1. Neuropsychological Functions of the prefrontal cortex 김홍근 대구대학교 재활심리학과

2. Overview  Prefrontal executive function  Regional prefrontal syndromes  Neuropsychological assessment of prefrontal syndromes

3. The prefrontal lobe as “the seat of the highest human mentality”  Phylogenetic perspective  Ontogenetic perspective  Anatomical perspective  Neuropsychological perspective

4. Phylogenetic perspective: Species differences in prefrontal cortex

5. Ontogenetic perspective: Late maturation of prefrontal cortex 3 3 3 2 2 2 1 1 1 ( 출처 : 연세의대 신경해부학 / 조직학 website)

6. Anatomical perspective: Extensive prefrontal lobe connections ( 출처 : 연세의대 신경해부학 / 조직학 website)

7. Neuropsychological perspective: Phineas Gage (accident in 1848) ( 출처 : 연세의대 신경해부학 / 조직학 website)

8. Prefrontal function: Early descriptions  Personality (Harlow, 1868)  Abstract attitude (Goldstein, 1927)  Mental set (Jacobsen, 1935)  Self-regulation (Luria, 1962)  Concept formation (Milner, 1964)

9. Prefrontal function: Recent descriptions  Supervisory mental process  Cognitive flexibility  Meta-cognition  Goal-directed behavior  Executive function

10. An example of an executive

11. A model of prefrontal executive function Memory Attention LanguageSpatial Pr Executive Function

12. The regional prefrontal syndromes (Cummings, 1985) DorsolateralOrbitofrontal Mesial frontal

13. Core hypotheses Anatomical area FunctionSyndrome type DorsolateralCognitionDisorganized OrbitofrontalEmotionDisinhibited Mesial frontal MotivationApathetic

14. Dorsolateral syndrome (Disorganized type)  Poor judgment  Concrete thinking  Lack of insight  Poor planning  cognitive inflexibility

15. Orbitofrontal syndrome (Disinhibited type)  Social misbehavior  Poor impulse control  Emotional lability  Hypersexuality  Stimulus-driven behavior

16. Mesial frontal syndrome (Apathetic type)  Poor initiative  Diminished verbal output & motor behavior  Akinetic mutism  Urinary incontinence

17. Neuropsychological assessment of prefrontal syndromes: Overview  WAIS: Poor sensitivity  MMPI: Poor response validity  Specialized tests are needed  EXIT (EXecutive Intelligence Test) (Kim, 2001)

18. EXIT (EXecutive Intelligence Test)  Norm16~19, 20~24, 25~34, 35~44, 45~54, 55~64 yrs  Adm time25 minutes  ScoreEIQ (Executive IQ)  SubtestsStroop test Verbal fluency Design fluency Rey AVLT

19. Stroop test 파랑노랑빨강검정 빨강검정파랑노랑 노랑빨강파랑검정

20. Verbal fluency 사람사모사랑 하는 감정 사랑하니까사랑사랑사주 팔자 사과 나무사과사춘 기 사람사주사랑 이 불타는 나무

21. Design fluency

22. Rey AVLT  Recall 내가 불러 줬던 단어들을 기억 해서 말하시오  Recognition 내가 불러 줬던 단어들을 다음 에서 고르시오

23. Core features of EXIT as a psychometric instrument  Multi-task approach  Unstructured testing  Use of control tests  Qualitative scoring  Normative M=100, SD=15

24. The rationale for prefrontal pathology in schizophrenia  Disorganized thinking, speech, & behavior  Disordered dopamine systems  Prefrontal metabolic deficit

25. A validity study of EXIT  SampleSchizophrenic pts: n=45 Normal controls: n=27 Normal controls: n=27  Measure WAIS: VIQ, PIQ, FIQ EXIT: EIQ  HypothesisLargest group-difference in EIQ

26. Schizophrenic pts vs Normal controls

27. Case 1: Frontal head injury  Male, 29 yrs  Policeman  Car accident 6 months ago  Personality deterioration Disorganized behavior

28. Case 2: Parkinson’s disease  Female, 63 yrs  Housewife  Parkinson-like symptom onset: 3.5 yrs ago  Progressive deterioration

29. Case 3: Korsakoff’s disease  Female, 39 yrs  Housewife  Heavy alcohol ingestion during last 4 yrs  Physical weakness Mental confusion

30. Case 4: Carbon monoxide poisoning  Male, 36 yrs  Unemployed  Heart attack 6 months ago  Restlessness Stimulus-driven behavior

31. Summary  Prefrontal lobe as the central executive  3 types of regional prefrontal syndromes  EXIT (EXecutive Intelligence Test)