A selective and critical review of neuropsychological deficits and the frontal lobes

Abstract

Presumptions about the functions of the frontal lobes, and the sensitivity and specificity of certain tests to measure frontal lobe functions, are having a substantial influence on both clinical and research conclusions. In this paper the authors examine the details of the studies that have contributed to these presumptions, and find that the evidence to support these conclusions is weak. A detailed evaluation of the evidence relating to the Wisconsin Card Sorting Test and the Thurstone Word Fluency Test is also presented. Finally, the development of the belief that frontal lobe functions can be specifically measured is reviewed. The authors of this paper conclude that the "bewildering array" of deficits attributed to frontal lesions still seems to prevail.

The role of prefrontal cortex in working-memory capacity, executive attention, and general fluid intelligence: An individual-differences perspective

“…Fluency results should be interpreted with some caution, for, as Reitan and Wolfson (1994) indicate, few studies screen subjects for dysphasic symptoms, and so dysphasic disturbances may contribute to the left-hemisphere deficits seen in the literature. However, 133 Xe-inhalation, PET, and f MRI imaging data from healthy right-handed subjects corroborate the neuropsychological findings.…”

“…However, more recent data now provide mixed support for an association between WCST performance and dPFC structures (for reviews, see Mountain & Snow, 1993;Reitan & Wolfson, 1994). For example, relative to patients with posterior damage, patients with PFC damage are sometimes unimpaired on the WCST (see, e.g., Anderson, Damasio, Jones, & Tranel, 1991;Corcoran & Upton, 1993;Grafman, Jonas, & Salazar, 1990) and are sometimes impaired (see, e.g., Drewe, 1974;Milner, 1963;Nelson, 1976).…”

A Meta-Analytic Review of Verbal Fluency Performance Following Focal Cortical Lesions.

“…It has been noted that WCST-CC, although a widely used measure, has failed to consistently differentiate patients with frontal insult from healthy controls (Axelrod, Goldman, Heaton, & Curtiss, 1996;Crawford & Henry, in press;Mountain & Snow, 1993;R. M. Reitan & Wolfson, 1994).…”

Aging and source monitoring: Cognitive processes and neuropsychological correlates.

“…Furthermore, there may be age-related changes in performance on such tests independent of specific neuropathology in these particular brain regions (e.g., Reitan & Wolfson, 1994;Salthouse, Fristoe, & Rhee, 1996). Nevertheless, these tests are commonly used clinically, and thus it is of interest to determine with which specific aspects of episodic memory (e.g., old-new recognition, source identification) they are correlated.…”