Affiliations: Institute of Cognitive Neuroscience, UCL (University
College London), 17 Queen Square, London WC1N 3AR, UK | Kemsley National Centre for Neurorehabilitation, St
Andrew's Hospital, Northampton NN1 5DG, UK
Note: [] Corresponding author: Prof. Paul. W. Burgess, Institute of
Cognitive Neuroscience, UCL (University College London), 17 Queen Square,
London WC1N 3AR, UK. Tel.: +44 207 679 1177; Fax: +44 207 679 1177; E-mail:
p.burgess@psychol.ucl.ac.uk
Abstract: Purpose: Mesulam's (1986) mystery is that some patients with frontal
lobe damage may show no cognitive impairment according to traditional
office-based assessment procedures, yet nevertheless show marked cognitive
handicap in everyday life. Mesulam suggested that "the office setting may
introduce sufficient external structure to suppress some of these behavioral
tendencies" (p. 322). We ask if it is indeed the office setting that is the
problem, or whether it is that traditional assessments do not measure the full
range of cognitive functions supported by prefrontal cortex. Method: Neuropsychological case series study and review. Results: Traditional
methods for assessing cognitive deficits following frontal lobe damage
typically do not measure the full range of deficits that can occur. In
particular, rostral prefrontal cortex supports functions which are not
routinely assessed yet are crucial to competent everyday life performance.
These include meta-memory functions (e.g. context and source memory), complex
behavioural co-ordination (e.g. prospective memory and multitasking), and
mentalizing. Conclusions: New clinical assessment procedures are required
urgently. These could be based, in principle, both on recent experimental
findings from cognitive neuroscience, and observation of behaviour outside
office settings. These procedures could then be administered in an office
setting.
