Henri-Bhargava Alexandre, Stuss Donald T, Freedman Morris
Continuum (Minneap Minn). 2018 Jun;24(3, BEHAVIORAL NEUROLOGY AND PSYCHIATRY):704-726. doi: 10.1212/CON.0000000000000609.
Whereas it was previously thought that there was a single overarching frontal lobe syndrome, it is now clear that several distinct cognitive and behavioral processes are mediated by the frontal lobes. This article reviews these processes and the underlying neuroanatomy and provides an approach to the assessment of prefrontal lobe functions at the bedside.
Cognitive and behavioral frontal lobe functions are mediated by the prefrontal regions rather than the frontal lobes as a whole. At least five separate prefrontal functions have been defined: energization, task setting, monitoring, behavioral/emotional regulation, and metacognition. Energization is mediated by the superior medial prefrontal cortices bilaterally, task setting by the left lateral frontal cortex, monitoring by the right lateral prefrontal cortex, behavioral/emotional regulation by the orbitofrontal cortex, and metacognition by the frontal poles. Only task setting and monitoring are considered executive functions.
Distinct cognitive and behavioral processes are mediated by different parts of the frontal lobe. Lesions in these areas result in characteristic clinical deficits that are discussed in this article. Key messages are that prefrontal regions mediate the higher cortical functions (as opposed to the frontal lobes in general) and that prefrontal functions are not equivalent to executive functions.
以前人们认为存在一种单一的总体额叶综合征，而现在很清楚的是，额叶介导了几种不同的认知和行为过程。本文回顾了这些过程及其潜在的神经解剖学，并提供了一种在床边评估前额叶功能的方法。
认知和行为额叶功能由前额叶区域而非整个额叶介导。至少已定义了五种不同的前额叶功能：激活、任务设定、监控、行为/情绪调节和元认知。激活由双侧额内侧上皮质介导，任务设定由左侧额叶皮质介导，监控由右侧额叶皮质介导，行为/情绪调节由眶额叶皮质介导，元认知由额极介导。只有任务设定和监控被视为执行功能。
不同的认知和行为过程由额叶的不同部分介导。这些区域的损伤会导致本文中讨论的特征性临床缺陷。关键信息是前额叶区域介导高级皮质功能（与一般的额叶相对），且前额叶功能不等同于执行功能。
