Regional frontal injuries cause distinct impairments in cognitive control

Background: Lesions of the frontal lobes may impair the capacity of patients to control otherwise intact cognitive operations in the face of ambiguous sensory input or conflicting possible responses. Objective: To address the question of whether focal lesions in different regions of the frontal lobes produced specific impairments in cognitive control. Methods: We evaluated 42 patients with chronic frontal lesions and 38 control subjects on a modified Stroop test that allowed measurement of reaction times and errors. Planned, stratified analyses permitted identification of discrete frontal lesions that are critical for impaired performance. Results: Lesions of the left ventrolateral region produced an increased number of incorrect responses to distractors. Lesions of a large portion of the right superior medial region, including anterior cingulate, supplementary motor area (SMA), pre-SMA, and dorsolateral areas, caused a slow reaction time and a decreased number of correct responses to targets. Conclusion: Lesions in two distinct frontal regions impair cognitive control for a Stroop task, and the mechanisms of impairment are specific to the region of injury. This is support for a general proposal that the supervisory system is constructed of distinct subsystems.