Skip to main content
×
Home
    • Aa
    • Aa

Impairments of emotion and real-world complex behavior following childhood- or adult-onset damage to ventromedial prefrontal cortex

  • STEVEN W. ANDERSON (a1), JOSEPH BARRASH (a1) (a2), ANTOINE BECHARA (a1) and DANIEL TRANEL (a1)
Abstract

The behavioral syndrome resulting from damage to the ventromedial prefrontal (VM) region presents major challenges for clinical assessment and management, stemming from the absence of reliable neurologic or psychometric markers, coupled with often debilitating impairments of decision-making and behavior regulation. Damage to this region disrupts neural circuitry critical for emotion, which in turn may contribute to impairments in real-world competencies. Here we present findings from patients with focal lesions in the VM region acquired either in childhood or adulthood, and show that there is a relationship between emotional dysfunction and impairments in real-world behavioral competencies. Emotion was rated by participants' relatives on dimensions including frustration tolerance, lability, anxiety, and blunted affect. Real-world competencies were rated by the relatives on dimensions including judgment, planning, and initiation, and were evaluated by clinician ratings in areas including social, financial, and occupational function. VM damage resulted in severe disruption of emotion, and this emotional dysfunction accounted for a significant portion of impaired real-world competencies. The long-term impairments associated with childhood-onset lesions were at least as severe as those resulting from adult-onset damage. Greater focus on the contribution of emotional dysfunction to the real-world competencies of patients with damage in the VM region may sharpen their neuropsychological assessment and facilitate rehabilitation efforts. (JINS, 2006, 12, 224–235.)

Copyright
Corresponding author
Reprint requests to: Steven W. Anderson, Ph.D., Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA 52242. E-mail: steven-anderson@uiowa.edu
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

Anderson, S.W., Bechara, A., Damasio, H., Tranel, D., & Damasio, A.R. (1999). Impairment of social and moral behavior related to early damage in the human prefrontal cortex. Nature Neuroscience, 2, 10321037.

Anderson, S.W., Damasio, H., & Damasio, A.R. (2005). A neural basis for collecting behavior in humans. Brain, 128, 201212.

Anderson, S.W., Damasio, H., Jones, R.D., & Tranel, D. (1991). Wisconsin Card Sorting Test performance as a measure of frontal lobe damage. Journal of Clinical and Experimental Neuropsychology, 13, 909922.

Bar-On, R., Tranel, D., Denburg, N.L., & Bechara, A. (2003). Exploring the neurological substrates of emotional and social intelligence. Brain, 126, 17901800.

Barrash, J., Tranel, D., & Anderson, S.W. (2000). Acquired personality disturbances associated with bilateral damage to the ventromedial prefrontal region. Developmental Neuropsychology, 18, 355381.

Bechara, A., Tranel, D., Damasio, H., & Damasio, A.R. (1996). Failure to respond autonomically to anticipated future outcomes following damage to prefrontal cortex. Cerebral Cortex, 6, 215225.

Camille, N., Coricelli, G., Sallet, J., Pradat-Diehl, P., Duhamel, J.-R., & Sirigu, A. (2004). The involvement of the orbitofrontal cortex in the experience of regret. Science, 304, 11671170.

Damasio, H. & Frank, R. (1992). Three-dimensional in vivo mapping of brain lesions in humans. Archives of Neurology, 49, 137143.

Eslinger, P.J. (1998). Neurological and neuropsychological bases of empathy. European Neurology, 39, 193199.

Eslinger, P.J. & Damasio, A.R. (1985). Severe disturbance of higher cognition after bilateral frontal lobe ablation: Patient EVR. Neurology, 35, 17311741.

Eslinger, P.J., Flaherty-Craig, C.V., & Benton, A.L. (2004). Developmental outcomes after early prefrontal cortex damage. Brain and Cognition, 55, 84103.

Eslinger, P.J., Grattan, L.M., & Damasio, A.R. (1992). Developmental consequences of childhood frontal lobe damage. Archives of Neurology, 49, 764769.

Frank, R.J., Damasio, H., & Grabowski, T.J. (1997). Brainvox: An interactive, multimodal visualization and analyss system for neuroanatomical imaging. Neuroimage, 5, 1330.

Frith, U. & Frith, C.D. (2003). Development and neurophysiology of mentalizing. Philosophical Transactions of the Royal Society of London, 358, 459473.

Grafman, J., Jonas, B., & Salazar, A. (1990). Wisconsin Card Sorting Test performance based on location and size of neuroanatomical lesion in Vietnam veterans with penetrating head injury. Perceptual and Motor Skills, 71, 11201122.

Gusnard, D.A., Akbudak, E., Shulman, G.L., & Raichle, M.E. (2001). Medial prefrontal cortex and self-referential mental activity: Relation to a default mode of brain function. Proceedings of the National Academy of Science, 98, 42594264.

Happaney, K., Zelazo, P.D., & Stuss, D.T. (2004). Development of orbitofrontal function: Current themes and future directions. Brain and Cognition, 55, 110.

Kelley, W.M., Macrae, C.N., Wyland, C.L., Caglar, S., Inati, S., & Heatherton, T.F. (2002). Finding the self? An event-related fMRI study. Journal of Cognitive Neuroscience, 14, 785794.

Machado, C.J. & Bachevalier, J. (2003). Non-human primate models of childhood psychopathology: The promise and the limitations. Journal of Child Psychology and Psychiatry, 44, 6487.

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 & Psychiatry, 57, 15181524.

Saver, J. & Damasio, A.R. (1991). Preserved access and processing of social knowledge in a patient with acquired sociopathy due to ventromedial frontal damage. Neuropsychologia, 29, 12411249.

Siegert, R.J., McPherson, K.M., & Taylor, W.J. (2004). Toward a cognitive-affective model of goal-setting in rehabilitation: Is self-regulation theory a key step?Disability and Rehabilitation, 26, 11751183.

Shamay-Tsoory, S.G., Tomer, R., Goldsher, D., Berger, B.D., & Aharon-Peretz, J. (2004). Impairment in cognitive and affective empathy in patients with brain lesions: Anatomical and cognitive correlates. Journal of Clinical and Experimental Neuropsychology, 26, 11131127.

Shallice, T. & Burgess, W.P. (1991). Deficits in strategy application following frontal lobe damage in man. Brain, 114, 727741.

Stuss, D.T. & Levine, B. (2002). Adult clinical neuropsychology: Lessons from studies of the frontal lobes. Annual Review of Psychology, 53, 401433.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Journal of the International Neuropsychological Society
  • ISSN: 1355-6177
  • EISSN: 1469-7661
  • URL: /core/journals/journal-of-the-international-neuropsychological-society
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords:

Metrics

Full text views

Total number of HTML views: 8
Total number of PDF views: 75 *
Loading metrics...

Abstract views

Total abstract views: 322 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 29th May 2017. This data will be updated every 24 hours.