Publicación en la Revista Internacional de Neuropsychological de la sociedad
Enviado por laxdark • 30 de Octubre de 2014 • Tutoriales • 6.847 Palabras (28 Páginas) • 219 Visitas
Journal of the International Neuropsychological Society (2013), 19, 1–12.
Copyright E INS. Published by Cambridge University Press, 2013.
doi:10.1017/S135561771300060X
1 Neuroanatomical Correlates of Executive Functions:
2 A Neuropsychological Approach Using the EXAMINER
3 Battery
4 Heather Robinson,1 Matthew Calamia,1 Jan Gla¨scher,2 Joel Bruss,3
AND Daniel Tranel1,3
5 1Department of Psychology, University of Iowa, Iowa City, Iowa
6 2Department for Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
7 3Department of Neurology, Division of Behavioral Neurology and Cognitive Neuroscience, University of Iowa College of Medicine,
8 Iowa City, Iowa
9 (RECEIVED January 15, 2013; FINAL REVISION May 4, 2013; ACCEPTED May 6, 2013)
10 Abstract
11 Executive functions (EF) encompass a variety of higher-order capacities such as judgment, planning, decision-making,
12 response monitoring, insight, and self-regulation. Measuring such abilities quantitatively and establishing their neural
13 correlates has proven to be challenging. Here, using a lesion-deficit approach, we report the neural correlates of a variety
14 of EF tests that were developed under the auspices of the NINDS-supported EXAMINER project (Kramer, 2011;
15 www.examiner.ucsf.edu). We administered a diverse set of EF tasks that tap three general domains—cognitive, social/
16 emotional, and insight—to 37 patients with focal lesions to the frontal lobes, and 25 patients with lesions outside the
17 frontal lobes. Using voxel-based lesion-symptom mapping (VLSM), we found that damage to the ventromedial prefrontal
18 cortex (vmPFC) was predominately associated with deficits in social/emotional aspects of EF, while damage to
19 dorsolateral prefrontal cortex (dlPFC) and anterior cingulate was predominately associated with deficits in cognitive
20 aspects of EF. Evidence for an important role of some non-frontal regions (e.g., the temporal poles) in some aspects of
21 EF was also found. The results provide further evidence for the neural basis of EF, and extend previous findings of the
22 dissociation between the roles of the ventromedial and dorsolateral prefrontal sectors in organizing, implementing, and
23 monitoring goal-directed behavior. (JINS, 2013, 19, 1–12) 24
25 Keywords: Insight, Self-monitoring, FrSBe, Lesion, Cognitive control, Empathy
26 INTRODUCTION
27 Executive functioning (EF) is a broad term encompassing
28 domains such as volition, planning and decision-making,
29 purposive action, self-regulation, and effective performance
30 (Lezak, Howieson, Bigler, & Tranel, 2012). Although a diverse
31 set of brain regions are involved in executive functioning, the
32 frontal lobes are considered to provide the principal neural
33 substrate (e.g., Stuss, 2011; Stuss & Knight, 2002). Within the
34 frontal lobes, the division between the dorsolateral prefrontal
35 cortex (dlPFC) and the ventromedial prefrontal cortex (vmPFC)
36 is critical in understanding two distinct types of abilities sub-
37 sumed under the term executive functioning: ‘‘metacognitive
38 executive functions’’ and ‘‘emotional/motivational executive
39 functions,’’ respectively (Ardila, 2008; Stuss, 2011).
Metacognitive executive functions are those which organize 40
and monitor goal-directed behavior. These functions include 41
abilities assessed by traditional clinical and laboratory measures 42
of executive functioning (e.g., planning, response inhibition, 43
working memory) (Ardila, 2008). Various structural models 44
of these metacognitive functions have been proposed in 45
the literature. For example, Latzman and Markon (2010) 46
identified a three factor structure (‘‘conceptual flexibility,’’ 47
‘‘monitoring,’’ ‘‘inhibition’’) for scores on the Delis-Kaplan 48
Executive Function System (D-KEFS). This structure is 49
similar to a three-factor model (‘‘shifting,’’ ‘‘updating,’’ 50
‘‘inhibition’’) found using a different set of executive 51
functioning measures (Miyake et al., 2000). 52
In a lesion study of popular neuropsychological measures 53
of these ‘‘metacognitive’’ types of executive functions 54
(e.g., Wisconsin Card Sorting Test, Controlled Oral Word 55
Association Test), a relationship between deficits in these 56
functions and damage to the dlPFC and anterior cingulate 57
was found (Gla¨scher et al., 2012). This is consistent with a 58
Correspondence and reprint requests to: Daniel Tranel, Department of
Neurology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive,
Iowa City, Iowa 52242. E-mail:
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