Executive functions after orbital or lateral prefrontal lesions: neuropsychological profiles and self-reported executive functions in everyday living.
OBJECTIVE
This study examined the effects of chronic focal lesions to the lateral prefrontal cortex (LPFC) or orbitofrontal cortex (OFC) on neuropsychological test performance and self-reported executive functioning in everyday living.


METHODS
Fourteen adults with OFC lesions were compared to 10 patients with LPFC injuries and 21 healthy controls. Neuropsychological tests with emphasis on measures of cognitive executive function were administered along with the Behavior Rating Inventory of Executive Functions (BRIEF-A) and a psychiatric screening instrument.


RESULTS
The LPFC group differed from healthy controls on neuropsychological tests of sustained mental effort, response inhibition, working memory and mental switching, while the BRIEF-A provided more clinically important information on deficits in everyday life in the OFC group compared to the LPFC group. Correlations between neuropsychological test results and BRIEF-A were weak, while the BRIEF-A correlated strongly with emotional distress.


CONCLUSIONS
It was demonstrated that LPFC damage is particularly prone to cause cognitive executive deficit, while OFC injury is more strongly associated with self-reported dysexecutive symptoms in everyday living. The study illustrates the challenge of identifying executive deficit in individual patients and the lack of strong anatomical specificity of the currently employed methods. There is a need for an integrative methodological approach where standard testing batteries are supplemented with neuropsychiatric and frontal-specific rating scales.
Sunnaas Rehabilitation Hospital, Norway. marianne.lovstad@sunnaas.no
M
M
Løvstad
I
I
Funderud
T
T
Endestad
P
P
Due-Tønnessen
T R
TR
Meling
M
M
Lindgren
R T
RT
Knight
A K
AK
Solbakk
D000203:Activities of Daily Living; D000328:Adult; D000704:Analysis of Variance; D001930:Brain Injuries / Q000453:epidemiology / Q000503:physiopathology* / Q000523:psychology; D003072:Cognition Disorders / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology* / Q000523:psychology; D056344:Executive Function; D005260:Female; D005625:Frontal Lobe / Q000293:injuries* / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D009664:Norway / Q000453:epidemiology; D017397:Prefrontal Cortex / Q000293:injuries / Q000503:physiopathology; D057566:Self Report