Focal left prefrontal lesions and cognitive impairment: A multivariate lesion-symptom mapping approach

• Published in: Neuropsychologia 2020-01, Vol.136, p.107253-107253, Article 107253
• Main Authors: Arbula, Sandra, Ambrosini, Ettore, Della Puppa, Alessandro, De Pellegrin, Serena, Anglani, Mariagiulia, Denaro, Luca, Piccione, Francesco, D'Avella, Domenico, Semenza, Carlo, Corbetta, Maurizio, Vallesi, Antonino
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Brain Neoplasms - complications; Brain Neoplasms - pathology; Brain Neoplasms - physiopathology; Brain tumor; Cognitive dysfunction; Cognitive Dysfunction - etiology; Cognitive Dysfunction - pathology; Cognitive Dysfunction - physiopathology; Dorsolateral prefrontal cortex; Female; Frontal lobe; Humans; Male; Middle Aged; Multivariate Analysis; Multivariate lesion-symptom mapping; Nerve Net - pathology; Nerve Net - physiopathology; Prefrontal Cortex - pathology; Prefrontal Cortex - physiopathology; Principal Component Analysis; Severity of Illness Index; Young Adult
• ISSN: 0028-3932; 1873-3514
• DOI: 10.1016/j.neuropsychologia.2019.107253

Despite network studies of the human brain have brought consistent evidence of brain regions with diverse functional roles, the neuropsychological approach has mainly focused on the functional specialization of individual brain regions. Relatively few neuropsychological studies try to understand whether the severity of cognitive impairment across multiple cognitive abilities can be related to focal brain injuries. Here we approached this issue by applying a latent variable modeling of the severity of cognitive impairment in brain tumor patients, followed by multivariate lesion-symptom methods identifying brain regions critically involved in multiple cognitive abilities. We observed that lesions in confined left lateral prefrontal areas including the inferior frontal junction produced the most severe cognitive deficits, above and beyond tumor histology. Our findings support the recently suggested integrated albeit modular view of brain functional organization, according to which specific brain regions are highly involved across different sub-networks and subserve a vast range of cognitive abilities. Defining such brain regions is relevant not only theoretically but also clinically, since it may facilitate tailored tumor resections and improve cognitive surgical outcomes. •Focal brain injury can cause severe impairments across multiple cognitive abilities.•Severity of cognitive impairment was assessed with principal component analysis.•Multivariate lesion-symptom mapping linked damage variability to impairment severity.•Confined left lateral prefrontal lesions produced most severe cognitive deficits.•Integrated albeit modular view of brain functional organization is supported.