Jose : Neuropsychology of executive functions in patients with focal lesion in the prefrontal
cortex : a systematic review
● The PFC plays a central role in the more complex and more evolved behavior of the
human species
○ Responsible for setting objectives and goals + devising plans to achieve them
○ Leading brain region to carry out plans, arranging more basic skills and applying
them in the correct order
○ Responsible for assessing the consequences of these actions in relation to our
intentions
● The PFC is located in the most anterior area of the brain and constitutes about 29% of
the human cerebral cortex
● PFC is the anatomical substrate of the most complex mental processes of the human
being, playing a capital part in our potential to adapt to dynamic and changing
environments
○ Role of identification of
■ The objective - the what
■ The planning - the how
■ The subsequent initiation of the action - the when
● PFC is associated with numerous complex cognitive functions → attention, memory,
language and EF (executive functions)
● Great importance in the proper functioning of more basic psychological processes due to
its extensive reciprocal connections with almost all cortical and subcortical structures
● Great versatility shows how the prefrontal lobe is designed to have an essential
importance in the integration and control of information from different functional domains
● PFC functional subdivisions
○ Dorsolateral (DL) → working memory, problem solving and the integration of
cognitive skills
○ Ventromedial (VM)
○ Orbitofrontal (OFC)
■ VM and OFC associated with emotion, decision making, social behavior
and inhibition
, ○ Superior medial frontal cortex (formed by medial walls of the hemispheres above
the ventromedial sector. includes anterior cingulate cortex) → error monitoring
and conflict resolution
● All the subregions have different connections with thalamic nuclei and different
interconnections with other cortical and subcortical structures
● Lesions studies give us insight into the necessary functions of brain structures, whereas
functional magnetic resonance imaging (fMRI) analysis reflects mere correlations with
psychological process
● A patient with PFC damage will retain the ability to perform basic cognitive skills,
recognize objects and memorize information among others
○ When a task requires the coordination of these cognitive skills in order to reach a
goal → performance affected
● PFC lesions are related to a variety of cognitive, emotional and behavioral alterations =
Executive functions
○ mainly defined as a set of cognitive processes that coordinate more basic
processes for the resolution of complex behaviors, associated with more abstract
and more phylogenetically evolved functions
● Damage to PFC → problems with initiative, motivation, formulation of goals and plans
and self control
● EF =/= other cognitive processes
○ EF explain the “how” of human behavior
, ● Alterations in EF have fundamentally been considered prototypical of PFC damage,
even so the equivalence between this area and executive functioning cannot be
assumed, especially in view of the occurrence of the dysexecutive syndrome in patients
with damage to other brain regions
● Psychometric tests for EF also show sensitivity, but not specificity for frontal lobe
damage, stating that both frontal and non-frontal brain regions are necessary for the
normal functioning of this construct
● most experimental tests that measure this EF do not have ecological validity, due to
their score not being representative of real-world settings
Discussion
● The vast majority of studies reported a significant relationship between PFC lesions and
the performance on the EF task
Decision making
● Somatic marker hypothesis → decisions are made depending on the emotional value
produced by different options
● Through this emotional mechanism, the individual is guided by generating emotional
states that inform him in advance of the possible consequences of an action with
uncertain result
● VM is responsible for decision making and the capacity to plan by integrating emotional,
cognitive and sensory information from extensive reciprocal connections that provide
information form both the internal and external world allowing the individual to
orchestrate a wide range of functions and generate somatic markers
● Decision making arises from cortical and subcortical structures
, ● OFC → reinforcement and reward system + inhibitory control, based on the emotional
meaning of the stimuli when choosing an option
● Neural networks in the VM which are responsible for coding the subjective values of
different types of options in decision making → common currency model
○ The VM calculates the subjective value of each option in an abstract space of
values, allowing its comparison with other options and then informs the motor
system of the winning option
○ the sensory signals are contextualized by motivational and cognitive signals by a
variety of brain regions, to then be passed onto the VM, where these different
attributes are transformed into an “abstract common currency value”
○ The VM is
■ crucial to form vivid representations of future rewards (and goals)
■ capable of competing with immediate rewards through top-down signals,
■ promoting resistance to immediate gratification
■ favoring long-term advantageous responses
○ VM is also responsible for coding these values through learning by punishment,
since these patients can only learn through positive reinforcement
○ The FPC would be responsible for coding the value of the reward history trends
that are relevant for future decision making
○ OFC is essential to make decisions based on the value of the stimulus and not
based on the value of the action
● General deficits in the production of somatic markers that represent a body change in
emotional state, regardless of valence
● Deficits in decision making can result from problems with regulating emotions + can
explain the inability to integrate the information received by somatic markers in the VM,
preventing the anticipation of future negative consequences
● VM is a necessary area for the normal regulation of emotions → damage can produce a
pattern of hyper irrationality
○ this can be avoided by presenting the benefits in the immediate context (rather
than delayed benefits or gratification)
● unilateral VM lesions may have different effects depending on the hemisphere involved
○ patients with right VM injuries had problems when maintaining a job, poor
performance in the decision-making test and deficits in the anticipatory
responses of SCR
○ ⇒ right VM more involved in emotional processing → better decision making
● Patients with VM damage persist in making long term disadvantageous decisions
Moral reasoning
● Moral judgements/reasoning are a type of evaluation based on the adequacy of one’s
own behavior and social ideas of what is right/what is wrong
● MJ
cortex : a systematic review
● The PFC plays a central role in the more complex and more evolved behavior of the
human species
○ Responsible for setting objectives and goals + devising plans to achieve them
○ Leading brain region to carry out plans, arranging more basic skills and applying
them in the correct order
○ Responsible for assessing the consequences of these actions in relation to our
intentions
● The PFC is located in the most anterior area of the brain and constitutes about 29% of
the human cerebral cortex
● PFC is the anatomical substrate of the most complex mental processes of the human
being, playing a capital part in our potential to adapt to dynamic and changing
environments
○ Role of identification of
■ The objective - the what
■ The planning - the how
■ The subsequent initiation of the action - the when
● PFC is associated with numerous complex cognitive functions → attention, memory,
language and EF (executive functions)
● Great importance in the proper functioning of more basic psychological processes due to
its extensive reciprocal connections with almost all cortical and subcortical structures
● Great versatility shows how the prefrontal lobe is designed to have an essential
importance in the integration and control of information from different functional domains
● PFC functional subdivisions
○ Dorsolateral (DL) → working memory, problem solving and the integration of
cognitive skills
○ Ventromedial (VM)
○ Orbitofrontal (OFC)
■ VM and OFC associated with emotion, decision making, social behavior
and inhibition
, ○ Superior medial frontal cortex (formed by medial walls of the hemispheres above
the ventromedial sector. includes anterior cingulate cortex) → error monitoring
and conflict resolution
● All the subregions have different connections with thalamic nuclei and different
interconnections with other cortical and subcortical structures
● Lesions studies give us insight into the necessary functions of brain structures, whereas
functional magnetic resonance imaging (fMRI) analysis reflects mere correlations with
psychological process
● A patient with PFC damage will retain the ability to perform basic cognitive skills,
recognize objects and memorize information among others
○ When a task requires the coordination of these cognitive skills in order to reach a
goal → performance affected
● PFC lesions are related to a variety of cognitive, emotional and behavioral alterations =
Executive functions
○ mainly defined as a set of cognitive processes that coordinate more basic
processes for the resolution of complex behaviors, associated with more abstract
and more phylogenetically evolved functions
● Damage to PFC → problems with initiative, motivation, formulation of goals and plans
and self control
● EF =/= other cognitive processes
○ EF explain the “how” of human behavior
, ● Alterations in EF have fundamentally been considered prototypical of PFC damage,
even so the equivalence between this area and executive functioning cannot be
assumed, especially in view of the occurrence of the dysexecutive syndrome in patients
with damage to other brain regions
● Psychometric tests for EF also show sensitivity, but not specificity for frontal lobe
damage, stating that both frontal and non-frontal brain regions are necessary for the
normal functioning of this construct
● most experimental tests that measure this EF do not have ecological validity, due to
their score not being representative of real-world settings
Discussion
● The vast majority of studies reported a significant relationship between PFC lesions and
the performance on the EF task
Decision making
● Somatic marker hypothesis → decisions are made depending on the emotional value
produced by different options
● Through this emotional mechanism, the individual is guided by generating emotional
states that inform him in advance of the possible consequences of an action with
uncertain result
● VM is responsible for decision making and the capacity to plan by integrating emotional,
cognitive and sensory information from extensive reciprocal connections that provide
information form both the internal and external world allowing the individual to
orchestrate a wide range of functions and generate somatic markers
● Decision making arises from cortical and subcortical structures
, ● OFC → reinforcement and reward system + inhibitory control, based on the emotional
meaning of the stimuli when choosing an option
● Neural networks in the VM which are responsible for coding the subjective values of
different types of options in decision making → common currency model
○ The VM calculates the subjective value of each option in an abstract space of
values, allowing its comparison with other options and then informs the motor
system of the winning option
○ the sensory signals are contextualized by motivational and cognitive signals by a
variety of brain regions, to then be passed onto the VM, where these different
attributes are transformed into an “abstract common currency value”
○ The VM is
■ crucial to form vivid representations of future rewards (and goals)
■ capable of competing with immediate rewards through top-down signals,
■ promoting resistance to immediate gratification
■ favoring long-term advantageous responses
○ VM is also responsible for coding these values through learning by punishment,
since these patients can only learn through positive reinforcement
○ The FPC would be responsible for coding the value of the reward history trends
that are relevant for future decision making
○ OFC is essential to make decisions based on the value of the stimulus and not
based on the value of the action
● General deficits in the production of somatic markers that represent a body change in
emotional state, regardless of valence
● Deficits in decision making can result from problems with regulating emotions + can
explain the inability to integrate the information received by somatic markers in the VM,
preventing the anticipation of future negative consequences
● VM is a necessary area for the normal regulation of emotions → damage can produce a
pattern of hyper irrationality
○ this can be avoided by presenting the benefits in the immediate context (rather
than delayed benefits or gratification)
● unilateral VM lesions may have different effects depending on the hemisphere involved
○ patients with right VM injuries had problems when maintaining a job, poor
performance in the decision-making test and deficits in the anticipatory
responses of SCR
○ ⇒ right VM more involved in emotional processing → better decision making
● Patients with VM damage persist in making long term disadvantageous decisions
Moral reasoning
● Moral judgements/reasoning are a type of evaluation based on the adequacy of one’s
own behavior and social ideas of what is right/what is wrong
● MJ
