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Assessing the elusive cognitive deficits associated with ventromedial prefrontal damage: A case of a modern-day Phineas Gage

Published online by Cambridge University Press:  01 May 2004

M. ALLISON CATO ,
DEAN C. DELIS ,
TRACY J. ABILDSKOV  and
ERIN BIGLER
M. ALLISON CATO
Affiliation:
San Diego Veteran Affairs Healthcare System and University of California, San Diego, School of Medicine, San Diego, California Department of Clinical and Health Psychology and Malcom Randall VA RR&D Brain Rehabilitation Research Center, University of Florida, Gainesville, Florida
DEAN C. DELIS
Affiliation:
San Diego Veteran Affairs Healthcare System and University of California, San Diego, School of Medicine, San Diego, California
TRACY J. ABILDSKOV
Affiliation:
Department of Psychology, Brigham Young University, Provo, Utah
ERIN BIGLER
Affiliation:
Department of Psychology, Brigham Young University, Provo, Utah
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Abstract

Cognitive deficits following ventromedial prefrontal damage (VM-PFD) have been elusive, with most studies reporting primarily emotional and behavioral changes. The present case illustrates the utility of a process approach to assessing cognitive deficits following VM-PFD. At age 26, C.D. acquired bilateral VM-PFD, more so in the left frontal region, following a penetrating head injury. Despite exemplary premorbid academic and military performances, his subsequent history suggests dramatic occupational and social changes, reminiscent of Phineas Gage. In fact, lesion analysis revealed similar structural damage to that estimated of Gage. C.D.'s scores on the vast majority of neuropsychological measures were average to superior (e.g., Verbal IQ = 119). However, on several new process measures, particularly those that quantify error rates on multilevel executive function and memory tasks, C.D. exhibited marked impairments. From his pattern of deficits, C.D. appeared to sacrifice accuracy for speed and to adopt liberal response strategies, implicating problems with cognitive inflexibility, impulsivity, and disinhibition. The current findings suggest that VM-PFD may be associated with a wider spectrum of cognitive deficits than previously characterized. (JINS, 2004, 10, 453–465.)

Keywords

Ventromedial prefrontal cortexExecutive functionsTraumatic brain injury

Information

Type
CASE STUDY
Information
Journal of the International Neuropsychological Society , Volume 10 , Issue 3 , May 2004 , pp. 453 - 465
Copyright
© 2004 The International Neuropsychological Society

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References

REFERENCES

Angrilli, A., Palomba, D., Cantagallo, A., Maietti, A., & Stegagno, L. (1999). Emotional impairment after right orbitofrontal lesion in a patient without cognitive deficits. NeuroReport, 10, 1741–1746.CrossRefGoogle Scholar
Barch, D.M., Braver, T.S., Nystrom, L.E., Forman, S.D., Noll, D.C., & Cohen, J.D. (1997). Dissociating working memory from task difficulty in human prefrontal cortex. Neuropsychologia, 35, 1373–1380.CrossRefGoogle Scholar
Bechara, A., Damasio, A.R., Damasio, H., & Anderson, S.W. (1994). Insensitivity to future consequences following damage to human prefrontal cortex. Cognition, 50, 7–15.CrossRefGoogle Scholar
Bechara, A., Damasio, H., Tranel, D., & Anderson S.W. (1998). Dissociation of working memory from decision making within the human prefrontal cortex. Journal of Neuroscience, 18, 428–437.CrossRefGoogle Scholar
Bechara, A., Damasio, H., & Damasio, A.R. (2000). Emotion, decision making and the orbitofrontal cortex. Cerebral Cortex, 10, 295–307.CrossRefGoogle Scholar
Brickner, R.M. (1936). The intellectual functions of the frontal lobes: A study based upon observation of a man after partial bilateral frontal lobectomy. New York: The Macmillan Company.
Chao, L. & Knight, R.T. (1998). Contribution of human prefrontal cortex to delay performance. Journal of Cognitive Neuroscience, 10, 167–177.CrossRefGoogle Scholar
Crosson, B., Barco, P.P., Velozo, C.A., & Bolesta, M.M. (1989). Awareness and compensation in postacute head injury rehabilitation. Journal of Head Trauma Rehabilitation, 4, 46–54.CrossRefGoogle Scholar
Damasio, A.R. (1994). Descartes' error: Emotion, reason, and the human brain. New York: Grosset/Putnam.
Damasio, A.R. (1995). On some functions of the human prefrontal cortex. New York: New York Academy of Sciences.
Damasio, H. & Damasio, A.R. (1989). Lesion analysis in neuropsychology. New York: Oxford University Press.
Damasio, H., Grabowski, T., Frank, R., Galaburda, A.M., & Damasio, A.R. (1994). The return of Phineas Gage: Clues about the brain from the skull of a famous patient. Science, 264, 1102–1105.CrossRefGoogle Scholar
Delis, D., Kaplan, E., & Kramer, J. (2001) Delis-Kaplan Executive Function System manual. San Antonio, Texas: The Psychological Corporation.
Delis, D.C. & Jacobson, M. (2000). Neuropsychological testing. Encyclopedia of Psychology. New York: Oxford University Press and the American Psychological Association.
Delis, D.C., Kramer, J.H., Kaplan, E., & Ober, B.A. (2000). California Verbal Learning Test–Second Edition, Adult Version manual. San Antonio, Texas: The Psychological Corporation.
Dimitrov, M., Phipps, M., Zahn, T.P., & Grafman, J. (1999). A thoroughly modern Gage. Neurocase, 5, 345–354.CrossRefGoogle Scholar
Eslinger, P.J. & Damasio, A.R. (1985). Severe disturbance of higher cognition after bilateral frontal lobe ablation: Patient EVR. Neurology, 35, 1731–1741.CrossRefGoogle Scholar
Fleischman, J. (2002). Phineas Gage: A gruesome but true story about brain science. New York: Houghton Mifflin Co.
Fuster, J.M. (2000). Prefrontal neurons in networks of executive memory. Brain Research Bulletin, 52, 331–336.CrossRefGoogle Scholar
Goldman-Rakic, P.S. & Leung, H. (2002). Functional architecture of the dorsolateral prefrontal cortex in monkeys and humans. In D.T. Stuss & R.T. Knight (Eds.), Principles of frontal lobe function (pp. 85–95). London: Oxford University Press.
Goldstein, K. (1944). The mental changes due to frontal lobe damage. Journal of Psychology, 17, 187–208.CrossRefGoogle Scholar
Goldstein, K. & Scheerer, M. (1941). Abstract and concrete behavior: An experimental study with special tests. Psychological Monographs, 53, 151.CrossRefGoogle Scholar
Harlow, J.M. (1848). Passage of an iron rod through the head. Boston Medical Surgery Journal, 39, 389–393.Google Scholar
Heaton, R.K., Chelune, G.J., Talley, J.L., Kay, G.G., & Curtiss, G. (1993). Wisconsin Card Sorting Test manual. Odessa, Florida: Psychological Assessment Resources, Inc.
Hebb, D.O. (1945). Man's frontal lobes. Archives of Neurology and Psychiatry, 54, 10–24.CrossRefGoogle Scholar
Hebb, D.O. & Penfield, W. (1940). Human behavior after extensive bilateral removal from the frontal lobes. Archives of Neurology and Psychiatry, 43, 421–438.CrossRefGoogle Scholar
Kaplan, E. (1988). A process approach to neuropsychological assessment. In T. Boll & B.K. Bryant (Eds.), The Master lecture series: Vol. 7. Clinical neuropsychology and brain function: Research, measurement, and practice (pp. 127–167). Washington, DC: American Psychological Association.
Luria, A.R. (1969). Brain research and human behavior. Hygiene Mentale, 58, 1–19.Google Scholar
Luria, A.R. & Majovski, L.V. (1977). Basic approaches used in American and Soviet clinical neuropsychology. American Psychologist, 32, 959–968.CrossRefGoogle Scholar
MacMillan, M. (2000). An odd kind of fame: Stories of Phineas Gage. Cambridge: Cambridge University Press.
Milberg, W.P., Hebben, N., & Kaplan, E. (1996). The Boston process approach to neuropsychological assessment. In I. Grant & K. M. Adams (Eds.), Neuropsychological assessment of neuropsychiatric disorders (2nd ed., pp. 58–80). New York: Oxford University Press.
Nauta, W.J.H. (1971). The problem of the frontal lobe: A reinterpretation. Journal of Psychiatric Research, 8, 167–187.CrossRefGoogle Scholar
Öngür, D. & Price, J.L. (2000). The organization of networks within the orbital and medial prefrontal cortex of rats, monkeys and humans. Cerebral Cortex, 10, 206–219.CrossRefGoogle Scholar
Rasband, W. (1996). IMAGE (Version 1.60). Washington D.C.: National Institute of Health.
Regard, M., Strauss, E., & Knapp, P. (1982). Children's production on verbal and non-verbal fluency tasks. Perceptual and Motor Skills, 55, 839–844.CrossRefGoogle Scholar
Robb, R.A. (2001). ANALYZE: The biomedical imaging resource at Mayo Clinic. IEEE Transactions on Medical Imaging, 20, 854–867.CrossRefGoogle Scholar
Rolls, E.T., Hornak, J., Wade, D., & McGrath, J. (1994). Emotion-related learning in patients with social and emotional changes associated with frontal lobe damage. Journal of Neurology, Neurosurgery, and Psychiatry, 57, 1518–1524.CrossRefGoogle Scholar
Ruff, R.M., Light, R.H., & Evans, R.W. (1987). The Ruff Figural Fluency Test: A normative study with adults. Developmental Neuropsychology, 3, 37–51.CrossRefGoogle Scholar
Teuber, H.L. (1968). Disorders of memory following penetrating missile wounds of the brain. Neurology, 18, 287–288.Google Scholar
Teuber, H.L. & Weinstein, S. (1954). Performance on a formboard task after penetrating brain injury. Journal of Psychology, 38, 177–190.CrossRefGoogle Scholar
Toglia, J. & Kirk, U. (2000). Understanding awareness deficits following brain injury. NeuroRehabilitation, 15, 57–70.Google Scholar
Tranel, D. (2002). Emotion, decision making, and the ventromedial prefrontal cortex. In D.T. Stuss & R.T. Knight (Eds.), Principles of frontal lobe function (pp. 338–352). London: Oxford University Press.
Wechsler, D. (1997). Wechsler Adult Intelligence Scale–Third Edition and Wechsler Memory Scale–Third Edition technical manual. San Antonio, Texas: The Psychological Corporation.
Wechsler, D. (1999). Wechsler Abbreviated Scale of Intelligence manual. San Antonio, TX: The Psychological Corporation.
White, R.F. & Rose, F.E. (1997). The Boston process approach: A brief history and current practice. In G. Goldstein & T.M. Incagnoli (Eds.), Contemporary approaches to neuropsychological assessment. Critical issues in neuropsychology (pp. 171–211). New York: Plenum Press.
Wilkinson, G.S. (1993). The Wide Range Achievement Test–Third Edition administration manual. Wilmington, Delaware: Wide Range, Inc.