Which Of The Following Subtests Of The Wais Involves Cartoon Drawings?
Disturbances of college noesis and social behavior take long been recognized every bit common sequelae of lesions of prefrontal cortex. These behavioral changes accept been linked with damage specifically involving orbitofrontal or ventromedial prefrontal cortex, only the specific emotional, cognitive, and/or physiologic processes that may be disrupted have non been well elucidated. Several mechanisms have been proposed to explain the observed deficits in social beliefs following ventromedial prefrontal cortex lesions: impaired decision making due to lack of a "somatic marker,"1,2 the inability to modify beliefs appropriately in response to a modify in reinforcement contingencies,3,4 deficits in the power to represent the mental states of others or "theory of mind,"5 or the disability to access social knowledge.6,7 Regarding the latter hypothesis, some authors take argued that patients with ventromedial prefrontal cortex lesions have intact social knowledge,8 simply these claims have been based on single case studies or very pocket-size sample sizes. Therefore, we investigated whether patients with ventromedial prefrontal cortex lesions prove greater deficits in one aspect of social knowledge; namely, the ability to interpret and utilize nonverbal emotional expression, relative to healthy comparison subjects.
To test this hypothesis, we compared the performance of patients with ventromedial prefrontal cortex or dorsolateral prefrontal cortex lesions with healthy volunteers on the Tests of Social Intelligence (TSI).9 The TSI includes a series of drawings and cartoons that require subjects to utilize nonverbal cues to interpret social and emotional situations. Examples of tasks include choosing the right panel to match the emotions of cartoon characters expressed using facial expression or torso language or completing a drawing strip that depicts events within a social interaction. One of the tasks includes linguistic communication, but subjects must "read betwixt the lines" to understand the social pregnant of the exact expression.
Based on previous studies of frontal lobe patients,i,ii,4,5,7,10–21 we hypothesized that patients with ventromedial prefrontal cortex lesions, but non those with lesions involving dorsolateral and other prefrontal cortex areas outside of ventromedial sectors, would be impaired on the TSI, relative to salubrious volunteers. In add-on, to better understand any observed deficits in social cognition, we compared performance on the TSI with a standard job from the performance (nonverbal) scale of the Wechsler Adult Intelligence Scale (WAIS-R and WAIS-III),22,23 besides as an observer-rated measure out of real-life behavioral functioning, the Neurobehavioral Rating Calibration.24
METHODS
Subjects
Twenty-9 consecutive outpatients (26 males, three females) with nonprogressive prefrontal cortex lesions and 23 normal comparison subjects (21 males, 2 females) matched for age and education level were studied. The ventromedial group included 20 patients (xviii males, two females), while the dorsolateral group comprised nine patients (viii males, one female). There were no significant differences among the two patient groups or the normal comparison subjects in terms of age (ventromedial: hateful=53.1 years, SD=vi.8; dorsolateral: mean=fifty.3 years, SD=9.3; normal comparison: mean=50.1 years, SD=11.5) (F=0.56, df=2, 49, p=0.57) or number of years of education (ventromedial: mean=14.3, SD=two.7; dorsolateral: mean=thirteen.8, SD=2.v; normal comparing: hateful=xiv.2, SD=1.8) (F=0.18, df=2, 49, p=0.84).
Lesion Assay
Details of prefrontal cortex lesion information for patients are presented in Table 1. All had lesions bars to the frontal lobes, with the bulk secondary to penetrating head injury from missiles or shrapnel incurred during the Vietnam War (N=26). Other etiologies were similarly nonacute and included tumor resection (N=1; nine-calendar month-old injury) and stroke from aneurysmal subarachnoid hemorrhage (North=2; vi- and xi-year-erstwhile injuries).
We used templates from Damasio and Damasio25 to delineate the location of lesions. Patients were classified according to the presence of ventromedial prefrontal cortex damage (ventromedial group, N=twenty), or absence, the latter of which included primarily dorsolateral and dorsomedial prefrontal cortex areas (dorsolateral group, Northward=ix). Ventromedial prefrontal cortex was defined as including whatever of Brodmann's areas 11, 12, thirteen, fourteen, 47, and ventral expanse of x based on CT or MRI scans. Representative ventromedial prefrontal cortex and dorsolateral lesions are illustrated in Effigy 1. Lesion size was bachelor for 17 of the ventromedial patients and 8 of the dorsolateral patients and did not differ betwixt the two groups (ventromedial prefrontal cortex: mean=60.5 cc, SD=41.1; dorsolateral: mean=48.half dozen cc, SD=32.0) (t=0.72, df=32, p=0.48).
All participating subjects understood study procedures and gave their written informed consent to participate in the study. This work was approved by the Institutional Review Board of the National Institute of Neurological Disorders and Stroke, Bethesda, Maryland.
Materials
TSI.
The TSI consists of four different subtests (Expression, Missing Cartoons, Social Translations, and Cartoon Predictions) designed to measure the ability to empathise the thoughts, feelings, and intentions of other people every bit expressed in behavior.ix Carve up-one-half reliability is reported at 0.72 for the TSI, and performance on the TSI correlates with indices such equally job success, peer ratings of social preference, and functioning in interpersonal training courses.9 To minimize the influence of verbal abilities, memory, and full general intelligence on functioning, cartoons and drawings are primarily used, with the exception of the Social Translations subtest, which requires subjects to interpret verbal phrases in a given social context.
The original TSI included 30 items in the Expression set, 27 in the Missing Cartoons set, 24 in the Social Translations set, and thirty in the Drawing Predictions gear up. To preclude fatigue, we shortened the original subtests past randomly assigning test items to form 3 evenly divided blocks of items. For case, the 30 items in the Expression group were randomly assigned to 3 separate blocks with 10 items in each block. Subjects completed a 10-detail cake from the Expression fix, a 9-detail block from the Missing Cartoons set, an 8-item block from the Social Translations exam, and a 10-item block in the Cartoon Predictions Set, for a total of 37 items for the entire TSI task. Blocks for each of the subtests were randomly assigned to subjects, just all subjects completed the subtests in the following order: Expression, Missing Cartoons, Social Translations, and Cartoon Predictions. The full possible score on our modified version of the TSI was 37.
Our modified versions of the TSI were not probable to bias the results since we randomly allocated blocks of test items to subjects. In addition, rather than comparing performance on the TSI with published normative data on the original TSI, nosotros recruited a group of matched good for you volunteers to establish new norms for the revised test. Importantly, the performance of healthy volunteers on the revised TSI (hateful score of 26.half-dozen on modified 37-detail TSI=66.4%) was comparable to norms reported in the scoring manual for the original test (mean score of 80.two on original 121-item TSI=66.three%).9
TSI Subtests.
i. Expression. This subtest presents subjects with drawings of manus gestures, body postures, and facial expressions that testify the same thought, feeling or intention. Subjects must choose one of four alternative drawings that express the same emotion as the preceding drawings.
2. Missing Cartoons. Subjects are instructed to cull one of iv alternative cartoon panels to complete a serial of panels depicting characters interacting in an everyday social setting. Correct selection of the missing console requires subjects to accurately interpret the character'due south thoughts and feelings so that the completed drawing story is coherent.
3. Social Translations. This task assesses the ability to interpret the pregnant of verbal statements in different social contexts. Subjects are instructed to match different social situations that would convey the same meaning for a exact phrase. For example, the expression "delight" when used by an employer to employee, would have a similar meaning when used by a begetter to a son. In contrast, the aforementioned expression would have a dissimilar meaning when used past a beggar to a stranger or a chauffeur to his employer. Subjects choose from three possible response options.
4. Drawing Predictions. This subtest measures the power to predict social consequences by interpreting the intention and feelings of characters. Subjects must choose the correct panel from 3 alternatives that depict the event that would follow, based on the character's emotional reaction to a situation.
Neuropsychological.
We determined the clan betwixt performance on the TSI and scores on the Motion picture Arrangement subtest of the WAIS-R or WAIS-Iii.22,23 Subjects enrolled prior to 1997 (North=six) received the WAIS-R while the remaining (N=23) received the more recent version (WAIS-Iii). At that place were no differences in performance on the TSI for subjects who received earlier versus more recent versions of the intelligence tests (t=0.23, df=27, p=0.82). We focused on the motion picture system task because it primarily tests the ability to plan, interpret, and accurately anticipate consequences in nonverbal interpersonal situations.26 Subjects are required to rearrange cards that describe social situations into a cohesive story, but practice not choose from possible alternatives to complete the story. Therefore, we expected that skills used to consummate the Picture Arrangement task would contribute to functioning on the TSI.
Behavioral.
To decide whether operation on the social cognition tasks was indicative of observable, everyday behavior, patients were assessed using the Neurobehavioral Rating Scale.24 The Neurobehavioral Rating Scale is a validated measure of neuropsychiatric symptomatology resulting from head injury, such as loss of insight, disinhibition, and impaired attending. The behavior of patients with prefrontal cortex lesions was rated by the research assistant during neuropsychological testing. Information were available for 25 of the 29 subjects. At that place were no differences in operation on the TSI for subjects who had a Neurobehavioral Rating Calibration score and those who did not (t=0.45, df=27, p=0.45).
All tasks were administered individually. No constraints on fourth dimension were imposed to consummate the TSI.
Statistical Analysis
We compared differences in TSI performance between each patient subgroup and the normal comparison group using the nonparametric statistical equivalent of a planned independent t test, the Isle of man-Whitney U test, because the TSI data (particularly subscale scores) were not commonly distributed. Nosotros used overall scores on the TSI ("total TSI score") and scores on each of the TSI subtests as dependent measures for these analyses. Analysis of variance and t tests were used to examine grouping differences on demographic and clinical variables. Pearson's correlation was used to make up one's mind associations betwixt functioning on the TSI and other neuropsychological and behavioral measures. The alpha level was set at 0.05, two-tailed probability was used for all analyses.
RESULTS
Effects of Lesion Location on TSI Performance
Mean scores on the TSI and its subscales for both patient groups and normal comparison subjects are reported in Table 2.
All subjects performed at above adventure levels, indicating that errors were not due to simply guessing at random (score 10.75 out of 37 if performing at gamble). This is particularly important in the instance of ventromedial patients, who may make errors due to difficulties in inhibiting responses, rather than to a true arrears in interpreting and using nonverbal emotional cues. Every bit indicated previously, the functioning of healthy volunteers in our study (mean score of 26.6 on modified 37-item TSI=66.4%) was comparable to norms reported in the scoring manual (hateful score of eighty.2 on original 121-item TSI=66.3%).9
Every bit hypothesized, ventromedial patients had lower total TSI scores as compared with the normal comparison group (Mann-Whitney U=88.0, p=0.001), while dorsolateral patients were not significantly impaired relative to normal comparison subjects (Mann-Whitney U=71.0, p=0.18). Ventromedial patients were specifically impaired on the Expression and Missing Cartoons subtests (U=128.5, p=0.011; U=105.5, p=0.002, respectively). In other words, ventromedial patients had difficulty choosing drawings to match an emotion expressed through facial expression, gestures, or body posture (Expression subtest) or to consummate a series of cartoon panels depicting a social interaction (Missing Cartoons subtest).
We wished to evaluate the possibility of a failure to find differences in functioning on the TSI betwixt the dorsolateral and normal comparing groups due to low statistical power given the smaller number of dorsolateral patients (N=nine). Thus, we reanalyzed the TSI data by dividing the ventromedial group co-ordinate to whether lesions were unilateral (N=10) or bilateral (N=10), since these sample sizes were more than comparable to that of the dorsolateral patients. For these analyses, total TSI scores were used. Both ventromedial groups performed more poorly on the TSI as compared to the normal comparison grouping, although the group difference for patients with unilateral ventromedial prefrontal cortex lesions trended only toward statistical significance (normal comparison, mean=24.6, SD=three.4; unilateral ventromedial prefrontal cortex: mean=twenty.half dozen, SD=6.0; Mann-Whitney U=69.5, p=0.074; bilateral ventromedial prefrontal cortex: mean=17.8, SD=iv.3; Mann-Whitney U=18.five, p<0.001). Thus, it is unlikely that low statistical ability alone accounted for the failure to find statistically significant differences between dorsolateral and normal comparison groups.
Relationship Between Measures of Social Cognition and Neuropsychological Tests
We examined the association between functioning on the TSI and the Picture Arrangement subtest of the WAIS-R/WAIS-3, a task requiring similar cognitive abilities. In dorsolateral patients, total TSI and Pic Arrangement scores were strongly correlated (r=0.81, N=9, p=0.009), only this was not the example for patients with ventromedial prefrontal cortex lesions (r=0.21, N=twenty, p=0.38). These results suggest that the deficits observed in ventromedial patients on the TSI were specific to the emotional elements inherent in the TSI, rather than to a more than general cognitive difficulty in arranging images to create a logically coherent story.
Relationship With Neurobehavioral Rating Calibration
Equally shown in Figure ii, performance on the TSI was negatively and moderately correlated with ratings of behavior on the Neurobehavioral Rating Scale in both the entire patient grouping (r=−0.47, p=0.018) and among ventromedial patients only (r=0.44, p=0.078). These results indicate an clan betwixt social cognitive harm and greater observed psychopathology.
Word
The primary aim of this study was to examine the effects of ventromedial prefrontal cortex lesions on the power to use nonverbal cues to interpret emotional expression and social interaction. Consequent with our hypotheses, ventromedial patients showed deficits on the TSI, with specific impairments in the ability to employ nonverbal cues to understand emotional expression (Expression subtest), besides equally the ability to consummate a socially meaningful story by interpreting the feelings and behavior of characters (Missing Cartoons subtest). No differences in operation betwixt patients and comparison subjects were institute on the subtests that assess the ability to interpret the significant of verbal statements in different social contexts (Social Translations subtest) and to predict social consequences by interpreting the intention and feelings of others (Cartoon Predictions). We found that deficits on the TSI were not related to more general cognitive impairment on another nonverbal job, the Picture Arrangement examination from the Performance subscale of the WAIS, and TSI deficits were correlated with ratings of real-life behavior equally determined by the Neurobehavioral Rating Calibration.
Our findings are broadly consistent with the experimental literature showing deficits in socially relevant beliefs following ventromedial prefrontal cortex lesions.1,ii,iv,v,vii,10–21 In particular, previous studies accept demonstrated impairment in identifying emotional expression using face or voice stimuli following ventral frontal harm7,27 and deficits in representing the mental states of others on verbal theory of mind tasks.5,ten These findings are in line with our results which demonstrate deficits in perception of nonverbal emotional cues (Expression subtest) and in interpreting the thoughts, feelings, and behavior of characters to create a story (Missing Cartoons subtest) in ventromedial patients.
Two case reports also included portions of the TSI every bit a mensurate of social noesis, with variable results. Saver and Damasioviii found that East.Five.R., a patient with ventromedial prefrontal cortex bifrontal injuries, performed inside the normal range on the Cartoon Predictions subtest of the TSI, which tests the ability to predict the most likely consequences of a social situation, consequent with our results. They did non administer either of the two subtests for which we constitute ventromedial patients were dumb (Expression and Missing Cartoons). Three of the TSI subtests were used in another case study of a woman with traumatic orbitofrontal brain injury by Cicerone et al.28 Similar to our ventromedial group, this patient showed deficits in interpreting thematic relationships involving nonverbal interpersonal interactions (Missing Cartoons). However, in contrast to the report reported by Saver and Damasio8 and our findings, this patient was found to exist impaired on the Cartoon Predictions subtest and in interpreting the meanings of verbal, social exchanges in dissimilar contexts (Social Translations). We did non discover deficits in operation on the Social Translations subtest in our ventromedial prefrontal cortex subjects, and speculate that the use of verbal rather than nonverbal, stimuli may non have adequately tapped into the social cognitive impairment observed following ventromedial prefrontal cortex damage. For example, it may be that ventromedial patients partially compensate for their social cognitive deficits by recruiting verbal strategies to perform well on the Social Translations subtest. We besides did not detect statistically significant differences between ventromedial patients and healthy volunteers on the Drawing Predictions subtest, a task similar to the Missing Cartoons subtest. This may be due, in part, to the greater variability in performance in the ventromedial group in using nonverbal cues to predict the behavior of characters. The overall inconsistency of these results beyond studies highlights the difficulty in interpreting results from single case reports and points to the demand for studies of adequate samples of ventromedial patients. Although requiring replication, our results suggest that lesions of ventromedial prefrontal cortex are associated with deficits in social noesis; namely, the inability to understand nonverbal behavioral cues of emotional expression.
We also found that the deficits on the TSI were non associated with functioning on the Movie Arrangement subtest of the WAIS. Since both tasks present nonverbal stimuli in which subjects must use the behavior of characters to interpret a social state of affairs, we initially hypothesized a human relationship between scores on the Moving-picture show System and the TSI. However, we found a strong association between the 2 tasks in the dorsolateral group, simply not in the ventromedial group. These results bespeak that like cognitive and emotional processing skills are used in the Movie Arrangement and TSI by patients with dorsolateral lesions, and that the deficits observed in ventromedial patients appear to be specific to the TSI (due east.chiliad., a social cognitive component), rather than to full general impairment in performing a nonverbal job involving a sequence of actions. It may be that the TSI differs from the Flick Arrangement in that information technology emphasizes the ability to infer the thoughts and feelings of characters, similar to theory of mind tasks in which verbal stimuli are presented. This could be empirically validated by comparison the functioning of ventromedial patients on the TSI and on typical verbal theory of mind tasks.5
Importantly, we plant that deficits in social knowledge as assessed by the TSI were associated with increased ratings of neuropsychiatric disturbance on the Neurobehavioral Rating Calibration in the patient grouping equally a whole and a near-meaning trend in the ventromedial prefrontal cortex sample alone. This finding suggests that dumb power to translate nonverbal cues of emotional expression and social interaction may contribute to the socially abnormal behavior described in case reports of ventromedial patients such equally Phineas Gage29,30 and E.5.R.31 In addition, the observed association between the TSI and Neurobehavioral Rating Scale suggests that behavioral disturbances can be predicted by performance on objective social-cognitive tasks. Thus, the TSI, or a like job, may be useful in clinical settings to predict and monitor social and behavioral dysfunction following neuropsychiatric injury.
1 limitation of our written report relates to differences in sample size betwixt the two patient groups, with the ventromedial prefrontal cortex sample comprised of twice the number of patients equally the dorsolateral group. It may be argued that low statistical power accounted for the failure to detect significant differences in job operation between the smaller dorsolateral group and normal comparison subjects. However, when we reanalyzed a subset of the data to compare ventromedial prefrontal cortex subgroups (unilateral or bilateral lesions) of similar sample sizes (North=10) to that of the dorsolateral grouping (North=9), the finding of dumb TSI operation in ventromedial patients persisted. In addition, our finding of social cerebral deficits in ventromedial prefrontal cortex, only non dorsolateral patients, is consistent with the few studies that accept directly compared the two patient groups. Patients with dorsolateral lesions have been shown to perform normally on theory of heed tasks,5 implicit association tasks,19 and the Iowa Gambling Task.16 However, one written report provided contrary results. Manes and colleagues20 plant that patients with dorsolateral lesions (North=4) and dorsomedial lesions (N=5) showed some impairment on decision-making tasks relative to comparison subjects. Nosotros found no testify supporting a role for dorsolateral prefrontal cortex areas in interpreting nonverbal cues of emotional expression.
Additionally, previous studies of patients with focal encephalon damage suggest the contribution of the correct hemisphere to emotional expression,32–34and emotional perception35–37 and a specific function for correct ventromedial prefrontal cortex areas in mediating altered emotion, behavior, and decision making.38 Tranel and his colleagues38 found that while patients with correct-sided ventromedial prefrontal cortex lesions (N=4) were more impaired on the gambling task relative to patients with left-sided ventromedial prefrontal cortex lesions (Northward=3), the latter grouping did not perform too as normal comparing subjects. Patients with right-sided ventromedial prefrontal cortex damage showed like impairments to those with bilateral ventromedial prefrontal cortex lesions, with a trend to choose from disadvantageous card decks and generating smaller anticipatory skin conductance responses. We were unable to examine laterality by lesion location effects in our study because of inadequate numbers inside each cell.
In summary, we establish objective testify of deficits in social knowledge in patients with ventromedial prefrontal cortex damage as compared with normal comparing subjects. We propose that the inability to access social knowledge, which serves to guide appropriate behavior, may be ane mechanism whereby patients with ventromedial prefrontal cortex lesions exhibit abnormal social behavior. Few studies of ventromedial patientsvii take evaluated for deficits in social cognition using nonverbal stimuli, as was done in our study. The majority take focused on abnormalities of behavior in response to upshot contingencies2,4 or accept employed exact tasks assessing theory of listen or moral judgment.v,viii Other findingsvii,20,38 implicate the role of the right ventromedial prefrontal cortex in social cerebral abilities. If social cognitive ability is more lateralized towards the right hemisphere, information technology is possible that nonverbal stimuli would better evaluate social cognitive deficits in ventromedial patients. Future studies using comparable verbal and nonverbal tasks of social cognition are required to empirically validate this hypothesis.
ACKNOWLEDGMENTS
The authors give thanks Charlotte F. Manly, Ph.D., for guidance in analyzing the data and for helpful comments on a previous version of this manuscript. A portion of this work has been presented at the 14th Annual Meeting of the American Neuropsychiatric Association, Honolulu, Hawaii, Feb 2–4, 2003.
Figure 1. Representative Ventromedial and Dorsolateral Prefrontal Cortext Lesions
Figure one as shown is but numbers, not lesions.
Figure ii. Relationship Between Social Cognitive Impairment and Observed Psychopathology
Tabular array i. Location, Etiology, and Size of Frontal Lobe Lesions in the Patient Population
TABLE 2. Scores on Tests of Scial Intelligence and Its Subscales of Patients With Ventromedial or Dorsolateral Prefrontal Cortex Lesions and Normal Comparing Subjects
References
1 Damasio AR, Tranel D, Damasio H: Individuals with sociopathic behavior caused by frontal harm fail to respond autonomically to social stimuli. Behav Encephalon Res 1990; 41:81–94Crossref, Medline, Google Scholar
2 Bechara A, Damasio AR, Damasio H, et al: Insensitivity to future consequences following damage to man prefrontal cortex. Cognition 1994; 50:vii–15Crossref, Medline, Google Scholar
three Rolls ET: The orbitofrontal cortex. Phil Trans R Soc Lond B Biol Sci 1996; 351:1433–1443; discussion 1443–1444Crossref, Medline, Google Scholar
4 Rolls ET, Hornak J, Wade D, et al: Emotion-related learning in patients with social and emotional changes associated with frontal lobe damage. J Neurol Neurosurg Psychiatry 1994; 57:1518–1524Crossref, Medline, Google Scholar
five Stone VE, Baron-Cohen S, Knight RT: Frontal lobe contributions to theory of mind. J Cogn Neurosci 1998; 10:640–656Crossref, Medline, Google Scholar
6 Grafman J, Schwab K, Warden D, et al: Frontal lobe injuries, violence, and assailment: a study of the Vietnam Caput Injury Study. Neurology 1996; 46:1231–1238Crossref, Medline, Google Scholar
7 Hornak J, Rolls ET, Wade D: Confront and voice expression identification in patients with emotional and behavioural changes post-obit ventral frontal lobe harm. Neuropsychologia 1996; 34:247–261Crossref, Medline, Google Scholar
8 Saver JL, Damasio AR: Preserved access and processing of social cognition in a patient with acquired sociopathy due to ventromedial frontal impairment. Neuropsychologia 1991; 29:1241–1249Crossref, Medline, Google Scholar
9 O'Sullivan Yard, Guilford J: Four Gene Tests of Social Intelligence (Behavioral Cognition): Manual of Instructions and Interpretations. Palo Alto, Calif, Consulting Psychologists Press, 1976Google Scholar
10 Rowe AD, Bullock PR, Polkey CE, et al: "Theory of mind" impairments and their relationship to executive functioning following frontal lobe excisions. Brain 2001; 124(part three):600–616Google Scholar
11 Happe F, Malhi GS, Checkley South: Caused mind-blindness following frontal lobe surgery? a single case written report of impaired "theory of listen" in a patient treated with stereotactic anterior capsulotomy. Neuropsychologia 2001; 39:83–90Crossref, Medline, Google Scholar
12 Shammi P, Stuss DT: Humour appreciation: a part of the correct frontal lobe. Encephalon 1999; 122 (part 4):657–666Google Scholar
thirteen Dimitrov M, Grafman J, Hollnagel C: The furnishings of frontal lobe damage on everyday problem solving. Cortex 1996; 32:357–366Crossref, Medline, Google Scholar
14 Bechara A, Tranel D, Damasio H, et al: Failure to respond autonomically to anticipated future outcomes post-obit damage to prefrontal cortex. Cereb Cortex 1996; 6:215–225Crossref, Medline, Google Scholar
15 Bechara A, Damasio H, Tranel D, et al: Deciding advantageously before knowing the advantageous strategy. Scientific discipline 1997; 275:1293–1295Crossref, Medline, Google Scholar
sixteen Bechara A, Damasio H, Tranel D, et al: Dissociation of working retentivity from decision making within the human prefrontal cortex. J Neurosci 1998; 18:428–437Crossref, Medline, Google Scholar
17 Bechara A, Tranel D, Damasio H: Characterization of the decision-making arrears of patients with ventromedial prefrontal cortex lesions. Encephalon 2000; 123(part xi):2189–2202 Google Scholar
18 Bechara A, Damasio H, Damasio AR, et al: Unlike contributions of the human amygdala and ventromedial prefrontal cortex to conclusion-making. J Neurosci 1999; 19:5473–5481Crossref, Medline, Google Scholar
nineteen Milne Due east, Grafman J: Ventromedial prefrontal cortex lesions in humans eliminate implicit gender stereotyping. J Neurosci 2001; 21:RC150Google Scholar
20 Manes F, Sahakian B, Clark Fifty, et al: Determination-making processes following damage to the prefrontal cortex. Brain 2002; 125(office 3):624–639Google Scholar
21 Rogers RD, Everitt BJ, Baldacchino A, et al: Dissociable deficits in the controlling cognition of chronic amphetamine abusers, opiate abusers, patients with focal impairment to prefrontal cortex, and tryptophan-depleted normal volunteers: evidence for monoaminergic mechanisms. Neuropsychopharmacology 1999; 20:322–339Crossref, Medline, Google Scholar
22 Wechsler D: Wechsler Developed Intelligence Scale, third ed (WAIS-Three). San Antonio, Tex, Psychological Corp, 1997Google Scholar
23 Wechsler D: Wechsler Adult Intelligence Scale—Revised (WAIS-R). San Antonio, Tex, Psychological Corp, 1981Google Scholar
24 Levin HS, High WM, Goethe KE, et al: The Neurobehavioral Rating Calibration: cess of the behavioural sequelae of head injury by the clinician. J Neurol Neurosurg Psychiatry 1987; fifty:183–193Crossref, Medline, Google Scholar
25 Damasio H, Damasio A: Lesion Analysis in Neuropsychology. New York, Oxford University Press, 1989Google Scholar
26 Groth-Marnat G: Handbook of Psychological Assessment. New York, John Wiley & Sons, 1997Google Scholar
27 Blair RJ, Cipolotti 50: Impaired social response reversal: a case of "acquired sociopathy." Brain 2000; 123(office 6):1122–1141 Google Scholar
28 Cicerone K, Tanenbaum L: Disturbance of social knowledge after traumatic orbitofrontal brain injury. Arch Clin Neuropsychol 1997; 12:173–188Crossref, Medline, Google Scholar
29 Harlow JM: Passage of an fe rod through the head. Boston Med & Surgical J 1848; 39:389–393Crossref, Google Scholar
30 Harlow JM: Recovery from the passage of an atomic number 26 bar through the head. Publications of the Massachusetts Medical Society 1868; 2:239–347Google Scholar
31 Eslinger PJ, Damasio AR: Severe disturbance of college cognition subsequently bilateral frontal lobe ablation: patient EVR. Neurology 1985; 35:1731–1741Crossref, Medline, Google Scholar
32 Ross ED, Mesulam MM: Dominant language functions of the right hemisphere? prosody and emotional gesturing. Arch Neurol 1979; 36:144–148Crossref, Medline, Google Scholar
33 Buck R, Duffy RJ: Nonverbal communication of touch in brain-damaged patients. Cortex 1980; 16:351–362Crossref, Medline, Google Scholar
34 Weintraub South, Mesulam MM: Developmental learning disabilities of the right hemisphere: emotional, interpersonal, and cognitive components. Arch Neurol 1983; twoscore:463–468Crossref, Medline, Google Scholar
35 Kolb B, Taylor L: Affective behavior in patients with localized cortical excisions: role of lesion site and side. Scientific discipline 1981; 214:89–91Crossref, Medline, Google Scholar
36 Borod JC, Cicero BA, Obler LK, Welkowitz J, Erhan HM, Santschi C, Grunwald IS, Agosti RM, Whalen JR: Right hemisphere emotional perception: evidence across multiple channels. Neuropsychology 1998; 12:446–458Crossref, Medline, Google Scholar
37 Heilman KM, Bowers D, Speedie L, et al: Comprehension of melancholia and nonaffective prosody. Neurology 1984; 34:917–921Crossref, Medline, Google Scholar
38 Tranel D, Bechara A, Denburg NL: Asymmetric functional roles of right and left ventromedial prefrontal cortices in social comport, decision-making, and emotional processing. Cortex 2002; 38:589–612Crossref, Medline, Google Scholar
Source: https://neuro.psychiatryonline.org/doi/10.1176/jnp.17.1.66
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