Neuropsychological Functions Neuropsychological Functions of the prefrontal cortexof the prefrontal cortex

김홍근대구대학교 재활심리학과

OverviewOverview

Prefrontal executive functionPrefrontal executive functionRegional prefrontal syndromesRegional prefrontal syndromesNeuropsychological assessment Neuropsychological assessment

of prefrontal syndromesof prefrontal syndromes

The prefrontal lobe as “the seat of the The prefrontal lobe as “the seat of the highest human mentality”highest human mentality”

Phylogenetic perspectivePhylogenetic perspectiveOntogenetic perspectiveOntogenetic perspectiveAnatomical perspectiveAnatomical perspectiveNeuropsychological perspectiveNeuropsychological perspective

Phylogenetic perspective: Phylogenetic perspective: Species differences in prefrontal cortexSpecies differences in prefrontal cortex

Ontogenetic perspective:Ontogenetic perspective:Late maturation of prefrontal cortexLate maturation of prefrontal cortex

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33

22

22

2211

11

11

( 출처 : 연세의대 신경해부학 / 조직학 website)

Anatomical perspective: Anatomical perspective: Extensive prefrontal lobe connectionsExtensive prefrontal lobe connections

( 출처 : 연세의대 신경해부학 / 조직학 website)

Neuropsychological perspective:Neuropsychological perspective:Phineas Gage Phineas Gage (accident in 1848)(accident in 1848)

( 출처 : 연세의대 신경해부학 / 조직학 website)

Prefrontal function: Prefrontal function: Early descriptionsEarly descriptions

Personality (Harlow, 1868)Personality (Harlow, 1868)Abstract attitude (Goldstein, 1927)Abstract attitude (Goldstein, 1927)Mental set (Jacobsen, 1935)Mental set (Jacobsen, 1935)Self-regulation (Luria, 1962)Self-regulation (Luria, 1962)Concept formation (Milner, 1964)Concept formation (Milner, 1964)

Prefrontal function: Prefrontal function: Recent descriptionsRecent descriptions

Supervisory mental processSupervisory mental processCognitive flexibilityCognitive flexibilityMeta-cognitionMeta-cognitionGoal-directed behaviorGoal-directed behaviorExecutive functionExecutive function

An example of an executiveAn example of an executive

A model of prefrontal executive functionA model of prefrontal executive function

Memory

Attention

Language Spatial PrExecutive

Function

The regional prefrontal syndromesThe regional prefrontal syndromes(Cummings, 1985)(Cummings, 1985)

Dorsolateral Orbitofrontal

Mesial frontal

Core hypothesesCore hypotheses

Anatomical

area

Function Syndrometype

DorsolateralDorsolateral CognitionCognition DisorganizedDisorganized

OrbitofrontalOrbitofrontal EmotionEmotion Disinhibited Disinhibited

Mesial frontalMesial frontal MotivationMotivation Apathetic Apathetic

Dorsolateral syndromeDorsolateral syndrome(Disorganized type)(Disorganized type)

Poor judgmentPoor judgmentConcrete thinkingConcrete thinkingLack of insightLack of insightPoor planningPoor planningcognitive cognitive

inflexibilityinflexibility

Orbitofrontal syndromeOrbitofrontal syndrome (Disinhibited type)(Disinhibited type)

Social misbehaviorSocial misbehaviorPoor impulse controlPoor impulse controlEmotional labilityEmotional labilityHypersexualityHypersexualityStimulus-driven Stimulus-driven

behaviorbehavior

Mesial frontal syndromeMesial frontal syndrome (Apathetic type)(Apathetic type)

Poor initiativePoor initiativeDiminished verbal Diminished verbal

output & motor output & motor behaviorbehavior

Akinetic mutismAkinetic mutismUrinary incontinenceUrinary incontinence

Neuropsychological assessment of Neuropsychological assessment of prefrontal syndromes: Overviewprefrontal syndromes: Overview

WAIS: Poor sensitivityWAIS: Poor sensitivityMMPI: Poor response validityMMPI: Poor response validitySpecialized tests are neededSpecialized tests are neededEXIT (EXecutive Intelligence Test)EXIT (EXecutive Intelligence Test)

(Kim, 2001)(Kim, 2001)

EXIT (EXecutive Intelligence Test) EXIT (EXecutive Intelligence Test)

NormNorm 16~19, 20~24, 25~34, 16~19, 20~24, 25~34, 35~44, 45~54, 55~64 yrs35~44, 45~54, 55~64 yrs

Adm timeAdm time 25 minutes25 minutesScoreScore EIQ (Executive IQ)EIQ (Executive IQ)SubtestsSubtestsStroop testStroop test

Verbal fluency Verbal fluency Design fluencyDesign fluencyRey AVLTRey AVLT

Stroop testStroop test

파랑 노랑 빨강 검정

빨강 검정 파랑 노랑

노랑 빨강 파랑 검정

Verbal fluencyVerbal fluency

사람 사모사랑하는 감정

사랑하니까 사랑사랑 사주 팔자

사과 나무 사과사춘기

사람 사주사랑이 불타는 나무

Design fluencyDesign fluency

Rey AVLTRey AVLT

RecallRecall

내가 불러 줬던 내가 불러 줬던 단어들을 단어들을 기억해서 기억해서 말하시오말하시오

RecognitionRecognition

내가 불러 줬던 내가 불러 줬던 단어들을 다음 단어들을 다음 에서 고르시오에서 고르시오

Core features of EXIT as Core features of EXIT as a psychometric instrumenta psychometric instrument

Multi-task approachMulti-task approachUnstructured testingUnstructured testingUse of control testsUse of control testsQualitative scoringQualitative scoringNormative M=100, SD=15Normative M=100, SD=15

The rationale for prefrontal pathology The rationale for prefrontal pathology in schizophreniain schizophrenia

Disorganized thinking, speech, Disorganized thinking, speech, & behavior& behavior

Disordered dopamine systemsDisordered dopamine systemsPrefrontal metabolic deficitPrefrontal metabolic deficit

A validity study of EXITA validity study of EXIT

SampleSample Schizophrenic pts: n=45Schizophrenic pts: n=45

Normal controls: n=27Normal controls: n=27MeasureMeasure WAIS: VIQ, PIQ, FIQ WAIS: VIQ, PIQ, FIQ

EXIT: EIQEXIT: EIQHypothesisHypothesis Largest group-difference Largest group-difference

in EIQin EIQ

Schizophrenic pts vs Normal controlsSchizophrenic pts vs Normal controls

70

80

90

100

110

VIQ PIQ FIQ EIQ

NormalsSchizos

Case 1: Frontal head injuryCase 1: Frontal head injury

10399 101

56

50

60

70

80

90

100

110

VIQ PIQ FIQ EIQ

Male, 29 yrsMale, 29 yrsPolicemanPolicemanCar accident Car accident

6 months ago6 months agoPersonality Personality

deterioration deteriorationDisorganized Disorganized behavior behavior

Case 2: Parkinson’s diseaseCase 2: Parkinson’s disease

99 100 100

73

60

70

80

90

100

110

VIQ PIQ FIQ EIQ

Female, 63 yrsFemale, 63 yrsHousewifeHousewifeParkinson-like Parkinson-like

symptom onset: symptom onset: 3.5 yrs ago3.5 yrs ago

Progressive Progressive deteriorationdeterioration

Case 3: Korsakoff’s diseaseCase 3: Korsakoff’s disease

91

8387

49

40

50

60

70

80

90

100

VIQ PIQ FIQ EIQ

Female, 39 yrsFemale, 39 yrsHousewifeHousewifeHeavy alcohol Heavy alcohol

ingestion ingestion during last 4 yrsduring last 4 yrs

Physical weaknessPhysical weaknessMental confusionMental confusion

Case 4: Carbon monoxide poisoningCase 4: Carbon monoxide poisoning

94 92 93

49

40

50

60

70

80

90

100

VIQ PIQ FIQ EIQ

Male, 36 yrsMale, 36 yrsUnemployedUnemployedHeart attack Heart attack

6 months ago6 months agoRestlessnessRestlessness

Stimulus-driven Stimulus-driven behavior behavior

SummarySummary

Prefrontal lobe as the central Prefrontal lobe as the central executiveexecutive

3 types of regional prefrontal 3 types of regional prefrontal syndromessyndromes

EXIT (EXecutive Intelligence Test)EXIT (EXecutive Intelligence Test)