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

Published online by Cambridge University Press:  22 March 2006

STEVEN W. ANDERSON ,
JOSEPH BARRASH ,
ANTOINE BECHARA  and
DANIEL TRANEL
STEVEN W. ANDERSON
Affiliation:
Department of Neurology, University of Iowa Carver College of Medicine, Iowa City, Iowa
JOSEPH BARRASH
Affiliation:
Department of Neurology, University of Iowa Carver College of Medicine, Iowa City, Iowa VA Medical Center, Iowa City, Iowa
ANTOINE BECHARA
Affiliation:
Department of Neurology, University of Iowa Carver College of Medicine, Iowa City, Iowa
DANIEL TRANEL
Affiliation:
Department of Neurology, University of Iowa Carver College of Medicine, Iowa City, Iowa
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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.)

Keywords

Prefrontal cortexEmotionDecision-making
Type
SYMPOSIUM
Information
Journal of the International Neuropsychological Society , Volume 12 , Issue 2 , March 2006 , pp. 224 - 235
Copyright
© 2006 The International Neuropsychological Society

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