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Fifty Years of Prefrontal Cortex Research: Impact on Assessment

  • Paul W. Burgess (a1) and Donald T. Stuss (a2) (a3) (a4)


Our knowledge of the functions of the prefrontal cortex, often called executive, supervisory, or control, has been transformed over the past 50 years. After operationally defining terms for clarification, we review the impact of advances in functional, structural, and theoretical levels of understanding upon neuropsychological assessment practice as a means of identifying 11 principles/challenges relating to assessment of executive function. Three of these were already known 50 years ago, and 8 have been confirmed or emerged since. Key themes over this period have been the emergence of the use of naturalistic tests to address issues of “ecological validity”; discovery of the complexity of the frontal lobe control system; invention of new tests for clinical use; development of key theoretical frameworks that address the issue of the role of prefrontal cortex systems in the organization of human cognition; the move toward considering brain systems rather than brain regions; the advent of functional neuroimaging, and its emerging integration into clinical practice. Despite these huge advances, however, practicing neuropsychologists are still desperately in need of new ways of measuring executive function. We discuss pathways by which this might happen, including decoupling the two levels of explanation (information processing; brain structure) and integrating very recent technological advances into the neuropsychologist’s toolbox. (JINS, 2017, 23, 755–767)


Corresponding author

Correspondence and reprint requests to: Donald T. Stuss, Sunnybrook Health Sciences Centre, 2075 Bayview Ave. Toronto, ON M4N 3M5. E-mail:


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Alexander, G.E., DeLong, M.R., & Strick, P.I. (1986). Parallel organization of functionally segregated circuits linking basal ganglia and cortex. Annual Review of Neuroscience, 9, 357381.
Alexander, M.P., Stuss, D.T., Picton, T., Shallice, T., & Gillingham, S. (2007). Regional frontal injuries cause distinct impairments in cognitive control. Neurology, 68, 15151523.
Alexander, M.P., Stuss, D.T., & Fansabedian, N. (2003). California verbal learning test: Performance by patients with focal frontal and non-frontal lesions. Brain, 126, 14931503.
Alexander, M.P., Stuss, D.T., Shallice, T., Picton, T.W., & Gillingham, S. (2005). Impaired concentration due to frontal lobe damage from two distinct lesion sites. Neurology, 65, 572579.
Anderson, C.V., Bigler, E.D., & Blatter, D.D. (1995). Frontal lobe lesions, diffuse damage, and neuropsychological functioning in traumatic brain-injured patients. Journal of Clinical and Experimental Neuropsychology, 17(6), 900908.
Baddeley, A.D. (1986). Working memory. Oxford: Clarendon Press.
Baddeley, A., Della Sala, S., Papagno, C., & Spinnler, H. (1997). Dual-task performance in dysexecutive and nondysexecutive patients with a frontal lesion. Neuropsychology, 11, 187194.
Badre, D. (2008). Cognitive control, hierarchy, and the rostro-caudal organization of the frontal lobes. Trends in Cognitive Sciences, 12, 193200. doi: 10.1016/j.tics.2008.02.004
Bechara, A., Damasio, H., Tranel, D., & Damasio, A.R. (2005). The Iowa Gambling Task and the somatic marker hypothesis: Some questions and answers. Trends in Cognitive Sciences, 9, 159162.
Benoit, R.G., Gilbert, S.J., Volle, E., & Burgess, P.W. (2010). When I think about me and simulate you: Medial rostral prefrontal cortex and self-referential processes. NeuroImage, 50, 13401349.
Benton, A.L. (1991). The prefrontal region: Its early history. In H.S. Levin, H.M. Eisenberg & A.L. Benton (Eds.), Frontal lobe function and dysfunction (pp 334). New York: Oxford University Press.
Burgess, P.W. (1997). Theory and methodology in executive function research. In P. Rabbitt (Ed.), Methodology of frontal and executive function (pp 81116). Hove, UK: Psychology Press.
Burgess, P.W., Alderman, N., Evans, J., Emslie, H., & Wilson, B.A. (1998). The ecological validity of tests of executive function. Journal of the International Neuropsychological Society, 4, 547558.
Burgess, P.W., Alderman, N., Volle, E., Benoit, R.G., & Gilbert, S.J. (2009). Mesulam’s frontal lobe mystery re-examined. Restorative Neurology and Neuroscience, 27, 493506.
Burgess, P.W., Alderman, N., Forbes, C., Costello, A., Coates, L., Dawson, D.R., & Channon, S. (2006). The case for the development and use of “ecologically valid” measures of executive function in experimental and clinical neuropsychology. Journal of the International Neuropsychological Society, 12, 116.
Burgess, P.W., Dumontheil, I., & Gilbert, S.J. (2007). The gateway hypothesis of rostral prefrontal cortex (area 10) function. Trends in Cognitive Sciences, 11, 290298.
Burgess, P.W., Gonen-Yaacovi, G., & Volle, E. (2011). Functional neuroimaging studies of prospective memory: What have we learnt so far? Neuropsychologia, 49, 22462257.
Burgess, P.W., Gonen-Yaacovi, G., & Volle, E. (2012). Rostral prefrontal cortex: What neuroimaging can learn from human neuropsychology. In B. Levine & F.I.M. Craik (Eds.), Mind and the frontal lobes: Cognition, behavior, and brain imaging (pp. 4792). New York: Oxford University Press.
Burgess, P.W., & Shallice, T. (1996a). Bizarre responses, rule detection and frontal lobe lesions. Cortex, 32, 241259.
Burgess, P.W., & Shallice, T. (1996b). Response suppression, initiation and strategy use following frontal lobe lesions. Neuropsychologia, 34, 263273.
Burgess, P.W., & Shallice, T. (1997). The Hayling and Brixton tests. Bury St. Edmunds, UK: Thames Valley Test Company.
Burgess, P.W., Veitch, E., Costello, A., and Shallice, T. (2000). The cognitive and neuroanatomical correlates of multitasking. Neuropsychologia, 38, 848863.
Burgess, P.W., & Wu, H.-C. (2013). Rostral prefrontal cortex (Brodmann Area 10): Metacognition in the brain. In D.T. Stuss & R.T. Knight (Eds.), Principles of frontal lobe function (2nd ed., pp. 524544). New York: Oxford University Press.
Catani, C., Dell’Acqua, F., Bizzi, A., Forkel, S.J., Williams, S.C., Simmons, A., Murphy, D.G., & Thiebaut de Schotten, M. (2012). Beyond cortical localization in clinico-anatomical correlation. Cortex, 48, 12621287.
Channon, S. (2004). Frontal lobe dysfunction and everyday problem-solving: Social and non-social contributions. Acta Psychologica, 115(2-3), 235254.
Christensen, A.-L. (1975). Luria’s neuropsychological investigation. New York: Spectrum Publications.
Cicerone, K., Levin, H., Malec, J., Stuss, D., & Whyte, J. (2006). Cognitive rehabilitation interventions for executive function: Moving from bench to bedside in patients with traumatic brain injury. Journal of Cognitive Neuroscience, 18, 12121222.
Clark, l, Cools, R., & Robbins, T.W. (2004). The neuropsychology of ventral prefrontal cortex: Decision-making and reversal learning. Brain and Cognition, 55, 4153.
Craik, F.I.M., Moroz, T.M., Moscovitch, M., Stuss, D.T., Winocur, G., Tulving, E., & Kapur, S. (1999). In search of the self: A positron emission tomography study. Psychological Science, 10, 2634.
Cummings, J.L. (1995). Anatomic and behavioral aspects of frontal-subcortical circuits. In J. Grafman, K.J. Holyoak & F. Boller (Eds.), Structure and functions of the human prefrontal cortex, Vol. 769, pp. 113). New York: New York Academy of Sciences.
Damasio, A.R. (1996). The somatic marker hypothesis and the possible functions of the prefrontal cortex. Philosophical Transactions of the Royal Society of London B: Biological Sciences, 351, 14131420.
Dawson, D.R., Anderson, N.D., Burgess, P.W., Cooper, E., Krpan, K.M., & Stuss, D.T. (2009). Further development of the multiple errands test: Standardized scoring, reliability, and ecological validity for the Baycrest version. Archives of Physical Medicine and Rehabilitation, 90(S1), 4151.
Demakis, G.J. (2004). Frontal lobe damage and tests of executive processing: A meta-analysis of the category test, Stroop test, and trail-making test. Journal of Clinical and Experimental Neuropsychology, 26, 441450.
D’Esposito, M., & Badre, D. (2012). Combining the insights derived from lesion and fMRI studies to understand the function of prefrontal cortex. In B. Levine & F.I.M. Craik (Eds.), Mind and the frontal lobes. Cognition, behavior, and brain imaging (pp. 93108). Oxford/New York: Oxford University Press.
Dubois, B., Slachevsky, A., Litvan, I., & Pillon, B. (2000). The FAB: A frontal assessment battery at bedside. Neurology, 55, 16211626.
Duncan, J., & Miller, E.K. (2013). Adaptive neural coding in frontal and parietal cortex. In D.T. Stuss & R.T. Knight (Eds.), Principles of frontal lobe function (2nd ed., pp. 292301). New York: Oxford University Press.
Duncan, J., & Owen, A.M. (2000). Common regions of the human frontal lobe recruited by diverse cognitive demands. Trends in Neurosciences, 23, 475483.
Duncan, J., Parr, A., Woolgar, A., Thompson, R., Bright, P., Cox, S., & Nimmo-Smith, I. (2008). Goal neglect and Spearman’s g: Competing parts of a complex task. Journal of Experimental Psychology: General, 137, 131148.
Eslinger, P.J., & Damasio, A.R. (1985). Severe disturbance of higher cognition after bilateral frontal lobe ablation. Neurology, 35(12), 17311741.
Fellows, L.K., & Farah, M.J. (2005). Different underlying impairments in decision-making following ventromedial and dorsolateral frontal lobe damage in humans. Cerebral Cortex, 15, 5863.
Floden, D., Alexander, M.P., Kubu, C., Katz, D., & Stuss, D.T. (2008). Impulsivity and risk-taking behavior in focal frontal lobe lesions. Neuropsychologia, 46, 213223.
Floden, D., Vallesi, A., & Stuss, D.T. (2011). Task context and frontal lobe activation in the Stroop task. Journal of Cognitive Neuroscience, 23, 867879.
Gilbert, S.J., Spengler, S., Simons, J.S.S., Steele, J.D., Lawrie, S.M., Frith, C.D., & Burgess, P.W. (2006). Functional specialisation within rostral prefrontal cortex (area 10): A meta-analysis. Journal of Cognitive Neuroscience, 18(6), 932948.
Gilbert, S.J., Gollwitzer, P.M., Cohen, A.L., Oettingen, G., & Burgess, P.W. (2009). Separable brain systems supporting cued versus self-initiated realization of delayed intentions. Journal of Experimental Psychology: Learning, Memory, and Cognition, 35, 905915.
Gilbert, S.J., Gonen-Yaacovi, G., Benoit, R.G., Volle, E., & Burgess, P.W. (2010). Distinct functional connectivity associated with lateral versus medial rostral prefrontal cortex: A meta-analysis. NeuroImage, 53, 13591367.
Gioia, G.A., Isquith, P.K., Guy, S.C., & Kenworthy, L. (2000). Behavior rating inventory of executive function. Child Neuropsychology, 6, 235238. doi: 10.1076/chin.
Gonen-Yaacovi, G., & Burgess, P.W. (2012). Prospective memory: The future for future intentions. Psychologica Belgica, 173(52/2-3), 173204.
Grace, J., & Malloy, P.F. (2001). Frontal Systems Behavior Scale (FrSBe). Lutz, FL: PAR.
Gratton, C., Nomura, E.M., Perez, F., & D’Esposito, M. (2012). Focal brain lesions to critical locations cause widespread disruption of the modular organization of the brain. Journal of Cognitive Neuroscience, 24, 12761285.
Halstead, W.C. (1947). Brain and intelligence: A quantitative study of the frontal lobes. Chicago: University of Chicago Press.
Harlow, J.M. (1848). Passage of an iron bar through the head. Boston Medical and Surgical Journal, 39, 389393.
Helfrich, R.F., & Knight, R.T. (2016). Oscillatory dynamics of prefrontal cognitive control. Trends in Cognitive Science, 20, 916930.
Hwang, K., Bertolero, M., Liu, W., & D’Esposito, M. (2017). The human thalamus is an integrative hub for functional brain networks. Journal of Neuroscience, 37, 55945607.
Knight, C., Alderman, N., & Burgess, P.W. (2002). Development of a simplified version of the multiple errands test for use in hospital settings. Neuropsychological Rehabilitation, 12, 231255.
Koechlin, E., Ody, C., & Kouneiher, F. (2003). The architecture of cognitive control in the human prefrontal cortex. Science, 302, 11811185.
Koechlin, E., & Summerfield, C. (2007). An information theoretical approach to prefrontal executive function. Trends in Cognitive Science, 11, 229235.
Levine, B., Robertson, I.H., Clare, L., Carter, G., Hong, J., Wilson, B.A., & Stuss, D.T. (2000). Rehabilitation of executive functioning: An experimental-clinical validation of Goal Management Training. Journal of the International Neuropsychological Society, 6, 299312.
Luria, A.R. (1966). Higher cortical functions in man (2nd ed.). New York: Basic Books.
Manly, T., Hawkins, K., Evans, J., Woldt, K., & Robertson, I.H. (2002). Rehabilitation of executive function: Facilitation of effective goal management on complex tasks using periodic auditory alerts. Neuropsychologia, 40(3), 271281.
Milner, B. (1963). Effects of different brain lesions on card sorting: The role of the frontal lobes. Archives of Neurology, 9, 90100.
Norman, D.A., & Shallice, T. (1986). Attention to action: Willed and automatic control of behavior. In R.J. Davidson, G.E. Schwartz & D. Shapiro (Eds.), Consciousness and self-regulation: Advances in research. (Vol. IV, pp. 118). New York: Plenum Press.
Pandya, D.N., & Barnes, C.L. (1987). Architecture and connections of the frontal lobe. In E. Perecman (Ed.), The frontal lobes revisited (pp. 4172). New York: IRBN Press.
Pandya, D.N., & Yeterian, E.H. (1996). Morphological correlations of human and monkey frontal lobes. In A.R. Damasio, H. Damasio & Y. Christen (Eds.), Neurobiology of decision making (pp. 1346). New York: Springer-Verlag.
Petrides, M. (2013). The mid-dorsolateral prefronto-parietal network and the epoptic process. In D.T. Stuss & R.T. Knight (Eds.), Principles of frontal lobe function (2nd ed., pp. 7989). New York: Oxford University Press.
Perrine, K. (1993). Differential aspects of conceptual processing in the Category Test and Wisconsin Card Sorting Test. Journal of Clinical and Experimental Neuropsychology Section A: Neuropsychology, Development, and Cognition, 15, 461473.
Picton, T.W., Stuss, D.T., Alexander, M.P., Shallice, T., Binns, M.A., & Gillingham, S. (2007). Effects of focal frontal lesions on response inhibition. Cerebral Cortex, 17, 826838.
Picton, T.W., Stuss, D.T., Shallice, T., Alexander, M.P., & Gillingham, S. (2006). Keeping time: Effects of focal frontal lesions. Neuropsychologia, 44, 11951209.
Pinti, P., Aichelburg, C., Lind, F., Power, C., Swingler, E., Merla, A., & Tachtsidis, I. (2015). Using fibreless, wearable fNIRS to monitor brain activity in real-world cognitive tasks. Journal of Visualised Experiments, 106, e53336. doi: 10.3791/53336
Pribram, K.H. (1973). The primate frontal cortex-executive of the brain. In K.H. Pribram & A.R. Luria (Eds.), Psychophysiology of the Frontal Lobes (pp. 293314). New York: Academic Press.
Raichle, M.E. (2015). The brain’s default mode network. Annual Review of Neuroscience, 38, 433447. doi: 10.1146/annurev-neuro-071013-014030
Reitan, R.M. (1958). Validity of the trail making test as an indicator of organic brain damage. Perceptual and Motor Skills, 8, 271276.
Reitan, R.M., & Wolfson, D. (1995). Category test and trail making test as measures of frontal lobe functions. The Clinical Neuropsychologist, 9, 5056.
Reverberi, C., Lavaroni, A., Giglib, G.L., & Skrapb, M. (2005). Specific impairments of rule induction in different frontal lobe subgroups. Neuropsychologia, 43, 460472.
Szczepanski, S.M., & Knight, R.T. (2014). Insights into human behavior from lesions to the prefrontal cortex. Neuron, 83, 10021018.
Shallice, T. (1982). Specific impairments of planning. Philosophical Transactions of the Royal Society B: Biological Sciences, 298, 199209.
Shallice, T., & Burgess, P.W. (1991). Deficits in strategy application following frontal lobe damage in man. Brain, 114, 727741.
Shallice, T., & Burgess, P.W. (1996). The domain of supervisory processes and temporal organisation of behaviour. Philosophical Transactions of the Royal Society of London B, 351, 14051412.
Shallice, T., & Cooper, R. (2011). The organisation of mind. Oxford, UK: Oxford University Press.
Shallice, T., & Evans, M.E. (1978). The involvement of the frontal lobes in cognitive estimation. Cortex, 14, 294303.
Shallice, T., Stuss, D.T., Alexander, M.P., Picton, T.W., & Derkzen, D. (2008). The multiple dimensions of sustained attention. Cortex, 44, 794805.
Shallice, T., Stuss, D.T., Picton, T.W., Alexander, M.P., & Gillingham, S. (2008). Multiple effects of prefrontal lesions on task-switching. Frontiers in Human Neuroscience, 1, 112.
Shammi, P., & Stuss, D.T. (1999). Humour appreciation: A role of the right frontal lobe. Brain, 122, 657666.
Spitzer, D., White, S., Mandy, W., & Burgess, P.W. (2016). Confabulation in children with autism. Cortex, 87, 8095.
Stuss, D.T. (2007). New approaches to prefrontal lobe testing. In B. Miller & J. Cummings (Eds.), The human frontal lobes: Functions and disorders (2nd ed., pp. 292305). New York: Guilford Press.
Stuss, D.T. (2011a). Functions of the frontal lobes: Relation to executive functions. Journal of the International Neuropsychological Society, 17, 17.
Stuss, D.T. (2011b). Traumatic brain injury: Relation to executive dysfunction and the frontal lobes. Current Opinion in Neurology, 24, 584589.
Stuss, D.T., & Alexander, M.P. (2007). Is there a dysexecutive syndrome? Philosophical Transactions of the Royal Society of London . Series B: Biological Sciences, 362, 901915.
Stuss, D.T., Alexander, M.P., Shallice, T., Picton, T.W., Binns, M.A., MacDonald, R., & Katz, D.I. (2005). Multiple frontal systems controlling response speed. Neuropsychologia, 43, 396417.
Stuss, D.T., Alexander, M.P., Hamer, L., Palumbo, C., Dempster, R., Binns, M., & Izukawa, D. (1998). The effects of focal anterior and posterior brain lesions on verbal fluency. Journal of the International Neuropsychological Society, 4, 265278.
Stuss, D.T., & Benson, D.F. (1983). Emotional concomitants of psychosurgery. In K.M. Heilman & P. Satz (Eds.), Advances in neuropsychology and behavioral neurology. Vol. 1. Neuropsychology of human emotion (pp. 111140). New York/London: The Guilford Press.
Stuss, D.T., & Benson, D.F. (1986). The frontal lobes. New York: Raven Press.
Stuss, D.T., Binns, M.A., Murphy, K.J., & Alexander, M.P. (2002). Dissociations within the anterior attentional system: Effects of task complexity and irrelevant information on reaction time speed and accuracy. Neuropsychology, 16, 500513.
Stuss, D.T., Bisschop, S.M., Alexander, M.P., Levine, B., Katz, D., & Izukawa, D. (2001a). The Trail Making Test: A study in focal lesion patients. Psychological Assessment, 13, 230239.
Stuss, D.T., Floden, D., Alexander, M.P., Levine, B., & Katz, D. (2001b). Stroop performance in focal lesion patients: Dissociation of processes and frontal lobe lesion location. Neuropsychologia, 39, 771786.
Stuss, D.T., Gallup, G.G., & Alexander, M.P. (2001). The frontal lobes are necessary for “theory of mind”. Brain, 124, 279286.
Stuss, D.T., Levine, B., Alexander, M.P., Hong, J., Palumbo, C., Hamer, L., & Izukawa, D. (2000). Wisconsin Card Sorting Test performance in patients with focal frontal and posterior brain damage: Effects of lesion location and test structure on separable cognitive processes. Neuropsychologia, 38, 388402.
Stuss, D.T., Kaplan, E.F., Benson, D.F., Weir, W.S., Naeser, M.A., & Levine, H.L. (1981). Long-term effects of prefrontal leucotomy- An overview of neuropsychologic residuals. Journal of Clinical Neuropsychology, 3, 1332.
Stuss, D.T., & Knight, R.T. (Eds.). (2002). Principles of frontal lobe function. New York: Oxford University Press.
Stuss, D.T., & Knight, R.T. (Eds.). (2013). Principles of frontal lobe function (2nd ed). New York: Oxford University Press.
Stuss, D.T., Murphy, K.J., Binns, M.A., & Alexander, M.P. (2003). Staying on the job: The frontal lobes control individual performance variability. Brain, 126, 23632380.
Stuss, D.T., Shallice, T., Alexander, M.P., & Picton, T.W. (1995). A multidisciplinary approach to anterior attentional functions. Annals of the New York Academy of Sciences, 769, 191212.
Teuber, H.L. (1972). Unity and diversity of frontal lobe functions. Acta Neurobiologiae Experimentalis (Wars), 32, 615656.
Thiebaut de Schotten, M., Urbanski, M., Batrancourt, B., Levy, R., Dubois, B., Cerliani, L., & Volle, E. (2017). Rostro-caudal architecture of the frontal lobes in humans. Cerebral Cortex, 27, 40334047.
Thurstone, L.L., & Thurstone, T.G. (1938). Primary mental abilities. Chicago: University of Chicago Press.
Tilney, F. (1928). The brain, from ape to man. New York: Hoeber.
Vallesi, A., McIntosh, A.R., Alexander, M.P., & Stuss, D.T. (2009). fMRI evidence of a functional network setting the criteria for withholding a response. NeuroImage, 45, 537548.
Vallesi, A., McIntosh, A.R., Crescentini, C., & Stuss, D.T. (2012). fMRI investigation of speed-accuracy strategy switching. Human Brain Mapping, 33, 16771688.
Vallesi, A., McIntosh, A.R., Shallice, T., & Stuss, D.T. (2009). When time shapes behavior: fMRI evidence of brain correlates of temporal monitoring. Journal of Cognitive Neuroscience, 21, 11161126.
Volle, E., Costello, A., De L. Coates, L.M., Forbes, C., Towgood, K., Gilbert, S.J., & Burgess, P.W. (2012). Dissociation between verbal response initiation and suppression after prefrontal lesions. Cerebral Cortex, 22, 24282440. doi: 10.1093/cercor/bhr322
Warrington, E.K. (2000). Homophone meaning generation: A new test of verbal switching for the detection of frontal lobe dysfunction. Journal of the International Neuropsychological Society, 6, 643648.
Wheeler, M.A., Stuss, D.T., & Tulving, E. (1997). Toward a theory of episodic memory: The frontal lobes and autonoetic consciousness. Psychological Bulletin, 121, 331354.
Wilson, B.A., Evans, J.J., Emslie, H., Alderman, N., & Burgess, P.W. (1998). The development of an ecologically valid test for assessing patients with a dysexecutive syndrome. Neuropsychological Rehabilitation, 8, 213228.


Fifty Years of Prefrontal Cortex Research: Impact on Assessment

  • Paul W. Burgess (a1) and Donald T. Stuss (a2) (a3) (a4)


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