The impact of extensive medial frontal lobe damage on 'Theory of Mind' and cognition
The impact of extensive medial frontal lobe damage on 'Theory of Mind' and cognition
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DOI：
10.1093/brain/awh108
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发表时间：
2004-04-01
期刊：
影响因子：
14.5
通讯作者：
Husain, M
中科院分区：
文献类型：
--
作者：
Bird, CM;Castelli, F;Husain, M
人类通过将诸如欲望和信念等独立的心理状态归因于他人来预测和解释他人行为的能力，被认为是源于我们构建“心理理论”的能力。最近，一些神经影像学研究表明，内侧额叶在人类大脑中一个专门的“心理化”或“心理理论”网络中起着关键作用。在此，我们报告一位患者G.T.，她患有一种极其罕见的中风——双侧大脑前动脉梗死，没有破裂或与前交通动脉瘤相关的并发症。详细的高分辨率神经解剖学研究显示双侧内侧额叶广泛受损，包括通过对健康人类受试者进行功能神经影像学研究确定的对“心理理论”至关重要的区域。我们首次对这样一位患者进行了全面的认知状况评估，关键的是，对她在一系列“心理理论”测试中的表现进行了实验性研究。G.T.患有执行功能障碍综合征，其特征是计划和记忆受损，以及有虚构的倾向。然而，重要的是，她在探测其构建“心理理论”能力的任务上没有任何明显的损伤，这表明她因中风而受损的广泛内侧额叶区域对这一功能并非必不可少。这些发现对“心理理论”的功能解剖学以及我们对内侧额叶功能的理解具有重要意义。我们讨论了我们的结果与神经影像学研究之间差异的可能原因。我们得出结论，我们的发现提醒人们要谨慎，不要将功能成像作为确定认知神经解剖学的唯一方法。
The ability of humans to predict and explain other people's behaviour by attributing to them independent mental states, such as desires and beliefs, is considered to be due to our ability to construct a 'Theory of Mind'. Recently, several neuroimaging studies have implicated the medial frontal lobes as playing a critical role in a dedicated 'mentalizing' or 'Theory of Mind' network in human brains. Here, we report a patient, G.T., who suffered an exceptionally rare form of stroke-bilateral anterior cerebral artery infarction, without rupture or the complications associated with anterior communicating artery aneurysms. Detailed high-resolution neuroanatomical investigations revealed extensive damage to the medial frontal lobes bilaterally, including regions identified to be critical for 'Theory of Mind' by functional neuroimaging of healthy human subjects. For the first time in such a patient, we carried out a thorough assessment of her cognitive profile including, critically, an experimental investigation of her performance on a range of tests of 'Theory of Mind'. G.T. had a dysexecutive syndrome characterized by impairments in planning and memory, as well as a tendency to confabulate. Importantly, however, she did not have any significant impairment on tasks probing her ability to construct a 'Theory of Mind', demonstrating that the extensive medial frontal regions destroyed by her stroke are not necessary for this function. These findings have important implications for the functional anatomy of 'Theory of Mind', as well as our understanding of medial frontal function. Possible reasons for the discrepancies between our results and neuroimaging studies are discussed. We conclude that our findings urge caution against using functional imaging as the sole method of establishing cognitive neuroanatomy.