Wisconsin Card Sorting Test performance in patients with focal frontal and posterior brain damage: effects of lesion location and test structure on separable cognitive processes

Impairment in Cognitive and Affective Empathy in Patients with Brain Lesions: Anatomical and Cognitive Correlates

The present study was designed to examine the degree of impairment in cognitive and affective empathy among patients with focal brain lesions, and the contribution of specific cognitive abilities (such as cognitive flexibility and processing of emotional information), to empathy. The cognitive and affective empathic response of patients with localized prefrontal lesions (n=36) was compared to responses of patients with parietal lesions (n=15) and healthy control subjects (n=19). Results indicate that patients with prefrontal lesions (especially those with lesions involving the orbitoprefrontal and medial regions) were significantly impaired in both cognitive and affective empathy as compared to parietal patients and healthy controls. When the damage was restricted to the prefrontal cortex, either left- or right-hemisphere lesions resulted in impaired empathy. However, when the lesion involved the right hemisphere, patients with parietal lesions were also impaired. The pattern of relationships between cognitive performance and empathy suggested dissociation between the cognitive correlates of affective and cognitive empathy.

Elucidating the Nature of Deregulated Semantic Cognition in Semantic Aphasia: Evidence for the Roles of Prefrontal and Temporo-parietal Cortices

Semantic cognition—semantically driven verbal and nonverbal behavior—is composed of at least two interactive principal components: conceptual representations and executive control processes that regulate and shape activation within the semantic system. Previous studies indicate that semantic dementia follows from a progressive yet specific degradation of conceptual knowledge. In contrast, multimodal semantic impairment in aphasic patients (semantic aphasia [SA]) reflects damage to the control component of semantic cognition [Jefferies, E., & Lambon Ralph, M. A. Semantic impairment in stroke aphasia versus semantic dementia: A case-series comparison. Brain, 129, 2132–2147, 2006]. The purpose of the present study was to examine the nature of the semantic control deficits in SA in detail for the first time. Seven patients with SA were tested on four comprehension and naming tasks that directly manipulated the requirement for executive control in different ways. In line with many theories of cognitive control, the SA patients demonstrated three core features of impaired control: (i) they exhibited poor on-line manipulation and exploration of semantic knowledge; (ii) they exhibited poor inhibition of strongly associated distractors; and (iii) they exhibited reduced ability to focus on or augment less dominant aspects of semantic information, although the knowledge itself remained and could be successfully cued by external constraints provided by the examiner. Our findings are consistent with the notion that the anterior temporal lobes are crucial for conceptual knowledge whereas the left prefrontal and temporo-parietal cortices, damaged in patients with SA, play a critical role in regulating semantic activation in a task-appropriate fashion.

Reward acts as a signal to control delay-period activity in delayed-response tasks

Prefrontal delay-period activity represents a neural mechanism for the active maintenance of information and needs to be controlled by some signal to appropriately operate working memory. To examine whether reward-delivery acts as this signal, the effects of delay-period activity in response to unexpected reward-delivery were examined by analyzing single-neuron activity recorded in the primate dorsolateral prefrontal cortex. Among neurons that showed delay-period activity, 34% showed inhibition of this activity in response to unexpected reward-delivery. The delay-period activity of these neurons was affected by the expectation of reward-delivery. The strength of the reward signal in controlling the delay-period activity is related to the strength of the effect of reward information on the delay-period activity. These results indicate that reward-delivery acts as a signal to control delay-period activity.

Repetitive transcranial magnetic stimulation of dorsolateral prefrontal cortex affects performance of the wisconsin card sorting task during provision of feedback

Early functional neuroimaging studies of tasks evaluating executive processes, such as the Wisconsin card sorting task (WCST), only assessed trials in blocks that may contain a large amount of different cognitive processes. More recently, we showed using event-related fMRI that the dorsolateral prefrontal cortex (DL-PFC) significantly increased activity during feedback but not matching periods of the WCST, consistent with its proposed role in the monitoring of information in working memory. Repetitive transcranial magnetic stimulation (rTMS) is a method that allows to disrupt processing within a given cortical region and to affect task performance for which this region is significantly solicited. Here we applied rTMS to test the hypothesis that the DL-PFC stimulation influences monitoring of working memory without interfering with other executive functions. We applied rTMS to the right DL-PFC and the vertex (control site) in different time points of the WCST. When rTMS was applied to the DL-PFC specifically during the period when subjects were receiving feedback regarding their previous response, WCST performance deteriorated, while rTMS did not affect performance during matching either when maintaining set or during set-shifting. This selective impairment of the DL-PFC is consistent with its proposed role in monitoring of events in working memory.

Abrupt transitions between prefrontal neural ensemble states accompany behavioral transitions during rule learning

One of the most intriguing aspects of adaptive behavior involves the inference of regularities and rules in ever-changing environments. Rules are often deduced through evidence-based learning which relies on the prefrontal cortex (PFC). This is a highly dynamic process, evolving trial by trial and therefore may not be adequately captured by averaging single-unit responses over numerous repetitions. Here, we employed advanced statistical techniques to visualize the trajectories of ensembles of simultaneously recorded medial PFC neurons on a trial-by-trial basis as rats deduced a novel rule in a set-shifting task. Neural populations formed clearly distinct and lasting representations of familiar and novel rules by entering unique network states. During rule acquisition, the recorded ensembles often exhibited abrupt transitions, rather than evolving continuously, in tight temporal relation to behavioral performance shifts. These results support the idea that rule learning is an evidence-based decision process, perhaps accompanied by moments of sudden insight.

Investigating relationships between cortical thickness and cognitive performance in patients with schizophrenia and healthy adults

Relationships between prefrontal and temporal lobe grey matter volumes as assessed by magnetic resonance imaging and neurocognitive test results have been reported in schizophrenia. This investigation aimed to localize brain regions where cortical thickness and neurocognitive performance were related, and investigate if such relationships might differ in schizophrenia patients and healthy controls. Sixty-seven patients with schizophrenia and 69 healthy controls were characterized by neurocognitive testing and by brain cortical thickness maps. Putative cortical thickness/cognitive score relationships were investigated with contrast analyses of general linear models for the combined sample. Regions in which relationships were present were further investigated for diagnostic interaction. In the combined sample, significant positive relationships were found between frontal, temporal and occipital regions and tests for verbal IQ, verbal learning and executive functions. Diagnostic interaction was found for the relationships between verbal IQ and the right temporo-occipital junction and the left middle occipital gyrus. In conclusion, the significant relationships between cortical thickness and neurocognitive performances were localized in brain areas known to be involved in cognition. The relationships were similar in patients and controls, except for the right temporo-occipital and left occipital cortical areas, indicating a disrupted structure-function relationship in patients with schizophrenia compared to healthy control subjects.

A neuropsychological study of personality: trait openness in relation to intelligence, fluency, and executive functioning

Openness is a personality trait that has been linked to intelligence and divergent thinking. DeYoung, Peterson, and Higgins (2005) theorized that trait Openness depends on dopamine function, especially in the prefrontal cortex. We tested their theory in 335 healthy adults by hypothesizing that individual differences in Openness would correlate more strongly with performance on tests of executive function than on tests of intelligence and fluency. However, Openness correlated more strongly with verbal/crystallized intelligence (Gc; r = .44) than with executive functioning (r = .16) and fluency (r = .24). Further, the partial correlation between Openness and Gc increased from r = .26 among young adults to r = .53 among elderly adults. These findings suggest that Openness is more closely associated with the acquisition of broad verbal intellectual skills and knowledge than with executive abilities localized to a specific brain region or neurotransmitter system.

Role for presupplementary motor area in inhibition of cognitive set interference

Proactive interference (PI), which is formed through repetition of certain behavior and lasts for a while, needs to be inhibited in order for subsequent behavior to prevail over the antecedent one. Although the inhibitory mechanisms in the pFC have been reported that are recruited long after one behavior is updated to another, very little is known about the inhibitory mechanisms that are recruited immediately after the update. The WCST was modified in the present fMRI study such that inhibition of PI could be examined both immediately after and long after update of behavior. Use of "dual-match" stimuli allowed us to compare two types of trials where inhibition of PI was and was not required (control and release trials, respectively). Significant activation was observed in the left pre-SMA during control versus release trials. The pre-SMA activation was selective to PI inhibition required immediately after update of behavior, which exhibited marked contrast to the left anterior prefrontal activation selective to PI inhibition required long after the update. These results reveal dissociable inhibitory mechanisms in these two regions that are recruited in the different temporal contexts of the inhibitory demands imposed during performance of the task.

Rule-dependent anticipatory activity in prefrontal neurons

The flexibility of the behavior of humans and other primates comes from the cognitive capability to use different behavioral modes depending on the contextual information. To investigate the neural mechanism of such a cognitive function, we trained monkeys to participate in a repeated category-outcome reversal. To perform the task efficiently, they had to explore and remember the relevant rule, i.e., which group of stimuli was associated with which outcome, and apply that rule to the visual cue in order to predict an outcome and select a response correctly. We recorded single-unit activity from the prefrontal cortex, including dorsolateral/ventrolateral prefrontal cortex and orbitofrontal cortex, and found that many neurons in these areas showed rule-dependent changes in activity during the trial and during the inter-trial-interval. The time period when a high proportion of neurons started to show rule-dependent activity was the precue period, and the typical activity pattern at that time was sustained and increasing firing towards the onset of the cue ("anticipatory" precue activity). The results indicate that the prefrontal cortex is involved in maintaining rule information in the short-term memory within and between trials and that the rule information is anticipatorily activated towards the onset of the task-relevant cue.

Basic mathematical rules are encoded by primate prefrontal cortex neurons

Mathematics is based on highly abstract principles, or rules, of how to structure, process, and evaluate numerical information. If and how mathematical rules can be represented by single neurons, however, has remained elusive. We therefore recorded the activity of individual prefrontal cortex (PFC) neurons in rhesus monkeys required to switch flexibly between "greater than" and "less than" rules. The monkeys performed this task with different numerical quantities and generalized to set sizes that had not been presented previously, indicating that they had learned an abstract mathematical principle. The most prevalent activity recorded from randomly selected PFC neurons reflected the mathematical rules; purely sensory- and memory-related activity was almost absent. These data show that single PFC neurons have the capacity to represent flexible operations on most abstract numerical quantities. Our findings support PFC network models implementing specific "rule-coding" units that control the flow of information between segregated input, memory, and output layers. We speculate that these neuronal circuits in the monkey lateral PFC could readily have been adopted in the course of primate evolution for syntactic processing of numbers in formalized mathematical systems.

Executive function and fluid intelligence after frontal lobe lesions

Many tests of specific 'executive functions' show deficits after frontal lobe lesions. These deficits appear on a background of reduced fluid intelligence, best measured with tests of novel problem solving. For a range of specific executive tests, we ask how far frontal deficits can be explained by a general fluid intelligence loss. For some widely used tests, e.g. Wisconsin Card Sorting, we find that fluid intelligence entirely explains frontal deficits. When patients and controls are matched on fluid intelligence, no further frontal deficit remains. For these tasks too, deficits are unrelated to lesion location within the frontal lobe. A second group of tasks, including tests of both cognitive (e.g. Hotel, Proverbs) and social (Faux Pas) function, shows a different pattern. Deficits are not fully explained by fluid intelligence and the data suggest association with lesions in the right anterior frontal cortex. Understanding of frontal lobe deficits may be clarified by separating reduced fluid intelligence, important in most or all tasks, from other more specific impairments and their associated regions of damage.

Emotion, cognition, and mental state representation in amygdala and prefrontal cortex

Neuroscientists have often described cognition and emotion as separable processes implemented by different regions of the brain, such as the amygdala for emotion and the prefrontal cortex for cognition. In this framework, functional interactions between the amygdala and prefrontal cortex mediate emotional influences on cognitive processes such as decision-making, as well as the cognitive regulation of emotion. However, neurons in these structures often have entangled representations, whereby single neurons encode multiple cognitive and emotional variables. Here we review studies using anatomical, lesion, and neurophysiological approaches to investigate the representation and utilization of cognitive and emotional parameters. We propose that these mental state parameters are inextricably linked and represented in dynamic neural networks composed of interconnected prefrontal and limbic brain structures. Future theoretical and experimental work is required to understand how these mental state representations form and how shifts between mental states occur, a critical feature of adaptive cognitive and emotional behavior.

Executive dysfunction and periventricular diffusion tensor changes in amnesic mild cognitive impairment and early Alzheimer's disease

Our aim in this study was to explore the neural substrates of executive function in frontal and nonfrontal white matter using diffusion tensor imaging (DTI). We studied the relationship between executive dysfunction and DTI measurements on 13 subjects with amnesic mild cognitive impairment (aMCI), 11 subjects with early Alzheimer's disease (AD), and 16 control subjects. All participants underwent an examination of their intelligence, memory, and executive function and were subjected to DTI. Both aMCI and early AD subjects showed executive function impairment with differential performance in frontal-related behaviors. Both aMCI and early AD subjects showed increased mean diffusivity in the genu of the corpus callosum and left frontal periventricular white matter (PVWM), whereas subjects with early AD showed an additional decrease in the fractional anisotropy of bilateral frontal PVWM and in the genu of the corpus callosum. The frontal PVWM was associated with performance on the Verbal Fluency Test, the Wisconsin Card Sorting Test (WCST), and Part B of the Trail Making Test. The parietal PVWM was associated with perseverative errors on the WCST and Part A of the Trail Making Test. In summary, executive function was impaired in subjects with aMCI and early AD and was associated with frontal and parietal PVWM changes. These changes may be due to early AD degeneration of the lateral cholinergic projections or to early change of the superior longitudinal fasciculus.

Executive Functions after Age 5: Changes and Correlates

Research and theorizing on executive function (EF) in childhood has been disproportionately focused on preschool age children. This review paper outlines the importance of examining EF throughout childhood, and even across the lifespan. First, examining EF in older children can address the question of whether EF is a unitary construct. The relations among the EF components, particularly as they are recruited for complex tasks, appear to change over the course of development. Second, much of the development of EF, especially working memory, shifting, and planning, occurs after age 5. Third, important applications of EF research concern the role of school-age children's EF in various aspects of school performance, as well as social functioning and emotional control. Future research needs to examine a more complete developmental span, from early childhood through late adulthood, in order to address developmental issues adequately.

Different impairments of semantic cognition in semantic dementia and semantic aphasia: evidence from the non-verbal domain

Disorders of semantic cognition in different neuropsychological conditions result from diverse areas of brain damage and may have different underlying causes. This study used a comparative case-series design to examine the hypothesis that relatively circumscribed bilateral atrophy of the anterior temporal lobe in semantic dementia (SD) produces a gradual degradation of core semantic representations, whilst a deficit of cognitive control produces multi-modal semantic impairment in a subset of patients with stroke aphasia following damage involving the left prefrontal cortex or regions in and around the temporoparietal area; this condition, which transcends traditional aphasia classifications, is referred to as 'semantic aphasia' (SA). There have been very few direct comparisons of these patient groups to date and these previous studies have focussed on verbal comprehension. This study used a battery of object-use tasks to extend this line of enquiry into the non-verbal domain for the first time. A group of seven SA patients were identified who failed both word and picture versions of a semantic association task. These patients were compared with eight SD cases. Both groups showed significant deficits in object use but these impairments were qualitatively different. Item familiarity correlated with performance on object-use tasks for the SD group, consistent with the view that core semantic representations are degrading in this condition. In contrast, the SA participants were insensitive to the familiarity of the objects. Further, while the SD patients performed consistently across tasks that tapped different aspects of knowledge and object use for the same items, the performance of the SA participants reflected the control requirements of the tasks. Single object use was relatively preserved in SA but performance on complex mechanical puzzles was substantially impaired. Similarly, the SA patients were able to complete straightforward item matching tasks, such as word-picture matching, but performed more poorly on associative picture-matching tasks, even when the tests involved the same items. The two groups of patients also showed a different pattern of errors in object use. SA patients made substantial numbers of erroneous intrusions in their demonstrations, such as inappropriate object movements. In contrast, response omissions were more common in SD. This study provides converging evidence for qualitatively different impairments of semantic cognition in SD and SA, and uniquely demonstrates this pattern in a non-verbal expressive domain-object use.

Dose-dependent frontal hypometabolism on FDG-PET in methamphetamine abusers

OBJECTIVE

Although a lot of evidence from neuropsychological and neuroimaging studies supports the view that patients with substance dependence have abnormalities in the prefrontal cortex, functional deficits in the prefrontal cortex have not been fully investigated in methamphetamine (MA) dependent patients. This study was prepared to examine whether MA abusers have cerebral metabolic abnormalities and executive dysfunction.

METHOD

Twenty-four abstinent MA dependent patients and 21 age-matched control subjects underwent resting brain FDG-PET and completed computerized versions of the Wisconsin card sorting test (WCST). Resting brain PET images were obtained 30min after an intravenous injection of 370MBq of (18)F-FDG. Significant differences in glucose metabolism were estimated for every voxel using t-statistics on SPM2 implemented in Matlab.

RESULTS

Resting brain FDG-PET revealed significant hypometabolism in the left inferior frontal white matter (Talairach coordinates (x, y, z): -34, 7, 31) in MA dependent patients compared to the control subjects (corrected p=0.001, peak Z=5.37, voxel number 201). The nearest gray matter region was the left inferior frontal cortex (Brodmann area 9). There were negative correlations between the relative regional cerebral metabolism for glucose (rCMRglc) in the left inferior frontal white matter and the total cumulative dose of MA (r=-0.57, p<0.01). MA dependent patients completed significantly fewer categories (3.8+/-2.2) and made more perseveration errors (21.3+/-11.8) and total errors (43.5+/-19.5) on the WCST when compared to the control subjects (p<0.01).

CONCLUSIONS

These data suggest that MA dependent patients have dose-dependent frontal hypometabolism and frontal executive dysfunction.

Perseveration related to frontal lesion in mice using the olfactory H-maze

The delayed reaction paradigm, consisting to discover two different rules consecutively (delayed alternation and non-alternation task) followed by a delayed reversal task, is a specific marker for the functioning of primate prefrontal cortex. Although several works in rodents report the use of operant delayed alternation tasks, in none of the studies mice with lesion of the prefrontal cortex were used in this paradigm. In the current study, mouse experiments were conducted using a new, totally automated device, the olfactory H-maze. Here, we show that unilateral lesion of the dorsomedial prefrontal cortex in mice induced similar deficits to those observed after frontal lesions in monkeys and humans. These pronounced learning deficits seem to come from difficulty elaborating a new rule and the inability to inhibit the previous rule, characterized by perseveration after prefrontal cortex lesion. The present results demonstrate that this very simple experimental paradigm using the olfactory H-maze presents the advantage to be fast (one training session) and well suited to assess the frontal functions in mice. It should be useful for testing pharmacological or stem cell approaches in order to reduce organic damages or gain insight into the cognitive functions of the frontal cortex using transgenic or gene-targeting mice.

Dissociable components of rule-guided behavior depend on distinct medial and prefrontal regions

Much of our behavior is guided by rules. Although human prefrontal cortex (PFC) and anterior cingulate cortex (ACC) are implicated in implementing rule-guided behavior, the crucial contributions made by different regions within these areas are not yet specified. In an attempt to bridge human neuropsychology and nonhuman primate neurophysiology, we report the effects of circumscribed lesions to macaque orbitofrontal cortex (OFC), principal sulcus (PS), superior dorsolateral PFC, ventrolateral PFC, or ACC sulcus, on separable cognitive components of a Wisconsin Card Sorting Test (WCST) analog. Only the PS lesions impaired maintenance of abstract rules in working memory; only the OFC lesions impaired rapid reward-based updating of representations of rule value; the ACC sulcus lesions impaired active reference to the value of recent choice-outcomes during rule-based decision-making.

Neuropsychological outcome and community re-integration following traumatic brain injury: The impact of frontal and non-frontal lesions

PRIMARY OBJECTIVE

To examine the relationship between cortical lesion location and brain injury outcome. It was hypothesized that focal frontal lesions after traumatic brain injury (TBI) would result in decreased executive and memory functioning and poor community participation outcome.

RESEARCH DESIGN

Three quasi-experimental, prospective studies employed a total of 643 patients with focal frontal, fronto-temporal, non-frontal or no lesions in CT scans.

METHODS AND PROCEDURES

CT scan analysis, neuropsychological assessment, the Neurobehavioural Functioning Inventory (NFI), the Community Integration Questionnaire (CIQ).

MAIN RESULTS

In study 1, frontal and fronto-temporal groups performed worse in executive functioning and better in constructional ability. Study 2 found no differences in neuropsychological and community re-integration measures at 1-year follow-up. Study 3 found comparable neuropsychological test score improvement across groups over 1 year.

CONCLUSIONS

Results are consistent with previous findings and document the potential for test score improvement with rehabilitation and suggest that lesion location needs to be considered when individual rehabilitation plans are being implemented in the post-acute stage of TBI.

Disentangling the prefrontal network for rule selection by means of a non-verbal variant of the Wisconsin Card Sorting Test

This study disentangles the prefrontal network underlying executive functions involved in the Wisconsin Card Sorting Test (WCST). During the WCST, subjects have to perform two key processes: first, they have to derive the correct sorting rule for each trial by trial-and-error, and, second, they have to detect when this sorting rule is changed by the investigator. Both cognitive processes constitute key components of the executive system, which is subserved by the prefrontal cortex. For the current fMRI experiment, we developed a non-verbal variant of the WCST. Subjects were instructed either to respond according to a given sorting rule or to detect the correct sorting rule, like in the original version of the WCST. Data were obtained from 14 healthy male volunteers and analysed using SPM and a random effects model. All conditions activated a fronto-parietal network, which was generally more active when subjects had to search for the correct sorting rule than when the rule was announced beforehand. Significant differences between these two conditions were seen in the dorsolateral prefrontal cortex (PFC) and the parietal lobe. In addition, the data provided new evidence for the assumption of differentiated roles of the left and right prefrontal cortex. Although the right PFC showed a general involvement in response selection and the execution of goal directed responses, based on given rules, the left PFC was only activated when inductive reasoning and feedback integration was required.

The Wisconsin Card Sorting Test and the cognitive assessment of prefrontal executive functions: a critical update

For over four decades the Wisconsin Card Sorting Test (WCST) has been one of the most distinctive tests of prefrontal function. Clinical research and recent brain imaging have brought into question the validity and specificity of this test as a marker of frontal dysfunction. Clinical studies with neurological patients have confirmed that, in its traditional form, the WCST fails to discriminate between frontal and non-frontal lesions. In addition, functional brain imaging studies show rapid and widespread activation across frontal and non-frontal brain regions during WCST performance. These studies suggest that the concept of an anatomically pure test of prefrontal function is not only empirically unattainable, but also theoretically inaccurate. The aim of the present review is to examine the causes of these criticisms and to resolve them by incorporating new methodological and conceptual advances in order to improve the construct validity of WCST scores and their relationship to prefrontal executive functions. We conclude that these objectives can be achieved by drawing on theory-guided experimental design, and on precise spatial and temporal sampling of brain activity, and then exemplify this using an integrative model of prefrontal function [i.e., Miller, E. K. (2000). The prefrontal cortex and cognitive control. Nature Reviews Neuroscience, 1, 59-65.] combined with the formal information theoretical approach to cognitive control [Koechlin, E., & Summerfield, C. (2007). An information theoretical approach to prefrontal executive function. Trends in Cognitive Sciences, 11, 229-235.].

Conflict-induced behavioural adjustment: a clue to the executive functions of the prefrontal cortex

The behavioural adjustment that follows the experience of conflict has been extensively studied in humans, leading to influential models of executive-control adjustment. Recent studies have revealed striking similarities in conflict-induced behavioural adjustment between humans and monkeys, indicating that monkeys can provide a model to study the underlying neural substrates and mechanisms of such behaviour. These studies have advanced our knowledge about the role of different prefrontal brain regions, including the anterior cingulate cortex (ACC) and the dorsolateral prefrontal cortex (DLPFC), in executive-control adjustment and suggest a pivotal role for the DLPFC in the dynamic tuning of executive control and, consequently, in behavioural adaptation to changing environments.

Increased dopamine release in the right anterior cingulate cortex during the performance of a sorting task: a [11C]FLB 457 PET study

There is clear evidence that the prefrontal cortex is strongly involved in executive processes and that dopamine can influence performance on working memory tasks. Although, some studies have emphasized the role of striatal dopamine in executive functions, the role played by prefrontal dopamine during executive tasks is unknown. In order to investigate cortical dopamine transmission during executive function, we used D(2)-dopamine receptor ligand [(11)C]FLB 457 PET in healthy subjects while performing the Montreal Card Sorting Task (MCST). During the retrieval with shift task of the MCST, the subjects had to match each test card to one of the reference cards based on a classification rule (color, shape or number) determined by comparing the previously viewed cue card and the current test card. A reduction in [(11)C]FLB 457 binding potential in the right dorsal anterior cingulate cortex (ACC) was observed when subjects performed the active task compared to the control task. These findings may suggest that right dorsal ACC dopamine neurotransmission increases significantly during the performance of certain executive processes, e.g., conflict monitoring, in keeping with previous evidence from fMRI studies showing ACC activation during similar tasks. These results may provide some insights on the origin of cognitive deficits underlying certain neurological disorders associated with dopamine dysfunction, such as Parkinson's disease and schizophrenia.

Using the Wisconsin Card Sorting Test to assess learning potential in normal IQ schizophrenia: does it have potential?

BACKGROUND

Learning potential, a dynamic multi-administration approach to assessment, is claimed to predict functional outcome in schizophrenia better than traditional single-administration neuropsychological tests.

AIMS

This study investigates the relation between learning potential and clinical and demographic variables, social functioning and neuropsychological abilities in a sample of 30 participants with schizophrenia with a mean IQ score within the normal range (mean Wechsler Abbreviated Scale of Intelligence (WASI) IQ=106).

METHODS

Two Wisconsin Card Sorting Test (WCST) based methods for assessing learning potential are compared.

RESULTS

The dimensional approach (calculation of gain scores following training) identified one aspect of executive functioning (set shifting) to be related to learning potential. Associations with other neuropsychological tests and social functioning were however limited. The categorical approach (separating high-achievers from learners and non-learners) was not sensitive within this normal IQ sample.

CONCLUSIONS

Although there seems to be a relation between learning potential and some aspects of executive functioning, the two existing WCST methods should be used with caution when assessing learning potential in individuals with schizophrenia who have IQ scores within the normal range.

Automatic and Flexible: The Case of Non-conscious Goal Pursuit

Arguing from the nature of goal pursuit and from the economy of mental resources this paper suggests that automatic goal pursuit, much like its controlled counterpart, may be flexible. Two studies that employ goal priming procedures examine this hypothesis using the Wisconsin Card Sorting Test (Study 1) and a variation of the Iowa Gambling Task (Study 2). Implications of the results for our understanding of the dichotomy between automatic and controlled processes in general, and for our conception of automatic goal pursuit in particular, are discussed.

Role of medial cortical, hippocampal and striatal interactions during cognitive set-shifting

To date, few studies have examined the functional connectivity of brain regions involved in complex executive function tasks, such as cognitive set-shifting. In this study, eighteen healthy volunteers performed a cognitive set-shifting task modified from the Wisconsin card sort test while undergoing functional magnetic resonance imaging. These modifications allowed better disambiguation between cognitive processes and revealed several novel findings: 1) peak activation in the caudate nuclei in the first instance of negative feedback signaling a shift in rule, 2) lowest caudate activation once the rule had been identified, 3) peak hippocampal activation once the identity of the rule had been established, and 4) decreased hippocampal activation during the generation of new rule candidates. This pattern of activation across cognitive set-shifting events suggests that the caudate nuclei play a role in response generation when the identity of the new rule is unknown. In contrast, the reciprocal pattern of hippocampal activation suggests that the hippocampi help consolidate knowledge about the correct stimulus-stimulus associations, associations that become inappropriate once the rule has changed. Functional connectivity analysis using Granger Causality Mapping revealed that caudate and hippocampal regions interacted indirectly via a circuit involving the medial orbitofrontal and posterior cingulate regions, which are known to bias attention towards stimuli based on expectations built up from task-related feedback. Taken together, the evidence suggests that these medial regions may mediate striato-hippocampal interactions and hence affect goal-directed attentional transitions from a response strategy based on stimulus-reward heuristics (caudate-dependent) to one based on stimulus-stimulus associations (hippocampus-dependent).

Theta burst stimulation-induced inhibition of dorsolateral prefrontal cortex reveals hemispheric asymmetry in striatal dopamine release during a set-shifting task: a TMS-[(11)C]raclopride PET study

The prefrontostriatal network is considered to play a key role in executive functions. Previous neuroimaging studies have shown that executive processes tested with card-sorting tasks requiring planning and set-shifting [e.g. Montreal-card-sorting-task (MCST)] may engage the dorsolateral prefrontal cortex (DLPFC) while inducing dopamine release in the striatum. However, functional imaging studies can only provide neuronal correlates of cognitive performance and cannot establish a causal relation between observed brain activity and task performance. In order to investigate the contribution of the DLPFC during set-shifting and its effect on the striatal dopaminergic system, we applied continuous theta burst stimulation (cTBS) to left and right DLPFC. Our aim was to transiently disrupt its function and to measure MCST performance and striatal dopamine release during [(11)C]raclopride PET. A significant hemispheric asymmetry was observed. cTBS of the left DLPFC impaired MCST performance and dopamine release in the ipsilateral caudate-anterior putamen and contralateral caudate nucleus, as compared to cTBS of the vertex (control). These effects appeared to be limited only to left DLPFC stimulation while right DLPFC stimulation did not influence task performance or [(11)C]raclopride binding potential in the striatum. This is the first study showing that cTBS, by disrupting left prefrontal function, may indirectly affect striatal dopamine neurotransmission during performance of executive tasks. This cTBS-induced regional prefrontal effect and modulation of the frontostriatal network may be important for understanding the contribution of hemisphere laterality and its neural bases with regard to executive functions, as well as for revealing the neurochemical substrate underlying cognitive deficits.

Behavioural assays to model cognitive and affective dimensions of depression and anxiety in rats

Animal models have been used extensively to investigate neuropsychiatric disorders, such as depression, and their treatment. However, the aetiology and pathophysiology of many such disorders are largely unknown, which makes validation of animal models particularly challenging. Furthermore, many diagnostic symptoms are difficult to define, operationalize and quantify, especially in experimental animals such as rats. Thus, rather than attempting to model complex human syndromes such as depression in their entirety, it can be more productive to define and model components of the illness that may account for clusters of co-varying symptoms, and that may share common underlying neurobiological mechanisms. In preclinical investigations of the neural regulatory mechanisms linking stress to depression and anxiety disorders, as well as the mechanisms by which chronic treatment with antidepressant drugs may exert their beneficial effects in these conditions, we have employed a number of behavioural tests in rats to model specific cognitive and anxiety-like components of depression and anxiety disorders. In the present study, we review the procedures for conducting four such behavioural assays: the attentional set-shifting test, the elevated-plus maze, the social interaction test and the shock-probe defensive burying test. The purpose is to serve as a guide to the utility and limitations of these tools, and as an aid in optimising their use and productivity.

Cognitive flexibility in preschoolers: the role of representation activation and maintenance

Preschoolers' lack of cognitive flexibility has often been attributed to perseverative processing. This study investigates alternative potential sources of difficulty such as deficits in activating previously ignored information and in maintaining currently relevant information. In Experiment 1, a new task tapping attentional switching was designed to isolate the difficulty of overriding an initial representation, that is, perseverative processing ('Perseveration' version), and the difficulty of activating a previously ignored representation, that is, activation deficit ('Activation-deficit' version). Three-year-olds' performance suggested that inflexibility may primarily stem from an activation deficit. Control experiments confirmed that the difficulty of the 'Activation-deficit' version could not be attributed to the effect of attraction to novelty. In Experiment 2, 'distraction' errors, alleged to reflect a failure to maintain a relevant representation, and 'perseverative' errors were distinguished. The results highlighted the important role of representation maintenance in flexibility. The present study indicates that preschoolers' lack of cognitive flexibility is multi-determined and prompts us to reconsider the role of perseveration.

Mapping task switching in frontal cortex through neuropsychological group studies

This paper considers evidence provided by large neuropsychological group studies and meta-analyses of functional imaging experiments on the location in frontal cortex of the subprocesses involved in the carrying out of task-switching paradigms. The function of the individual subprocesses is also considered in the light of analyses of the performance of normal subjects.

Differential prefrontal-like deficit in children after cerebellar astrocytoma and medulloblastoma tumor

Background

This study was realized thanks to the collaboration of children and adolescents who had been resected from cerebellar tumors. The medulloblastoma group (CE+, n = 7) in addition to surgery received radiation and chemotherapy. The astrocytoma group (CE, n = 13) did not receive additional treatments. Each clinical group was compared in their executive functioning with a paired control group (n = 12). The performances of the clinical groups with respect to controls were compared considering the tumor's localization (vermis or hemisphere) and the affectation (or not) of the dentate nucleus. Executive variables were correlated with the age at surgery, the time between surgery-evaluation and the resected volume.

Methods

The executive functioning was assessed by means of WCST, Complex Rey Figure, Controlled Oral Word Association Test (letter and animal categories), Digits span (WISC-R verbal scale) and Stroop test. These tests are very sensitive to dorsolateral PFC and/or to medial frontal cortex functions. The scores for the non-verbal Raven IQ were also obtained. Direct scores were corrected by age and transformed in standard scores using normative data. The neuropsychological evaluation was made at 3.25 (SD = 2.74) years from surgery in CE group and at 6.47 (SD = 2.77) in CE+ group.

Results

The Medulloblastoma group showed severe executive deficit (≤ 1.5 SD below normal mean) in all assessed tests, the most severe occurring in vermal patients. The Astrocytoma group also showed executive deficits in digits span, semantic fluency (animal category) and moderate to slight deficit in Stroop (word and colour) tests. In the astrocytoma group, the tumor's localization and dentate affectation showed different profile and level of impairment: moderate to slight for vermal and hemispheric patients respectively. The resected volume, age at surgery and the time between surgery-evaluation correlated with some neuropsychological executive variables.

Conclusion

Results suggest a differential prefrontal-like deficit due to cerebellar lesions and/or cerebellar-frontal diaschisis, as indicate the results in astrocytoma group (without treatments), that also can be generated and/or increased by treatments in the medulloblastoma group. The need for differential rehabilitation strategies for specific clinical groups is remarked. The results are also discussed in the context of the Cerebellar Cognitive Affective Syndrome.

Neuropsychological function-brain structure relationships and stage of illness: an investigation into chronic and first-episode schizophrenia

Neuropsychological function-brain structure relationships may differ as a function of illness stage because of progressive brain matter loss through the course of schizophrenia. In this study, we tested whether neuropsychological function-brain structure relationships differed as a function of illness stage. In addition, we tested whether these relationships differed between older and young healthy controls. Function-structure relationships were examined in 35 first-episode patients (31 with schizophrenia, 4 with schizoaffective disorder), 54 chronic schizophrenia patients, 21 older healthy controls and 20 young healthy controls. MRI volumes of frontal and temporal lobe structures, as well as the whole brain, were estimated using a region-of-interest approach. Hierarchical multiple regression analyses were performed between the MRI and neuropsychological measures. Stronger relationships of immediate memory-total prefrontal cortex (PFC) volume in chronic than first-episode patients, and in older than young controls were observed. The abstract reasoning (WCST perseverative errors)-total temporal lobe volume relationship was stronger in older than young controls. These function-structure relationships appeared unexplained by whole brain volume or age in chronic patients. A similar dissociation between young and older subjects of both healthy and patient groups suggests that a 'bigger-is-better' relationship style is present in older individuals regardless of a diagnosis of schizophrenia.

Multiple effects of prefrontal lesions on task-switching

This study examined the performance of 41 patients with focal prefrontal cortical lesions and 38 healthy controls on a task-switching procedure. Three different conditions were evaluated: single tasks without switches and two switching tasks with the currently relevant task signalled either 1500 ms (Long Cue) or 200 ms (Short Cue) before the stimulus. Patients with Superior Medial lesions showed both a general slowing of reaction time (RT) and a significantly increased switch cost as measured by RT. No other prefrontal group showed this increased reaction time switch cost. Increased error rates in the switching conditions, on the other hand, were observed in patients with Inferior Medial lesions and, to a lesser extent, ones with Superior Medial lesions. Patients with left dorsolateral lesions (9/46v) showed slower learning of the task as indicated by a high error rate early on. Several different processes are involved in task-switching and these are selectively disrupted by lesions to specific areas of the frontal lobes.

Cognitive function in the locked-in syndrome

OBJECTIVE

The lockedin syndrome (LIS) originates from a ventro-pontine lesion resulting in a complete quadraplegia and anarthria. Classically, communication remains possible by means of spared vertical eye movements and/or blinking. To allow assessing cognitive functions in LIS patients, we propose here a neuropsychological testing based on eye-coded communication.

METHODS

Ten chronic LIS survivors were assessed 1 to 6 years after their brain insult. One patient was evaluated subacutely (at 2 months) and retested at 6 and 16 months. Neuropsychological testing encompassed short- and long-term memory, attention, executive functioning, phonological and semantic processing and verbal intelligence.

RESULTS

None of the patients showed alterations in verbal intelligence. Impairments in one or several tests were found in five patients. In three of these patients, neuropsychological deficits could be related to additional cortical or thalamic structural brain lesions. In the other 2 patients, weakness or signs of fatigue only were observed in one or two cognitive tasks. Repeated measures in a subacute patient with pure brainstem lesion indicate the recovery of good levels of cognition 6 months after injury.

CONCLUSION

Results indicate that LIS patients can recover intact cognitive levels in cases of pure brainstem lesions, and that additional brain injuries are most likely responsible for associated cognitive deficits in the LIS. Furthermore, a systematic neuropsychological assessment in LIS patients would allow detecting their cognitive deficits,which will contribute to improve their quality of life and of communication with family and medical caretakers.

Independent Cognitive Effects of Atrophy and Diffuse Subcortical and Thalamico-Cortical Cerebrovascular Disease in Dementia

Background and Purpose— Brain atrophy, cortical infarction, and subcortical ischemic vasculopathy have all been associated with cognitive dysfunction. The interrelationships between these pathologies and their independent contributions to cognitive function remain unclear. Despite the high frequency of Alzheimer disease (AD) in those with clinically diagnosed vascular dementia, and the frequent findings of vascular disease in those with clinically diagnosed AD, many studies of brain-behavior relationships in dementia consider these populations separately. The present study sought to identify the correlates of independent domains of cognitive impairment in an unselected sample across a large range of severity and overlap of AD and VaD.

Methods— Two hundred five individuals from the Sunnybrook Dementia Study recruited from a university Memory clinic had detailed neuropsychological testing and MRI quantification using a multi-step postprocessing algorithm. A factor analysis of the cognitive protocol yielded a 3-factor solution, provisionally labeled: (1) short-term memory and language, (2) attention and working memory, and (3) mental flexibility.

Results— A factor analysis of brain measures identified 3 independent factors with measures of (1) brain atrophy, (2) subcortical vascular disease, and (3) strategic infarcts (anterior-medial thalamus and cortical infarcts). After accounting for the effects of age and education, measures of brain atrophy were the strongest correlates of all cognitive domains. Small vessel disease was independently associated with general severity, impaired short-term memory/language, and reduced mental flexibility, but not with poor working memory, presumably through disruption of frontal-subcortical connections. In contrast, strategic infarcts to anterior-medial thalamus and cortical gray matter were associated with poor short-term and working memory, but not with impairments in mental flexibility or global severity measures.

Conclusions— These data support the hypothesis that the thalamico-cortical network subserves both short-term and working memory. The findings also suggest that each type of pathology (atrophy, small vessel disease, and strategic infarcts) contribute independently to the pattern of cognitive disabilities associated with dementia. Particular attention to cerebrovascular disease in deep white or gray matter structures of the thalamico-cortical system is certainly warranted.

Impact of coexistent schizotypal personality traits on frontal lobe function in obsessive-compulsive disorder

OBJECTIVE

This study was a post-hoc analysis of the results from a neuropsychological battery which was conducted to investigate the frontal lobe difference between obsessive-compulsive disorder (OCD) patients with and without schizotypal personality trait (SPT), especially dorsolateral prefrontal and medial frontal functions.

METHODS

Fifty-five OCD patients were divided into two groups according to their Personality Disorder Questionnaire-4+ scores. Patients with OCD with SPT (n=17) and OCD without SPT (n=38) were compared to 52 schizophrenia patients and 67 healthy subjects. Two neuropsychological tasks, the Wisconsin Card Sorting Test (WCST) and verbal fluency tests which are considered to reflect dorsolateral and medial frontal functions, were selected for an analysis.

RESULTS

OCD with SPT patients and patients with schizophrenia performed significantly worse than controls in both the WCST and verbal fluency tasks, whereas OCD without SPT patients showed no deficits in the same tasks. Moreover, we found no statistically significant difference in either task between patients having OCD with SPT and patients with schizophrenia.

CONCLUSION

This study indicate that OCD with SPT may have distinct patterns of neurocognitive deficit that differ from those of OCD without SPT, especially in terms of frontal lobe function.

Inactivation of the medial prefrontal cortex of the rat impairs strategy set-shifting, but not reversal learning, using a novel, automated procedure

The medial prefrontal cortex (mPFC) of the rat plays an essential role in behavioral flexibility, as lesions or inactivations of this region impair shifting between strategies or attentional sets using a variety of different behavioral tests. In the present study, we assessed the effects of inactivation of the mPFC on strategy set-shifting and reversal learning, using a novel, automated procedure conducted in an operant chamber. In Experiment 1, inactivation of the mPFC with bupivacaine did not impair the initial learning of a visual-cue (i.e.; always press the lever with a cue light illuminated above it) or a response (i.e.; always press the left lever) discrimination. Control rats required greater number of trials to shift from using a visual-cue to a response strategy than the opposite shift. mPFC inactivation impaired performance of a visual-cue-response set-shift, but not the easier response-visual-cue shift. In Experiment 2, pre-exposure to the visual-cue stimulus lights increased the difficulty of the response-visual-cue shift, reflected by a greater number of trials required by control rats to achieve criterion relative to those in Experiment 1. Under these conditions, inactivation of the mPFC did impair performance of this set-shift. In contrast, mPFC inactivation did not affect reversal learning of a response discrimination. These findings highlight the utility of this automated procedure for assessing set-shifting mediated by the mPFC. Furthermore, they reveal that the relative difficulty of the type of shift rats are required to perform has a direct impact on whether or not the mPFC contributes to this form of behavioral flexibility.

Does lateral parietal cortex support episodic memory? Evidence from focal lesion patients

Although neuroimaging and human lesion studies agree that the medial parietal region plays a critical role in episodic memory, many neuroimaging studies have also implicated lateral parietal cortex, leading some researchers to suggest that the lateral region plays a heretofore underappreciated role in episodic memory. Because there are very few extant lesion data on this matter, we examined memory in six cases of focal lateral parietal damage, using both clinical and experimental measures, in which we distinguished between recollection and familiarity. The patients did not have amnesia, but they did show evidence of disrupted recollection on an anterograde memory task. Although the exact mechanisms remain to be elucidated, lateral parietal damage appears to impair some aspects of episodic memory.

Deficits of knowledge versus executive control in semantic cognition: insights from cued naming

Deficits of semantic cognition in semantic dementia and in aphasia consequent on CVA (stroke) are qualitatively different. Patients with semantic dementia are characterised by progressive degradation of central semantic representations, whereas multimodal semantic deficits in stroke aphasia reflect impairment of executive processes that help to direct and control semantic activation in a task-appropriate fashion [Jefferies, E., & Lambon Ralph, M. A. (2006). Semantic impairment in stroke aphasia vs. semantic dementia: A case-series comparison. Brain 129, 2132-2147]. We explored interactions between these two aspects of semantic cognition by examining the effects of cumulative phonemic cueing on picture naming in case series of these two types of patient. The stroke aphasic patients with multimodal semantic deficits cued very readily and demonstrated near-perfect name retrieval when cumulative phonemic cues reached or exceeded the target name's uniqueness point. Therefore, knowledge of the picture names was largely intact for the aphasic patients, but they were unable to retrieve this information without cues that helped to direct activation towards the target response. Equivalent phonemic cues engendered significant but much more limited benefit to the semantic dementia patients: their naming was still severely impaired even when most of the word had been provided. In contrast to the pattern in the stroke aphasia group, successful cueing was mainly confined to the more familiar un-named pictures. We propose that this limited cueing effect in semantic dementia follows from the fact that concepts deteriorate in a graded fashion [Rogers, T. T., Lambon Ralph, M. A., Garrard, P., Bozeat, S., McClelland, J. L., & Hodges, J. R., et al. (2004). The structure and deterioration of semantic memory: A neuropsychological and computational investigation. Psychological Review 111, 205-235]. For partially degraded items, the residual conceptual knowledge may be insufficient to drive speech production to completion but these items might reach threshold when they are bolstered by cues.

Chronic unpredictable stress induces a cognitive deficit and anxiety-like behavior in rats that is prevented by chronic antidepressant drug treatment

Chronic stress is a risk factor for the development of many psychopathological conditions in humans, including major depression and anxiety disorders. There is a high degree of comorbidity of depression and anxiety. Moreover, cognitive impairments associated with frontal lobe dysfunction, including deficits in cognitive set-shifting and behavioral flexibility, are increasingly recognized as major components of depression, anxiety disorders, and other stress-related psychiatric illnesses. To begin to understand the neurobiological mechanisms underlying the cognitive and emotional consequences of chronic stress, it is necessary to employ an animal model that exhibits similar effects. In the present study, a rat model of chronic unpredictable stress (CUS) consistently induced a cognitive impairment in extradimensional set shifting capability in an attentional set shifting test, suggesting an alteration in function of the medial prefrontal cortex. CUS also increased anxiety-like behavior on the elevated plus-maze. Further, chronic treatment both with the selective norepinephrine reuptake blocker, desipramine (7.5 mg/kg/day), and the selective serotonin reuptake blocker, escitalopram (10 mg/kg/day), beginning 1 week before CUS treatment and continuing through the behavioral testing period, prevented the CUS-induced deficit in extradimensional set-shifting. Chronic desipramine treatment also prevented the CUS-induced increase in anxiety-like behavioral reactivity on the plus-maze, but escitalopram was less effective on this measure. Thus, CUS induced both cognitive and emotional disturbances that are similar to components of major depression and anxiety disorders. These effects were prevented by chronic treatment with antidepressant drugs, consistent also with clinical evidence that relapse of depressive episodes can be prevented by antidepressant drug treatment.

The multiple dimensions of sustained attention

Sustained counting (or temporal numerosity judgements) has been one of the key means of investigating anterior attentional processes. Forty-three patients with localised lesions to the frontal lobes were assessed on two tests of the ability to count the number (8-22) of stimuli presented at either a slow (roughly one per 3 sec) or fast (roughly three per sec) rate. Patients with lesions to the Superior Medial (SM) region (particularly Brodmann areas 24, 32, and 9) were impaired both in the Slow condition and also in the Fast condition, where they underestimated the number of stimuli. Patients with Right Lateral (RL) lesions (8, 45, and 46) also had difficulties in the Fast condition, especially when the number of targets was greater than 15. The results are considered from the perspectives of alternative positions on anterior attentional processes developed by Posner and Petersen (1990) and by Stuss et al. (1995). The most plausible interpretation is in terms of energising processes which involve the SM frontal cortex and monitoring processes which involve the RL frontal cortex.