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Regional frontal injuries cause distinct impairments in cognitive control

From Behavioral Neurology (M.P.A.), Beth Israel Deaconess Medical Center, and Harvard Medical School (M.P.A.), Boston, MA; Rotman Research Institute of Baycrest (M.P.A., D.T.S., T.P., T.S., S.G.) and University of Toronto (D.T.S., T.P.), Ontario, Canada; SISSA (T.S.), Trieste, Italy; and Institute of Cognitive Neuroscience (T.S.), London, UK.

Address correspondence and reprint requests to Dr Alexander, Beth Israel Deaconess Medical Center, BNU, KS 253, 330 Brookline Ave., Boston, MA 02215 malexand{at}bidmc.harvard.edu

Background: Lesions of the frontal lobes may impair the capacity of patients to control otherwise intact cognitive operations in the face of ambiguous sensory input or conflicting possible responses.

Objective: To address the question of whether focal lesions in different regions of the frontal lobes produced specific impairments in cognitive control.

Methods: We evaluated 42 patients with chronic frontal lesions and 38 control subjects on a modified Stroop test that allowed measurement of reaction times and errors. Planned, stratified analyses permitted identification of discrete frontal lesions that are critical for impaired performance.

Results: Lesions of the left ventrolateral region produced an increased number of incorrect responses to distractors. Lesions of a large portion of the right superior medial region, including anterior cingulate, supplementary motor area (SMA), pre-SMA, and dorsolateral areas, caused a slow reaction time and a decreased number of correct responses to targets.

Conclusion: Lesions in two distinct frontal regions impair cognitive control for a Stroop task, and the mechanisms of impairment are specific to the region of injury. This is support for a general proposal that the supervisory system is constructed of distinct subsystems.

See also page 1450

Received May 9, 2006. Accepted in final form February 7, 2007.

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