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Clinicometabolic dissociation of cognitive functions and social behavior in frontal lobe lesions

From Service Hospitalier Frédéric Joliot (Drs. Sarazin and Samson), CEA, Orsay, France; INSERM U 289 and Fédération de Neurologie (Drs. Pillon, Giannakopoulos, and Dubois); and Urgences Cerebro-vasculaires (Drs. Rancurel and Samson), Hôpital de la Salpêtrière, Paris, France.

Address correspondence and reprint requests to Dr. Pillon, INSERM U 289, Nouvelle Pharmacie, Hôpital de la Salpêtriére, 47 Boulevard de l'Hôpital, 75651 Paris Cedex 13, France.

Objective/background: Case studies suggest a dissociation between cognitive functions that have been impaired after damage to the dorsolateral prefrontal cortex and social skills disturbed when the ventromedial prefrontal areas are affected. Because this dissociation had not been confirmed in a clinical setting, clinicometabolic correlations were sought in 13 patients with various lesions of the prefrontal cortex.

Design/methods: The clinical assessment included extensive testing of executive functions and evaluation of behavioral abnormalities based on an informant questionnaire. Regional cerebral glucose metabolism (rCMRGlu) was measured with [¹⁸F] fluorodeoxyglucose ([¹⁸F] FDG) and 31-slide high-resolution PET.

Results: Executive-function test performance was significantly correlated with rCMRGlu in the dorsolateral prefrontal cortex (Brodmann's areas 8, 9, 45, 46, and 47) and anterior cingulate cortex (Brodmann's areas 24 and 32). Behavioral scores were significantly correlated with rCMRGlu in the frontopolar (Brodmann's area 10) and orbitofrontal cortex (Brodmann's areas 11, 12, 13, and 14).

Conclusion: These results show that impaired executive functions and serial skill deficits are associated with distinct metabolic patterns in patients with frontal lobe pathology. In agreement with activation studies in normal subjects, our data suggest the existence of a modular organization of the frontal cortex in humans, as previously reported in nonhuman primates.

Supported by the Commissariat à l'Energie Atomique (CEA, Orsay, France), the Institut National de la Santé et de la Recherche Médicale (INSERM, Paris, France), and the Fondation pour la Recherche Médicale (FRM, Paris, France).

Received October 29, 1997. Accepted in final form March 14, 1998.

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