Abstract
The orbitofrontal cortex (OFC) plays a crucial role in behavior and is a common site for damage due to different types of injuries, e.g., closed head injuries, cerebrovascular accidents, tumors, neurosurgical interventions. Despite the (severe) behavioral changes following OFC lesions, persons with damage to the OFC appear to be cognitively intact, i.e., at least when assessed by means of standard neuropsychological tests. Meanwhile, neuropsychological tests addressing reversal learning, gambling, and social cognition show a decline in these patients. The goal of the present review is to link the performance of these latter neuropsychological tests to behavior. The results suggest that in patients with orbitofrontal lesions, reversal learning is more associated with behavioral disinhibition and that impairment in recognition of expressed emotion is more associated with social inappropriate behavior. The faux pas test (theory of mind) appears not to be sensitive to orbitofrontal lesions. Future studies should involve a larger numbers of patients with well-defined locations in the OFC and should integrate specific neuropsychological tests and quantitative behavioral measures to better understand the contribution of the OFC to cognition and behavior.
About the authors
F.A. Jonker recieved his master of arts (MA) in 2000 in clinical psychology. He became a general mental healthcare psychologist (GZ-psychologist) in 2006. From 2008 he worked in a mental health institute for neuropsychiatry (Vesalius), sub-department of mental health institute Altrecht (the Netherlands). He became a specialist in clinical neuropsychology in 2012 and is head of the department. Since 2013 he is also is a researcher at the VU University Amsterdam (the Netherlands), department of Clinical Neuropsychology, specialist on the interaction between brain injury and behavior.
Cees Jonker received his graduation as neurologist in 1975 and specialized in behavioral neurology. He became a staff member on a neuropsychiatric institute, after that he was appointed at the Alzheimer Center at the VU University. In 1986 he defended his PhD thesis on Senile Dementia on Alzheimertype. From 1989–1994 he was scientific director of the Amsterdam Study on the Elderly (AMSTEL), a large-scale population-based study on cognitive decline and dementia. From 1995 he was associate professor at the LASA study and in 2001 he was appointed a professor in Diagnosis and Treatment of Dementia. He was honoured for his scientific work by the Dutch Psychiatric Association in 1987.
Philip Scheltens received his MD in 1984 at VU University and became a staff neurologist in 1991. He defended his PhD thesis on MRI in Alzheimer’s disease in 1993 and was appointed a Professor of Cognitive Neurology in 2000. From that time on he led the Alzheimer Center which grew into the largest in the Netherlands under his leadership in terms of patient care and research. He was honored with a membership of the Royal Academy of Arts and Sciences in 2011.
Erik Scherder is head of the department clinical Neuropsychology and full professor at the VU University Amsterdam (the Netherlands). Furthermore he is full professor for Human Movement Sciences at the Rijksuniversiteit Groningen (the Netherlands). Currently, he is conducting research on pain experience in people with neurodegenerative diseases.
Acknowledgments
F.A.J. would like to express his deep gratitude to E.J.A. Scherder, C. Jonker, and P. Scheltens, his research supervisors, for their patient guidance, enthusiastic encouragement, and critical revision of the manuscript for important intellectual content. He would also like to thank GGZ Altrecht, Vesalius Centre for Neuropsychiatry; Department of Clinical Neuropsychology, VU University; Alzheimer Centre and Department of Neurology, VU University Medical Center for their financial supporter on this research project.
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