4 Carbon monoxide poisoning
- Male, 36 yrs
- Unemployed
- Heart attack 6 months ago
- RestlessnessStimulus-driven behavior
31Summary
- Prefrontal lobe as the central executive
- 3 types of regional prefrontal syndromes
- EXIT (EXecutive Intelligence Test)