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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
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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