Cognitive and social-emotional changes associated with mesial orbitofrontal damage: Assessment and implications for treatment

Abstract

Clinical and experimental analysis of a 47-year-old female with an isolated right orbital frontal lesion is described. Although she voiced complaints of memory loss, neurological evaluation was negative with the exception of recall of only one of three words following delay on the Mini-Mental Status Examination. Results of comprehensive neuropsychological analyses revealed subtle right anterior brain dysfunction evident in memory for non-verbal information, cognitive efficiency, complex attention, visual-spatial planning and organization, strategy application, vulnerability to proactive interference and visual-spatial working memory. A plethora of social-emotional changes were reported and verified through empirical measures. Results were consistent with her reported functional limitations and suggest that the orbital frontal cortex provides critical neural mechanisms for adaptation, though without evident effects on general intellect, language or perception. Intervention approaches are described, but many impairments have remained intractable.