Unilateral frontal lobectomy can produce strategy application disorder.

Goldstein, Laura H.; Bernard, Sophie; Fenwick, Peter; Burgess, Paul W.; McNeil, Jane E.

doi:10.1136/jnnp.56.3.274

Cited by 97 publications

(67 citation statements)

References 9 publications

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“…This claim is consistent with both lesion and imaging data. At least five recent case studies (reviewed in Burgess, in press) have presented frontal lobe patients with an anatomical and neuropsychological profile similar to PF (Eslinger & Damasio, 1985;Goldstein, Bernard, Fenwick, Burgess, & McNeil, 1993;Shallice & Burgess, 1991b). Like PF, these patients had difficulty in coping with real-world (ill-structured) situations despite high IQ.…”

Section: Discussionmentioning

confidence: 99%

Role of the Right Prefrontal Cortex in Ill-Structured Planning

Goel

Grafman

2000

Cognitive Neuropsychology

167

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We tested an architect with a lesion to the right prefrontal cortex in a real-world architectural design/ planning task that required him to develop a new design for our lab space and compared his performance to an age-and education-matched architect.The patient understood the task and even observed that "this is a very simple problem." His sophisticated architectural knowledge base was still intact and he used it quite skilfully during the problem structuring phase. However, the patient's problem-solving behaviour differed from the control's behaviour in the following ways: (1) he was unable to make the transition from problem structuring to problem solving; (2) as a result preliminary design did not start until two thirds of the way into the session; (3) the preliminary design phase was minimal and erratic, consisting of three independently generated fragments; (4) there was no progression or lateral development of these fragments; (5) there was no carryover of abstract information into the preliminary design or later phases, and (6) the patient did not make it to the detailing phase. This suggests that the key to understanding our patient's deficit is to understand the cognitive processes and mechanisms involved in the preliminary design phase.We appeal to a theory of design problem solving (Goel, 1995) that associates cognitive processes involved in preliminary design with "lateral" state transformations and argues that "ill-structured" representational and computational systems are necessary to support these transformations. We conclude that the neural basis of this system is selectively damaged in our patient.

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Section: Discussionmentioning

confidence: 99%

Role of the Right Prefrontal Cortex in Ill-Structured Planning

Goel

Grafman

2000

Cognitive Neuropsychology

167

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“…Rule breaks could depend on prospective and retrospective memory, 12,33 as our results confirmed (significant correlation between rule breaks and DRS memory subscale), but also on planning capacities, consideration of internal signals acting as triggers for voluntary changes, and correct reevaluation of goals. 17,33,34 As for the number of subtasks, it could be linked to the inability to strategically plan, organize, and update current information, and to monitor ongoing performance. 33 A study by Alderman et al 35 with brain-injured participants showed 2 patterns of failure (number of rule breaks or failure to initiate tasks) in the simplified version of the Multiple Shopping Errands Test (The Multiple Shopping Errands Test, a ''real-life'' multitasking test carried out in a shopping center, requires the participant to buy specific things, obtain some information, be in a particular place at a particular time, and follow several rules while doing these things 35 ).…”

Section: Discussionmentioning

confidence: 99%

“…15 Studies have shown low correlations between the SET and traditional laboratory executive tests, whereas there are strong correlations between the SET and multitasking deficits in daily life. 17 This suggests that disabilities in situations involving multitasking are not reflected in performance on tests of executive functions that do not involve multitasking. Currently, a simplified version of the SET is commonly used, the Modified Six Elements Task (MSET).…”

mentioning

confidence: 99%

“…Specifically, it requires the capacity to create, maintain, and activate delayed intentions, as the right time to switch to a given task is not signalled by the situation. 15 From this perspective, the inability to create or consider internal signals that act prospectively as triggers for the initiation of behavior, 17 as well as the inability to flexibly allocate attention toward internal and external information, 14 may explain poor performance on the MSET and reduced GDB. A recent study highlighted a strong relationship between poorer performance on the MSET and a series of externalizing behavior changes in traumatic brain injury patients (eg, irritability and lack of planning), but also, to a lesser extent, with internalizing changes such as depression.…”

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confidence: 99%

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Apathy and Executive Dysfunction in Alzheimer Disease

Esposito

Rochat

Linden

et al. 2010

Alzheimer Disease &Amp; Associated Disorders

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Apathy, defined as a reduction in voluntary goal-directed behaviors, is one of the most common behavioral symptoms encountered in Alzheimer disease (AD). However, the processes underlying the different components of apathy are still unclear. The aim of this study was to explore a particularly important aspect of executive function in daily life: multitasking [assessed with the Modified Six Elements Task (MSET)], and its relationship with apathy in AD. Sixty-seven participants (37 AD patients matched with 30 control participants) were screened using the MSET. Simultaneously, a close relative of each patient was given the Apathy Inventory, which assesses 3 distinct dimensions of apathy (lack of initiative, lack of interest, and emotional blunting). AD patients presented significantly more multitasking deficits than control participants. In addition, regression analyses revealed that the number of rule breaks on the MSET (inability to perform several tasks in a predefined time observing a number of rules) was the best predictor of apathy, and especially of lack of initiative. These results suggest that the relation between lack of initiative and multitasking has a specific character and that mechanisms underlying multitasking constitute a key component of goal-directed behaviors.

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“…Since then, these tasks (and various modifications) have been utilized by a number of researchers to investigate executive functioning in normals and various patient populations (e.g., Alderman, Burgess, Knight, & Henman, 2003;Channon & Crawford, 1999;Duncan, Johnson, Swales, & Freer, 1997;Goel & Grafman, 2000;Goldstein, Bernard, Fenwick, Burgess, & McNeil, 1993;Jelicic, Henquet, Derix, & Jolles, 2001;Kafer & Hunter, 1997;Kliegel, McDaniel, & Einstein, 2000;Knight, Alderman, & Burgess, 2002;Levine, Dawson, Boutet, Schwartz, & Stuss, 2000a;Levine et al, in press Levine et al, 1998;Wilson et al, 1998), especially with an eye to rehabilitation planning (e.g., Levine et al, 2000b;Manly, Hawkins, Evans, Woldt, & Robertson, 2002). By now, there are consistent findings supporting the conclusion that these tasks are useful to characterize and quantify executive functioning deficits, and Burgess and his colleagues have made a convincing argument that "strategy application" types of task may be superior to traditional clinical neuropsychological tests (e.g., Wisconsin Card Sorting Test, WCST; Tower of London) at probing "real-world" deficits in executive functioning (Burgess et al, 2006).…”

Section: Introductionmentioning

confidence: 99%

Impaired behavior on real-world tasks following damage to the ventromedial prefrontal cortex

Tranel

Hathaway-Nepple

Anderson

2007

Journal of Clinical and Experimental Neuropsychology

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Patients with damage to the ventromedial prefrontal cortices (VMPC) commonly manifest blatant behavioral navigation defects in the real world, but it has been difficult to measure these impairments in the clinic or laboratory. Using a set of "strategy application" tasks, which were designed by Shallice and Burgess (1991) to be ecologically valid for detecting executive dysfunction, we investigated the hypothesis that VMPC damage would be associated with defective performance on such tasks, whereas damage outside the VMPC region would not. A group of 9 patients with bilateral VMPC damage was contrasted with comparison groups of participants with (a) prefrontal brain damage outside the VMPC region (n=8); (b) nonprefrontal brain damage (n=17); and (c) no brain damage (n=20). We found support for the hypothesis: VMPC patients had more impaired performances on the strategy application tasks, especially on a Multiple Errands Test that required patients to execute a series of unstructured tasks in a real-world setting (shopping mall). The results are consistent with the notion that efficacious behavioral navigation is dependent on the VMPC region. However, the strategy application tasks were relatively time consuming and effortful, and their diagnostic yield over and above conventional executive functioning tests may not be sufficient to warrant their inclusion in standard clinical assessment.

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Unilateral frontal lobectomy can produce strategy application disorder.

Cited by 97 publications

References 9 publications

Role of the Right Prefrontal Cortex in Ill-Structured Planning

Role of the Right Prefrontal Cortex in Ill-Structured Planning

Apathy and Executive Dysfunction in Alzheimer Disease

Impaired behavior on real-world tasks following damage to the ventromedial prefrontal cortex

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