How Early Damage to the Dorsomedial Prefrontal Hub in Human Brain Networks Affects Long Term Cognitive, Behavioral, and Neuroanatomical Outcomes

• Published in: Psychology & Neuroscience 2020-09, Vol.13 (3), p.245-256
• Main Authors: Okerstrom-Jezewski, Katrina L, Grafft, Amanda, Denburg, Natalie L, Bruss, Joel, Deifelt Streese, Carolina, Gratton, Caterina, Tranel, Daniel
• Format: Article
• Language: English
• Subjects: Brain Damage; Cerebrovascular Accidents; Female; Human; Injuries; Neural Networks; Neuropsychology; Onset (Disorders); Prefrontal Cortex
• ISSN: 1984-3054; 1983-3288
• DOI: 10.1037/pne0000222

Objective: Functional brain networks, which include important "hub" regions, provide important ways to understand recovery after brain damage. One crucial hub previously identified in adult human functional brain networks is in the dorsomedial prefrontal cortex (dmPFC). An open question is whether this hub is vulnerable during development. Method: Here, we describe the neuropsychological and neuroanatomical outcomes of a woman who sustained focal damage to the dmPFC hub from a stroke at age 7. Her rare lesion, acquired early in life and affecting the left dmPFC and underlying white matter, afforded a compelling opportunity for new insights into brain-behavior relationships from a developmental perspective. Results: Cognitive impairment ratings by clinical neuropsychologists showed stable cognition over 2 decades with moderate impairments in personal adjustment and adaptive functioning. The cognitive profile of this childhood-onset case is similar to two previously reported adult-onset cases with similar lesion locations. The results suggest that for the hub we sampled with these cases (midline dmPFC), cognitive and behavioral outcomes do not differ for childhood-onset versus adult-onset brain damage, as in both instances there were long-lasting moderate to severe impairments in personal adjustment and adaptive functioning. Preliminary resting-state fMRI data from the childhood-onset case and one of the adult-onset cases are used to propose future directions for exploring questions of neural plasticity and neurorestoration. Conclusions: This case study provides a rare window into cognitive and neural development following early injury to the dmPFC, enhancing understanding of the complex relationships between age at neurological injury, lesion location, and long-term cognitive and behavioral recovery. Public Significance Statement This research suggests that childhood brain damage to the frontal lobes of the brain causes long term cognitive and behavioral impairments that are similar to those seen in patients with damage acquired in adulthood. Use of neuroimaging may be informative to better understand how age of onset and location of brain damage relate to recovery. This work is important for informing clinical interventions and patient outcome expectations after brain injury early in life.