Assessing the elusive cognitive deficits associated with ventromedial prefrontal damage: A case of a modern-day Phineas Gage
Assessing the elusive cognitive deficits associated with ventromedial prefrontal damage: A case of a modern-day Phineas Gage
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DOI：
10.1017/s1355617704103123
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发表时间：
2004-05-01
影响因子：
2.6
通讯作者：
Bigler, E
中科院分区：
文献类型：
--
作者：
Cato, MA;Delis, DC;Bigler, E
腹内侧前额叶损伤（VM-PFD）后的认知缺陷一直难以捉摸，大多数研究主要报告情绪和行为变化。本病例说明了评估VM-PFD后认知缺陷的过程方法的实用性。在26岁时，C.D.获得双侧VM-PFD，在左额叶区域更甚，在穿透性头部损伤之后。尽管病态前的学术和军事表现堪称典范，但他后来的经历却显示出戏剧性的职业和社会变化，让人想起菲尼亚斯·盖奇（Phineas Gage）。事实上，损伤分析显示了与Gage估计的相似的结构损伤。西里尔·戴彼第在绝大多数神经心理学测试中，他的得分都在平均到优异之间（例如，言语智商= 119）。然而，在几个新的过程测量中，特别是那些量化多层次执行功能和记忆任务的错误率的测量，cd表现出明显的损伤。从他的缺陷模式来看，C.D.似乎为了速度而牺牲了准确性，并采取了自由的反应策略，这暗示了认知不灵活、冲动和去抑制的问题。目前的研究结果表明，VM-PFD可能与认知缺陷的范围比以前所描述的更广泛。
Cognitive deficits following ventromedial prefrontal damage (VM-PFD) have been elusive, with most studies reporting primarily emotional and behavioral changes. The present case illustrates the utility of a process approach to assessing cognitive deficits following VM-PFD. At age 26, C.D. acquired bilateral VM-PFD, more so in the left frontal region, following a penetrating head injury. Despite exemplary premorbid academic and military performances, his subsequent history suggests dramatic occupational and social changes, reminiscent of Phineas Gage. In fact, lesion analysis revealed similar structural damage to that estimated of Gage. C.D.'s scores on the vast majority of neuropsychological measures were average to superior (e.g., Verbal IQ = 119). However, on several new process measures, particularly those that quantify error rates on multilevel executive function and memory tasks, C.D. exhibited marked impairments. From his pattern of deficits, C.D. appeared to sacrifice accuracy for speed and to adopt liberal response strategies, implicating problems with cognitive inflexibility, impulsivity, and disinhibition. The current findings suggest that VM-PFD may be associated with a wider spectrum of cognitive deficits than previously characterized.