Staying on the job: the frontal lobes control individual performance variability.

The causes of variability of performance by individual subjects have rarely been investigated, although excessive variability or inconsistency may be a functionally significant factor for many real-life activities. Our objective was to determine whether patients with focal frontal brain lesions have excessive individual performance variability. Thirty-six patients with focal frontal (n=25) or non-frontal (n=11) lesions were compared with 12 control subjects on different measures of intra-individual variability: dispersion within a testing session; and consistency across testing sessions. Four reaction time tasks, varying in levels of complexity and based on a model of detection using feature integration, were administered. Following the first test session, 22 patients and 10 controls returned for two subsequent test sessions, which permitted the assessment of consistency of performance. Measures of abnormal dispersion of performance on these tests were observed in frontal patients only (except those with exclusively inferior medial damage). Disturbances in consistency of performance were observed primarily in patients with frontal lesions. Damage to the frontal lobes impairs the stability of cognitive performance. Damage to different frontal regions causes different profiles of abnormal variability. Fluctuations in performance of a task may underlie some of the reported difficulties in daily tasks reported by patients with frontal injuries.