title: Social cognition in patients following surgery to the prefrontal cortex.
abstract: Impaired social cognition, including emotion recognition, may explain dysfunctional emotional and social behaviour in patients with lesions to the ventromedial prefrontal cortex (VMPFC). However, the VMPFC is a large, poorly defined area that can be sub-divided into orbital and medial sectors. We sought to investigate social cognition in patients with discrete, surgically circumscribed prefrontal lesions. Twenty-seven patients between 1 and 12 months post-neurosurgery were divided into groups based on Brodmann areas resected, determined by post-surgical magnetic resonance imaging. We hypothesised that patients with lesions to the VMPFC (n=5), anterior cingulate cortex (n=4), orbitofrontal cortex (n=7) and dorsolateral prefrontal cortex (DLPFC, n=11) would perform worse than a control group of 26 extra-cerebral neurosurgery patients on measures of dynamic facial emotion recognition, theory of mind (ToM) and empathy. Results indicated the VMPFC-lesioned group performed significantly worse than the control group on the facial emotion recognition task overall, and for fear specifically, and performed worse on the ToM measure. The DLPFC group also performed worse on the ToM and empathy measures, but DLPFC lesion location was not a predictor of performance in hierarchical multiple regressions that accounted for other variables, including the reduced estimated verbal IQ in this group. It was concluded that isolated orbital or medial prefrontal lesions are not sufficient to produce impairments in social cognition. This is the first study to demonstrate that it is the combination of lesions to both areas that affect social cognition, irrespective of lesion volume. While group sizes were similar to other comparable studies that included patients with discrete, surgically circumscribed lesions to the prefrontal cortex, future large, multi-site studies are needed to collect larger samples and confirm these results.
authors.affiliation: Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Victoria, Australia; Department of Psychiatry, The University of Illinois at Chicago, Chicago, IL, USA. Electronic address: ljenkins@psych.uic.edu.
authors.forename: Lisanne Michelle
authors.initials: LM
authors.lastname: Jenkins
authors.affiliation: Melbourne Neuropsychiatry Centre, Psychiatry Department, The University of Melbourne, Parkville, Victoria, Australia.
authors.forename: David Gordon
authors.initials: DG
authors.lastname: Andrewes
authors.affiliation: Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Victoria, Australia.
authors.forename: Christian Luke
authors.initials: CL
authors.lastname: Nicholas
authors.affiliation: Department of Neurosurgery, The Royal Melbourne Hospital, Parkville, Victoria, Australia.
authors.forename: Katharine Jann
authors.initials: KJ
authors.lastname: Drummond
authors.affiliation: Department of Radiology, The Royal Melbourne Hospital, Parkville, Victoria, Australia.
authors.forename: Bradford Armstrong
authors.initials: BA
authors.lastname: Moffat
authors.affiliation: Department of Radiology, The Royal Melbourne Hospital, Parkville, Victoria, Australia.
authors.forename: Pramit
authors.initials: P
authors.lastname: Phal
authors.affiliation: Department of Radiology, The Royal Melbourne Hospital, Parkville, Victoria, Australia.
authors.forename: Patricia
authors.initials: P
authors.lastname: Desmond
authors.affiliation: Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, Nijmegen, The Netherlands; Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Roy Peter Caspar
authors.initials: RP
authors.lastname: Kessels
mesh_terms: D000328:Adult; D000368:Aged; D003072:Cognition Disorders / Q000523:psychology; D004644:Emotions / Q000502:physiology*; D004645:Empathy / Q000502:physiology*; D005149:Facial Expression; D005260:Female; D006179:Gyrus Cinguli / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D017397:Prefrontal Cortex / Q000503:physiopathology* / Q000601:surgery; D012938:Social Perception; D056345:Theory of Mind / Q000502:physiology*
keywords: Anterior cingulated; Orbitofrontal; Theory of mind; Ventromedial