Source Paper
A role of right middle frontal gyrus in reorienting of attention: a case study
Shruti Japee, Kelsey Holiday, Maureen D. Satyshur, Ikuko Mukai, Leslie G. Ungerleider
Frontiers in Systems Neuroscience • 2015
Source Paper
Shruti Japee, Kelsey Holiday, Maureen D. Satyshur, Ikuko Mukai, Leslie G. Ungerleider
Frontiers in Systems Neuroscience • 2015
The right middle fontal gyrus (MFG) has been proposed to be a site of convergence of the dorsal and ventral attention networks, by serving as a circuit-breaker to interrupt ongoing endogenous attentional processes in the dorsal network and reorient attention to an exogenous stimulus. Here, we probed the contribution of the right MFG to both endogenous and exogenous attention by comparing performance on an orientation discrimination task of a patient with a right MFG resection and a group of healthy controls. On endogenously cued trials, participants were shown a central cue that predicted with 90% accuracy the location of a subsequent peri-threshold Gabor patch stimulus. On exogenously cued trials, a cue appeared briefly at one of two peripheral locations, followed by a variable inter-stimulus interval (ISI; range 0-700 ms) and a Gabor patch in the same or opposite location as the cue. Behavioral data showed that for endogenous, and short ISI exogenous trials, valid cues facilitated responses compared to invalid cues, for both the patient and controls. However, at long ISIs, the patient exhibited difficulty in reverting to top-down attentional control, once the facilitatory effect of the exogenous cue had dissipated. When explicitly cued during long ISIs to attend to both stimulus locations, the patient was able to engage successfully in top-down control. This result indicates that the right MFG may play an important role in reorienting attention from exogenous to endogenous attentional control. Resting state fMRI data revealed that the right superior parietal lobule and right orbitofrontal cortex, showed significantly higher correlations with a left MFG seed region (a region tightly coupled with the right MFG in controls) in the patient relative to controls. We hypothesize that this paradoxical increase in cortical coupling represents a compensatory mechanism in the patient to offset the loss of function of the resected tissue in right prefrontal cortex.
Objective: Determine cognitive and behavioral profile of a patient post-frontal lobe tumor resection through comprehensive neuropsychological assessment measuring intelligence, memory, language, attention, and executive function
Gather these items before starting the experiment. Check off items as you prepare.
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Patient GE, a 31-year-old right-handed male with history of frontal-lobe tumor resection 4 years prior, was admitted to the National Institutes of Health under a natural history protocol
Note: Patient was generally reported to be asymptomatic and high-functioning at time of admission
“The patient (GE) in this case study was a 31 year-old right-handed male who underwent a frontal-lobe tumor resection, with subsequent radiation and several rounds of chemotherapy, 4 years prior to arriving at the National Institutes of Health (NIH). He was admitted to the NIH under a natural history protocol”
Administer WTAR to assess premorbid intellectual functioning and reading ability
Note: Patient scored 115 (norm 100, SD 15)
“Neuropsychological tests were performed on the patient to determine his cognitive and behavioral profile on different test batteries, as listed in Table 1”
Administer WASI subtests including vocabulary, block design, similarities, and matrix reasoning to measure general intellectual ability
Note: Yields VIQ, PIQ, and FSIQ scores. Patient VIQ 98, PIQ 93, FSIQ 96
“WASI: WECHSLER ABBREVIATED SCALE OF INTELLIGENCE Vocabulary 49 50 10 Block design 40 50 10 Similarities 49 50 10 Matrix reasoning 52 50 10”
Administer WMS-III to assess memory function including information/orientation, digit span, and local memory recall (immediate and delayed)
Note: Patient digit span 11, local memory I recall 9, local memory II recall 9
“WMS-III: WECHSLER MEMORY SCALE—THIRD EDITION Information and orientation 14 raw Digit span 11 10 3 Local memory I recall total 9 10 3”
Administer HVLT-R with three learning trials followed by delayed recall and recognition testing to measure verbal learning and memory
Note: Patient trial 1 recall 7, trial 2 recall 10, trial 3 recall 9, total recall 44, delayed recall 44
“HOPKINS VERBAL LEARNING TEST—REVISED Trial 1 recall correct 7 raw Trial 2 recall correct 10 raw Trial 3 recall correct 9 raw Total recall 44 50 10”
Administer BVMT-R with three learning trials followed by delayed recall and recognition testing to measure visuospatial memory
Note: Patient trial 1 recall 40, trial 2 recall 41, trial 3 recall 31, total recall 36, delayed recall 49
“BRIEF VISUOSPATIAL MEMORY TEST—REVISED Trial 1 recall correct 40 50 10 Trial 2 recall correct 41 50 10 Trial 3 recall correct 31 50 10”
Administer Rey Complex Figure Test requiring patient to copy complex figure and recall it after delay to measure visuospatial construction and visual memory
Note: Patient copy score >16%, delayed recall 38%
“REY COMPLEX FIGURE Copy >16% Delayed recall 38%”
Administer Benton Visual Form Discrimination Test to assess visual perception and discrimination ability
Note: Patient total score 30 (Within Normal Limits)
“BENTON VISUAL FORM DISCRIMINATION Total score 30 (Within Normal Limits)”
Administer COWAT/FAS test for letter fluency (F, A, S), category fluency, and Boston Naming Test to measure verbal fluency and language production
Note: Patient FAS 55, category fluency 32, Boston naming test 33
“CONTROLLED ORAL WORD ASSOCIATION TEST FAS 55 50 10 Category fluency 32 50 10 Boston naming test 33 50 10”
Administer Grooved Pegboard Test for both dominant (right) and non-dominant (left) hands to measure fine motor speed and dexterity
Note: Patient dominant hand 46, non-dominant hand 38
“GROOVED PEGBOARD Dominant hand (right) 46 50 10 Non-dominant hand (left) 38 50 10”
Administer Trail Making Test parts A and B to assess attention, processing speed, and executive function. Part A connects numbers in sequence, Part B alternates between numbers and letters
Note: Patient TMT-A 26 (0 errors), TMT-B 36 (0 errors)
“TRAIL MAKING TEST A 26 50 10 0 errors B 36 50 10 0 errors”
Administer SDMT to measure processing speed and attention through symbol-digit substitution task
Note: Patient score 0.8
“SYMBOL DIGIT MODALITIES TEST 0.8 0 1”
Administer CPT-II computerized continuous performance task to measure sustained attention and impulse control. Higher scores indicate more inattention
Note: Patient omissions 44, commissions 41, RT 60, RT std. error 57
“CONNERS' CPT-II Higher score = more inattention Omissions 44 50 10 Commissions 41 50 10 RT 60 50 10”
Administer WCST to assess executive function, cognitive flexibility, and perseveration through card sorting task. Measure trials administered, total errors, perseverative responses, perseverative errors, non-perseverative errors, conceptual-level responses, categories completed, and failure to maintain set
Note: Patient trials administered 128, total errors 29, perseverative responses 31, perseverative errors 29, non-perseverative errors 31, categories completed 6-10%
“WCST (WISCONSIN CARD SORTING TEST) Trials administered 128 raw Total errors 29 50 10 Perseverative responses 31 50 10 Perseverative errors 29 50 10”
Administer Stroop test measuring cognitive flexibility, attention, and inhibitory control through word reading, color naming, and color-word interference conditions
Note: Patient word score 42, color score 41, color-word score 45
“STROOP COLOR AND WORD TEST Word score 42 50 10 Color score 41 50 10 Color-word score 45 50 10”
Administer FrSBe family-rating form to assess behavioral and personality changes related to frontal lobe dysfunction. Higher scores indicate worse functioning in apathy, disinhibition, and executive dysfunction domains
Note: Patient apathy 39, disinhibition 38, executive dysfunction 40, total 38 (higher is worse)
“FrSBe (FRONTAL SYSTEMS SCALE OF BEHAVIOR) FAMILY-RATING FORM After apathy 39 50 10 (Higher is worse) After disinhibition 38 50 10 (Higher is worse)”
Administer BDI to measure severity of depressive symptoms
Note: Patient score 1 raw (Minimal depression)
“BECK DEPRESSION INVENTORY 1 raw (Minimal depression)”
Administer BAI to measure severity of anxiety symptoms
Note: Patient score 2 raw (Minimal anxiety)
“BECK ANXIETY INVENTORY 2 raw (Minimal anxiety)”
Administer MSVT to assess effort and validity of cognitive testing through immediate recognition, delayed recognition, consistency, paired associate, and free recall measures
Note: Patient immediate recognition 90, delayed recognition 100, consistency 90, paired associate 100, free recall 70
“MEDICAL SYMPTOM VALIDITY TEST Immediate recognition 90 raw Delayed recognition 100 raw Consistency 90 raw Paired associate 100 raw Free recall 70 raw”
Administer BIT conventional tests (line crossing, letter cancelation, star cancelation, figure and shape copying, line bisection, representational drawing) and behavioral tests (picture scanning, telephone dialing, menu reading, article reading, telling and setting time, coin sorting, address and sentence copying, map navigation, card sorting)
Note: Patient conventional test 145 raw, behavioral test 77 raw
“BEHAVIORAL INATTENTION TEST Conventional test 145 raw 146 Line crossing 36 36 Letter cancelation 39 39 Star cancelation 54 54”
Compile all neuropsychological test results into comprehensive cognitive and behavioral profile. Compare patient scores to normative data (mean 50, SD 10 for most tests) to determine areas of strength and deficit
Note: Results presented in Table 1 with patient scores, norm means, and standard deviations
“Neuropsychological tests were performed on the patient to determine his cognitive and behavioral profile on different test batteries, as listed in Table 1”
Right-handed patient who underwent frontal-lobe tumor resection with subsequent radiation and chemotherapy 4 years prior to testing. Admitted to NIH under natural history protocol, generally asymptomatic and high-functioning.