Normal memory and no confabulation after extensive damage to the orbitofrontal cortex

The bridge between cognition and behavior in acquired brain injury: A graph theoretical approach

BACKGROUND

The assumption is that executive dysfunctions (EF), associated with frontal lobe injury, are responsible for behavioral disturbances. Some studies do not find a relationship between EF and behavior following frontal lobe lesions. Our main goal of this study was to use a novel statistical method, graph theory, to analyze this relationship in different brain injury groups; frontal lobe damage, non-frontal lobe damage, and controls. Within the frontal group, we expect to find a pattern of executive nodes that are highly interconnected.

METHODS

For each group, we modeled the relationship between executive functions and behavior as a network of interdependent variables. The cognitive tests and the behavioral questionnaire are the "nodes" in the network, while the relationships between the nodes were modeled as the correlations between two nodes corrected for the correlation with all other nodes in the network. Sparse networks were estimated within each group using graphical LASSO. We analyzed the relative importance of the nodes within a network (centrality) and the clustering (modularity) of the different nodes.

RESULTS

Network analysis showed distinct patterns of relationships between EF and behavior in the three subgroups. The performance on the verbal learning test is the most central node in all the networks. In the frontal group, verbal memory forms a community with working memory and fluency. The behavioral nodes do not differentiate between groups or form clusters with cognitive nodes. No other communities were found for cognitive and behavioral nodes.

CONCLUSION

The cognitive phenotype of the frontal lobe damaged group, with its stability and proportion, might be theoretically interpreted as a potential "buffer" for possible cognitive executive deficits. This might explain some of the ambiguity found in the literature. This alternative approach on cognitive test scores provides a different and possibly complimentary perspective of the neuropsychology of brain-injured patients.

The limbic-reticular coupling theory of memory processing in the brain and its greater compatibility over other theories

The limbic-reticular coupling theory suggests that the hippocampus and amygdala regulate such descending limbic structures as the mammillary bodies, septum, hypothalamus and epithalamus to regulate the ascending noradrenergic, serotonergic, dopaminergic and cholinergic systems, performing declarative memory consolidation and recall. Recent studies have revealed that, less sensitive to familiarity, the hippocampus functions via the fornix, mammillary bodies and hypothalamus for memory recall. Lesions to the thalamic nuclei were complicated with damage to adjacent fornix, stria medullaris and habenula, simultaneously destroying two kinds of structures respectively for familiarity and recall. Furthermore, the orbitofrontal cortex was shown to be clinically irrelevant for memory recall. Electrophysiologically, the hippocampus regulates the raphe nuclei in complex ways, and the hippocampal theta wave activates the dopaminergic cells in ventral tegmental area and cholinergic neurons in basal forebrain, while cholinergic-modulated theta-gamma coupling mediates cortical recall. These concurrent advances support the limbic-reticular coupling theory for elucidation of memory recall.

The role of the orbitofrontal cortex in cognition and behavior

The orbitofrontal cortex (OFC) plays a crucial role in behavior and is a common site for damage due to different types of injuries, e.g., closed head injuries, cerebrovascular accidents, tumors, neurosurgical interventions. Despite the (severe) behavioral changes following OFC lesions, persons with damage to the OFC appear to be cognitively intact, i.e., at least when assessed by means of standard neuropsychological tests. Meanwhile, neuropsychological tests addressing reversal learning, gambling, and social cognition show a decline in these patients. The goal of the present review is to link the performance of these latter neuropsychological tests to behavior. The results suggest that in patients with orbitofrontal lesions, reversal learning is more associated with behavioral disinhibition and that impairment in recognition of expressed emotion is more associated with social inappropriate behavior. The faux pas test (theory of mind) appears not to be sensitive to orbitofrontal lesions. Future studies should involve a larger numbers of patients with well-defined locations in the OFC and should integrate specific neuropsychological tests and quantitative behavioral measures to better understand the contribution of the OFC to cognition and behavior.

MR imaging of subcallosal artery infarct causing amnesia after surgery for anterior communicating artery aneurysm

BACKGROUND AND PURPOSE

During surgery to treat an aneurysm in the anterior communicating artery, injury to the subcallosal artery, a perforator of the anterior communicating artery, may lead to infarction that produces basal forebrain amnesia after surgery. Our purpose was to examine whether 3D MR imaging can detect subcallosal artery infarction in patients with amnesia after surgery for an anterior communicating artery aneurysm.

MATERIALS AND METHODS

We evaluated 3D-T2-weighted MR images obtained a median of 4 months after treatment of anterior communicating artery aneurysm for the presence of infarcted foci in 10 consecutive patients with postoperative amnesia. Because the subcallosal artery and its neighboring perforator, the recurrent artery of Heubner, were considered the most easily affected vessels during that surgery, we focused mainly on 8 regions of the subcallosal artery territory per hemisphere and 5 regions of the recurrent artery of Heubner territory per hemisphere.

RESULTS

All 10 patients had infarcts in the territory of the subcallosal artery (median, 9 regions per patient), and most were bilateral (9 of 10 patients). Five patients had additional infarcted foci in the territory of the recurrent artery of Heubner (median, 1 region per patient), all unilateral. Among the regions perfused by the subcallosal artery, the column of the fornix was involved in all patients; the anterior commissure, in 9; and the paraterminal gyrus, in 8 patients.

CONCLUSIONS

3D MR imaging revealed subcallosal artery infarction, the distribution of which was mostly bilateral, presumably owing to the unpairedness of that artery, in patients with postoperative amnesia after anterior communicating artery aneurysm repair.

Olfactory impairment is correlated with confabulation in alcoholism: towards a multimodal testing of orbitofrontal cortex

BACKGROUND

Olfactory abilities are now a flourishing field in psychiatry research. As the orbitofrontal cortex appears to be simultaneously implicated in odour processing and executive impairments, it has been proposed that olfaction could constitute a cognitive marker of psychiatric states. While this assumption appears promising, very few studies have been conducted on this topic among psychopathological populations. The present study thus aimed at exploring the links between olfaction and executive functions. These links were evaluated using two tasks of comparable difficulty, one known to rely on orbitofrontal cortex processing (i.e., a confabulation task), and one not associated with this area (i.e., Stop-Signal task).

METHODOLOGY/PRINCIPAL FINDINGS

Twenty recently detoxified alcoholic individuals and twenty paired controls took part in an experiment evaluating olfactory abilities and executive functioning (i.e., Stop-Signal task and confabulation task). Comorbidities and potential biasing variables were also controlled for. Alcoholic individuals exhibited impaired performance for high-level olfactory processing and significant confabulation problems as compared to controls (but no deficit in Stop-Signal task), even when the influence of comorbidities was taken into account. Most importantly, olfactory abilities and confabulation rates were significantly correlated in both groups.

CONCLUSIONS/SIGNIFICANCE

Alcoholism jointly leads to olfactory and memory source impairments, and these two categories of deficits are associated. These results strongly support the proposition that olfactory and confabulation measures both index orbitofrontal functioning, and suggest that olfaction could become a reliable cognitive marker in psychiatric disorders. Moreover, it underlines the need to take into account these olfactory and source memory impairments in a clinical context.

Neurological and neurobehavioral assessment of experimental subarachnoid hemorrhage

About 50% of humans with aneurysmal subarachnoid hemorrhage (SAH) die and many survivors have neurological and neurobehavioral dysfunction. Animal studies usually focused on cerebral vasospasm and sometimes neuronal injury. The difference in endpoints may contribute to lack of translation of treatments effective in animals to humans. We reviewed prior animal studies of SAH to determine what neurological and neurobehavioral endpoints had been used, whether they differentiated between appropriate controls and animals with SAH, whether treatment effects were reported and whether they correlated with vasospasm. Only a few studies in rats examined learning and memory. It is concluded that more studies are needed to fully characterize neurobehavioral performance in animals with SAH and assess effects of treatment.

Entorhinal cortex of the monkey: IV. Topographical and laminar organization of cortical afferents

The nonhuman primate entorhinal cortex is the primary interface for information flow between the neocortex and the hippocampal formation. Based on previous retrograde tracer studies, neocortical afferents to the macaque monkey entorhinal cortex originate largely in polysensory cortical association areas. However, the topographical and laminar distributions of cortical inputs to the entorhinal cortex have not yet been comprehensively described. The present study examines the regional and laminar termination of projections within the entorhinal cortex arising from different cortical areas. The study is based on a library of 51 (3)H-amino acid injections that involve most of the afferent regions of the entorhinal cortex. The range of termination patterns was broad. Some areas, such as the medial portion of orbitofrontal area 13 and parahippocampal areas TF and TH, project widely within the entorhinal cortex. Other areas have a more focal and regionally selective termination. The lateral orbitofrontal, insular, anterior cingulate, and perirhinal cortices, for example, project only to rostral levels of the entorhinal cortex. The upper bank of the superior temporal sulcus projects mainly to intermediate levels of the entorhinal cortex, and the parietal and retrosplenial cortices project to caudal levels. The projections from some of these cortical regions preferentially terminate in the superficial layers (I-III) of the entorhinal cortex, whereas others project more heavily to the deep layers (V-VI). Thus, some of the cortical inputs may be more influential on the cortically directed outputs of the hippocampal formation or on gating neocortical information flow into the other fields of the hippocampal formation rather than contributing to the perforant path inputs to other hippocampal fields.