Department of Neuropsychology, National Hospital for Neurology and Neurosurgery, London, UK.
ISN Psychology, Institute for Social Neuroscience, Melbourne, Australia.
Neuropsychologia. 2020 Feb 3;137:107308. doi: 10.1016/j.neuropsychologia.2019.107308. Epub 2019 Dec 20.
Design (DF) and phonemic fluency tests (FAS; D-KEFS, 2001) are commonly used to investigate voluntary generation. Despite this, several important issues remain poorly investigated. In a sizeable sample of patients with focal left or right frontal lesion we established that voluntary generation performance cannot be accounted for by fluid intelligence. For DF we found patients performed significantly worse than healthy controls (HC) only on the switch condition. However, no significant difference between left and right frontal patients was found. In contrast, left frontal patients were significantly impaired when compared with HC and right frontal patients on FAS. These lateralization findings were complemented, for the first time, by three neuroimaging; investigations. A traditional frontal subgrouping method found significant differences on FAS between patients with or without Left Inferior Frontal Gyrus lesions involving BA 44 and/or 45. Parcel Based Lesion Symptom Mapping (PLSM) found lower scores on FAS were significantly associated with damage to posterior Left Middle Frontal Gyrus. An increase in rule break errors, so far only anecdotally reported, was associated with damage to the left dorsal anterior cingulate and left body of the corpus callosum, supporting the idea that conflict resolution and monitoring impairments may play a role. Tractwise statistical analysis (TSA) revealed that patients with disconnection; in the left anterior thalamic projections, frontal aslant tract, frontal; orbitopolar tract, pons, superior longitudinal fasciculus I and II performed significantly worse than patients without disconnection in these tracts on FAS. In contrast, PLSM and TSA analyses did not reveal any significant relationship between lesion location and performance on the DF switch condition. Overall, these findings suggest DF may have limited utility as a tool in detecting lateralized frontal executive dysfunction, whereas FAS and rule break behavior appears to be linked to a set of well localized left frontal grey matter regions and white matter tracts.
设计（DF）和音素流畅性测试（FAS；D-KEFS，2001）常用于研究自愿产生。尽管如此，仍有几个重要问题尚未得到充分研究。在一个相当数量的左或右额部局灶性损伤的患者样本中，我们确定自愿产生表现不能用流体智力来解释。对于 DF，我们发现患者仅在切换条件下的表现明显差于健康对照组（HC）。然而，左额和右额患者之间没有发现显著差异。相比之下，左额叶患者在 FAS 上与 HC 和右额叶患者相比，表现明显受损。这些侧化发现首次通过三项神经影像学研究得到了补充。一种传统的额叶亚组化方法发现，涉及 BA 44 和/或 45 的左下回额回损伤的患者在 FAS 上存在显著差异。基于体素的病变症状映射（PLSM）发现，FAS 得分较低与左中额后回的损伤显著相关。规则打破错误的增加，迄今为止仅为轶事报道，与左侧背侧前扣带回和左侧胼胝体体部的损伤相关，支持冲突解决和监测受损可能起作用的观点。束状统计分析（TSA）显示，在左侧丘脑前投射、额前斜束、额眶极束、脑桥、上纵束 I 和 II 中有连接中断的患者在 FAS 上的表现明显差于无这些束中断的患者。相比之下，PLSM 和 TSA 分析未发现病变位置与 DF 切换条件下表现之间存在任何显著关系。总的来说，这些发现表明 DF 作为检测额叶执行功能偏侧化的工具可能具有有限的效用，而 FAS 和规则打破行为似乎与一组定位良好的左额叶灰质区域和白质束有关。
