执行功能描述了各种各样的高阶认知过程,允许根据不断变化的环境修改思想和行为。最近对健康受试者的功能成像研究进行了全面的定量和系统的荟萃分析,确定了下额叶交界处(IFJ),位于下额沟和下中央前沟的交界处,对执行职能至关重要。患者的病变研究对于确认这一发现是必要的。
我们介绍,作为概念的证明,1名56岁女性患者,由大脑中动脉双侧区域的多发性卒中相关脑梗死引起的IFJ双侧缺血性病变。全面的神经心理学测试揭示了执行功能的特定缺陷,即工作记忆,任务切换,抑制控制,干扰分辨率,流利,和复杂的执行功能测试侧重于行动计划和解决问题的能力。记忆功能在正常范围内。此外,我们应用综合荟萃分析来验证IFJ对执行功能的重要性.(i)IFJ患者大脑中的病变与工作记忆功能成像研究中的区域激活相吻合,任务切换,还有Stroop任务.(ii)患者的IFJ中的病变应影响额叶网络,如连通性分析所示。(iii)我们引入了一种新的分析工具-症状的荟萃分析阅读(MARS)-能够从个体患者的影像学数据中预测临床症状。
我们的研究证实了IFJ作为因果代理的重要性,在额顶顶网络中,执行异常综合征.作为病变研究,它超越了相关成像方法。新的荟萃分析症状阅读方法可应用于其他患者和疾病。在个性化医学的框架内,它具有很高的潜力,可以在临床环境中促进个性化诊断和治疗。
Executive functions describe a wide variety of higher order cognitive processes allowing the modification of thought and behavior in response to changing contexts. Recent comprehensive quantitative and systematic meta-analyses on functional imaging studies in healthy subjects identified the inferior frontal junction (IFJ), located at the junction of the inferior frontal sulcus and the inferior precentral sulcus, as essential for executive functions. Lesion studies in patients are necessary for confirmation of this finding.
We present, as a proof of concept, a 56 year old woman with bilateral ischemic lesions in the IFJ caused by multiple stroke-related brain infarcts in the bilateral territory of the middle cerebral artery. Comprehensive neuropsychological testing revealed specific deficits in executive functions, namely working memory, task switching, inhibitory control, interference resolution, fluency, and complex executive function tests focusing on action planning and problem solving abilities. Memory functions were within the normal range. Furthermore, we applied comprehensive meta-analyses to validate the importance of the IFJ for executive functions. (i) Lesions in the patient\'s brain in the IFJ coincide with regional activation in functional imaging studies for working memory, task switching, and the Stroop task. (ii) Lesions in the patient\'s IFJ should affect a frontoparietal network as shown with connectivity analyses. (iii) We introduce a new analysis tool - Meta-Analytical Reading of Symptoms (MARS) - that enables prediction of clinical symptoms from imaging data in individual patients.
Our study confirms the importance of the IFJ as the causal agent, in a frontoparietal network, for dysexecutive syndrome. As a lesion study, it goes beyond correlational imaging approaches. The new meta-analytical symptom reading approach can be applied in other patients and diseases. It has a high potential to foster individualized diagnosis and therapy in clinical settings in the framework of personalized medicine.