title: Executive Dysfunction in Patients with Putaminal Hemorrhage.
abstract: BACKGROUND
  The frontal-subcortical circuits link the specific areas of the frontal cortex to the striatum, basal ganglia, and thalamus. Disruption of the frontal-subcortical circuits may lead to cognitive impairment with frontal lobe features. The putamen is a central component of frontal-subcortical circuits. Although putaminal lesions presumably lead to cognitive and behavioral changes, studies on frontal lobe dysfunctions after putaminal stroke are scarce. There are no previous studies that systematically examined frontal lobe functions with a focal putaminal lesion. The objective of this study is to demonstrate whether putaminal hemorrhage causes frontal lobe dysfunction.
  
  
  METHODS
  Cognitive functions, including various aspects of frontal lobe functions, were systematically assessed in 15 patients with left- or right-sided putaminal hemorrhage 2 months after the onset and compared with healthy controls.
  
  
  RESULTS
  Patients did not have signs of aphasia, apraxia, or spatial neglect. They performed significantly worse on tests of frontal lobe function, including Letter-Number Sequencing (U = 22, P < .001), lexical fluency (U = 30, P < .001), and motor series subtest (U = 45, P = .004) of the Frontal Assessment Battery. On the Wisconsin Card Sorting Test, patients performed significantly worse for "categories achieved" (U = 29.5, P < .001), "perseverative errors" (U = 25, P < .001), and "set loss" (U = 49, P = .008). None showed behavioral impairment.
  
  
  CONCLUSIONS
  Isolated putaminal hemorrhage causes modest frontal lobe dysfunction without behavioral symptoms. Our findings indicate that isolated putaminal hemorrhage disrupts the dorsolateral-striato-pallido-thalamic circuits and causes executive dysfunction.
authors.affiliation: Department of Psychology, Kobegakuin University, Kobe, Japan; Neurorehabilitation Research Institute, Morinomiya Hospital, Osaka, Japan; Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, Sendai, Japan. Electronic address: kokubo@human.kobegakuin.ac.jp.
authors.forename: Kae
authors.initials: K
authors.lastname: Kokubo
authors.affiliation: Department of Clinical Neuroscience, Yamagata University Graduate School of Medicine, Yamagata, Japan.
authors.forename: Kyoko
authors.initials: K
authors.lastname: Suzuki
authors.affiliation: Neurorehabilitation Research Institute, Morinomiya Hospital, Osaka, Japan.
authors.forename: Noriaki
authors.initials: N
authors.lastname: Hattori
authors.affiliation: Neurorehabilitation Research Institute, Morinomiya Hospital, Osaka, Japan.
authors.forename: Ichiro
authors.initials: I
authors.lastname: Miyai
authors.affiliation: Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, Sendai, Japan.
authors.forename: Etsuro
authors.initials: E
authors.lastname: Mori
mesh_terms: D000328:Adult; D003072:Cognition Disorders / Q000175:diagnosis* / Q000209:etiology*; D056344:Executive Function / Q000502:physiology*; D005260:Female; D007839:Functional Laterality; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D020146:Putaminal Hemorrhage / Q000150:complications*; D018709:Statistics, Nonparametric
keywords: Putaminal hemorrhage; Wisconsin Card Sorting Test; executive dysfunction; the frontal–subcortical circuits; working memory