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.)