Transcript 전두엽의 신경심리학적 기능

Neuropsychological Functions
of the prefrontal cortex
김홍근
대구대학교 재활심리학과
Overview
Prefrontal executive function
Regional prefrontal syndromes
Neuropsychological assessment
of prefrontal syndromes
The prefrontal lobe as “the seat of the
highest human mentality”
Phylogenetic perspective
Ontogenetic perspective
Anatomical perspective
Neuropsychological perspective
Phylogenetic perspective:
Species differences in prefrontal cortex
Ontogenetic perspective:
Late maturation of prefrontal cortex
1
3
2
3
2
1
2
3
(출처: 연세의대 신경해부학/조직학 website)
1
Anatomical perspective:
Extensive prefrontal lobe connections
(출처: 연세의대 신경해부학/조직학 website)
Neuropsychological perspective:
Phineas Gage (accident in 1848)
(출처: 연세의대 신경해부학/조직학 website)
Prefrontal function:
Early descriptions
Personality (Harlow, 1868)
Abstract attitude (Goldstein, 1927)
Mental set (Jacobsen, 1935)
Self-regulation (Luria, 1962)
Concept formation (Milner, 1964)
Prefrontal function:
Recent descriptions
Supervisory mental process
Cognitive flexibility
Meta-cognition
Goal-directed behavior
Executive function
An example of an executive
A model of prefrontal executive function
Memory
Language
Executive
Function
Attention
Spatial Pr
The regional prefrontal syndromes
(Cummings, 1985)
Dorsolateral
Orbitofrontal
Mesial frontal
Core hypotheses
Anatomical
area
Dorsolateral
Function
Syndrome
type
Cognition
Disorganized
Orbitofrontal
Emotion
Disinhibited
Mesial frontal Motivation
Apathetic
Dorsolateral syndrome
(Disorganized type)
Poor judgment
Concrete thinking
Lack of insight
Poor planning
cognitive
inflexibility
Orbitofrontal syndrome
(Disinhibited type)
Social misbehavior
Poor impulse control
Emotional lability
Hypersexuality
Stimulus-driven
behavior
Mesial frontal syndrome
(Apathetic type)
Poor initiative
Diminished verbal
output & motor
behavior
Akinetic mutism
Urinary incontinence
Neuropsychological assessment of
prefrontal syndromes: Overview
WAIS: Poor sensitivity
MMPI: Poor response validity
Specialized tests are needed
EXIT (EXecutive Intelligence Test)
(Kim, 2001)
EXIT (EXecutive Intelligence Test)
Norm
Adm time
Score
Subtests
16~19, 20~24, 25~34,
35~44, 45~54, 55~64 yrs
25 minutes
EIQ (Executive IQ)
Stroop test
Verbal fluency
Design fluency
Rey AVLT
Stroop test
파랑 노랑 빨강 검정
빨강 검정 파랑 노랑
노랑 빨강 파랑 검정
Verbal fluency
사람
하는 감정
사모
사랑
사랑하니까사랑사랑 사주 팔
자
사과 나무
기
사과
사춘
Design fluency
Rey AVLT
Recall
내가 불러 줬던
단어들을 기억
해서 말하시오
Recognition
내가 불러 줬던
단어들을 다음
에서 고르시오
Core features of EXIT as
a psychometric instrument
Multi-task approach
Unstructured testing
Use of control tests
Qualitative scoring
Normative M=100, SD=15
The rationale for prefrontal pathology
in schizophrenia
Disorganized thinking, speech,
& behavior
Disordered dopamine systems
Prefrontal metabolic deficit
A validity study of EXIT
Sample
Schizophrenic pts: n=45
Normal controls: n=27
Measure WAIS: VIQ, PIQ, FIQ
EXIT: EIQ
Hypothesis Largest group-difference
in EIQ
Schizophrenic pts vs Normal controls
110
100
Normals
Schizos
90
80
70
VIQ
PIQ
FIQ
EIQ
Case 1: Frontal head injury
 Male, 29 yrs
 Policeman
 Car accident
6 months ago
 Personality
deterioration
Disorganized
behavior
110
103
100
99
101
90
80
70
60
50
56
VIQ
PIQ
FIQ
EIQ
Case 2: Parkinson’s disease
 Female, 63 yrs
 Housewife
 Parkinson-like
symptom onset:
3.5 yrs ago
 Progressive
deterioration
110
100
99
100
100
90
80
73
70
60
VIQ
PIQ
FIQ
EIQ
Case 3: Korsakoff’s disease
 Female, 39 yrs
 Housewife
 Heavy alcohol
ingestion
during last 4 yrs
 Physical weakness
Mental confusion
100
90
91
83
87
80
70
60
49
50
40
VIQ
PIQ
FIQ
EIQ
Case 4: Carbon monoxide poisoning
 Male, 36 yrs
 Unemployed
 Heart attack
6 months ago
 Restlessness
Stimulus-driven
behavior
100
94
90
92
93
80
70
60
49
50
40
VIQ
PIQ
FIQ
EIQ
Summary
Prefrontal lobe as the central
executive
3 types of regional prefrontal
syndromes
EXIT (EXecutive Intelligence Test)