Another division: Motor (4) Premotor (6, 8, 43, 44, 45) Prefrontal (9-15, 46, 47) Neuropsychological
Manifestations of Frontal Lesions I Frontal Operculum (44,45,47) A) Left: Brocas aphasia B) Right: expressive aprosodia Superior Mesial (mesial 6, 24) A) Left: akinetic mutism
B) Right: akinetic mutism Bilateral lesions of mesial SMA (6) and anterior cingulate (24) produce more severe form of akinetic mutism Tranel, 1992
Neuropsychological Manifestations of Frontal Lobe Lesions II Inferior Mesial Region A) Orbital Region (10, 11) Lesions in this region
produce disinhibition, altered social conduct, acquired sociopathy, and other disturbances due to impairment in fronto-limbic relationships B) Basal Forebrain
(posterior extension of inferior mesial region, including diagonal band of Broca, nucleus accumbens, septal nuclei, substantia innominata)
Tranel, 1992 Lesions here produce prominent anterograde amnesia with confabulation Neuropsychological
Manifestations of Frontal Lobe Lesions III Lateral Prefrontal Region (8,9,46) Lesions in this region produce impairment in a variety of executive skills that cut across
domains. Some degree of material-specificity is present, but relatively weak. A) Fluency: impaired verbal fluency (left) or design fluency (right) B) Memory impairments:
defective recency judgment, metamemory defects, difficulties in memory monitoring Tranel, 1992 C) Impaired abstract concept
formation and hypothesis testing Phineas Gage (1823-1861, accident in 1848) Phineas Gages lesion reconstructed (H. Damasio and R. Frank, 1992)
Keys to Understanding Frontal Lobe Function Realize that it is as far away from the external world as any cortical region Appreciate patterns of connectivity (you can tell a lot about someone by
getting to know their friends) Appreciate inhibitory/excitatory (modulatory) aspects in addition to idea of specialized informationprocessors General Organization of Frontal cortical-striatal-pallidal-thalamiccortical loops
Loop Important in behavioral activation/intentional disorders Damage results in Akinetic mutism
Abulia Impairments in spontaneous initiation of behavior (Burruss, et. al., Radiology, 2000)
Motor Activation/Preparation Heilman, Watson, & Valenstein, 2003 Selective Engagement and Disengagement of Cortex
Thalamus A E G Cortex
B F C D J
I H Nucleus Reticularis Excitatory cortical projections to the thalamus (A) course through the nucleus
reticularis (NR) synapsing on inhibitory thalamic interneurons (B), reticulo-thalamic neurons (C), and providingarborizing collaterals (D). The direct cortical projection to the thalamic interneuron (B) results in the inhibition ofthalamo-cortical projection (E). This inhibition of thalamo-cortical projections results in the disengagement (inhibition) of select cortical areas. Thereticulo-thalamic neuron (C) synapses on, and inhibits, a thalamic interneuron (F), resulting in excitation of thethalamo-cortical neuron (G). This excitation of thethalamo-cortical projection results in theengagement of select cortical areas. The collateral (D) synapses on, and inhibits, a reticulo-thalamic neuron (H) which synapses on a thalamic
interneuron (I). The thalamic interneuron (I) inhibits thethalamo-cortical neuron (J) resulting in thedisengagement of select cortical areas. = Glutamatergic (excitatory) = GABA-ergic (inhibitory) Dashed lines represent inhibited neuron (neuron unable to exert its influence on downstream neuron).
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