Basal ganglia lesions and the theory of fronto-subcortical loops: neuropsychological findings in two patients with left caudate lesions
Abstract
Basal ganglia lesions have a high prevalence for associated behavioural impairments. However, the exact pattern of cognitive impairments and its relationship to individual basal ganglia lesion have rarely been investigated by means of a detailed neuropsychological and lesion study. Furthermore, different mechanisms have been proposed as relevant for the observed cognitive deficits; among these, the hypothesis of fronto-subcortical loops (Alexander et al., 1986) has made predictions regarding the relationship between the damage of particular striato-frontal circuits and the resulting behavioural impairment which await clinical confirmation. We present a study of two subjects who suffered a MRI-documented focal left basal ganglia hematoma. The two patients differed in their lesions; in one patient (PJ) large parts of the caudate nucleus were destroyed whereas in the other (AS) mainly the pallidum and putamen were lesioned and the caudate suffered only minor damage. In the acute phase, the behavioural and neuropsychological abnormalities were similar in both cases and included mainly abulia, an impairment of executive and attentional functions, and a severe amnestic syndrome. After several months many functions were restored in AS, whereas PJ's abilities remained largely defective. Based on these data and on previous case studies several conclusions are drawn. Left caudate lesions induce marked and long-lasting behavioural and neuropsychological impairments comprising predominantly drive, executive control, attention, and memory. The extent of lesion in the head of the caudate nucleus is the critical factor regarding the severity and the outcome of the syndrome, whereas damage to the putamen and pallidum is less crucial for cognitive functions. A subset of behavioural alterations, among them abulia, attentional and frontal-executive dysfunctions, can well be attributed to lesions of the anterior cingulate circuit and the dorsolateral-frontal circuit at the basal ganglia level. Other impairments, most importantly the prominent amnestic syndrome, are more difficult to interpret on the grounds of this hypothesis and may be related to other pathomechanisms.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Previous evidence implicates the left caudate in inattentiveness in patients with ADHD and in healthy subjects.
“This result is consistent with previous evidence implicating the left caudate in inattentiveness, not only in patients with ADHD, but also in healthy subjects (Schrimsher et al., 2002; Volkow et al., 2007a, b, 2009) and is also congruent with reports that lesions in the left caudate produce attentional deficits (Benke et al., 2003).”
From A positron emission tomography study of nigro-striatal dopaminergic mechanisms underlying attention: implications for ADHD and its treatment (2013) · cites this paper as Benke et al., 2003
Lesions in the left caudate produce attentional deficits.
“This result is consistent with previous evidence implicating the left caudate in inattentiveness, not only in patients with ADHD, but also in healthy subjects (Schrimsher et al., 2002; Volkow et al., 2007a, b, 2009) and is also congruent with reports that lesions in the left caudate produce attentional deficits (Benke et al., 2003).”
From A positron emission tomography study of nigro-striatal dopaminergic mechanisms underlying attention: implications for ADHD and its treatment (2013) · cites this paper as Benke et al., 2003
Cites
Folstein, M. F., Folstein, S. E., & McHugh, P. R. (1975) · Journal of Psychiatric Research · doi:10.1016/0022-3956(75)90026-6 · Cited by 88,282 · see citing works
Parallel organization of functionally segregated circuits linking basal ganglia and cortex
Alexander, G. E., DeLong, M. R., & Strick, P. L. (1986) · Annual Review of Neuroscience · doi:10.1146/annurev.ne.09.030186.002041 · Cited by 8,527 · see citing works
The attention system of the human brain
Posner, M. I., & Petersen, S. E. (1990) · Annual Review of Neuroscience · doi:10.1146/annurev.ne.13.030190.000325 · Cited by 8,070 · cited 1× · see citing works
“…(Caplan et al., 1990; Weiller et al., 1990; Kumral et al., 1999; Fimm et al., 2001), it is not clear which loop specifically mediates spatial attention, and it appears that other functional networks (Mesulam, 1981; Posner and Petersen, 1990) may provide a better explanation than the FSC-model.”
BackgroundA cortical network for directed attention and unilateral neglect
Mesulam, M. ‐. (1981) · Annals of Neurology · doi:10.1002/ana.410100402 · Cited by 2,498 · see citing works
Interhemispheric differences in the localization of psychological processes in man.
Milner, B. (1971) · British Medical Bulletin · doi:10.1093/oxfordjournals.bmb.a070866 · Cited by 2,405 · see citing works
Stuss, D. T., & Benson, D. F. (1986) · Raven Press eBooks · Cited by 2,102 · see citing works
Fuster, J. M. (1997) · Cited by 2,095 · see citing works
Jeurgen, K., Assheuer, J., & Paxinos, G. (1997) · Medical Entomology and Zoology · Cited by 1,403 · see citing works
Baxter, L. R. (1992) · Archives of General Psychiatry · doi:10.1001/archpsyc.1992.01820090009002 · Cited by 1,293 · see citing works
Behavioural Assessment of the Dysexecutive Syndrome
(2004) · Methodology Of Frontal And Executive Function · doi:10.4324/9780203344187-15 · Cited by 1,149 · see citing works
The behavioural and motor consequences of focal lesions of the basal ganglia in man.
Bhatia, K., & Marsden, C. (1994) · Brain : a journal of neurology · doi:10.1093/brain/117.4.859 · Cited by 1,137 · see citing works
Frontal-subcortical circuits and neuropsychiatric disorders
Mega, M. S., & Cummings, J. L. (1994) · Journal of Neuropsychiatry · doi:10.1176/jnp.6.4.358 · Cited by 726 · see citing works
Basal Ganglia Output and Cognition: Evidence from Anatomical, Behavioral, and Clinical Studies
Middleton, F. A., & Strick, P. L. (2000) · Brain and Cognition · doi:10.1006/brcg.1999.1099 · Cited by 657 · see citing works
Houk, J. C., & Wise, S. P. (1995) · Cerebral Cortex · doi:10.1093/cercor/5.2.95 · Cited by 594 · see citing works
LAPLANE, D., LEVASSEUR, M., PILLON, B., DUBOIS, B., BAULAC, M., MAZOYER, B., DINH, S. T., SETTE, G., DANZE, F., & BARON, J. C. (1989) · Brain · doi:10.1093/brain/112.3.699 · Cited by 415 · see citing works
Neurobehavioral changes associated with caudate lesions
Mendez, M. F., Adams, N. L., & Lewandowski, K. S. (1989) · Neurology · doi:10.1212/wnl.39.3.349 · Cited by 404 · see citing works
Aphasia With Predominantly Subcortical Lesion Sites
Naeser, M. A. (1982) · Archives of Neurology · doi:10.1001/archneur.1982.00510130004002 · Cited by 394 · see citing works
Impaired use of organizational strategies in free recall following frontal lobe damage
Gershberg, F. B. (1995) · Neuropsychologia · doi:10.1016/0028-3932(95)00103-a · Cited by 376 · see citing works
Aphasia With Nonhemorrhagic Lesions in the Basal Ganglia and Internal Capsule
Damásio, A. R., Damasio, H., Rizzo, M., Varney, N. R., & Gersh, F. (1982) · Archives of Neurology · doi:10.1001/archneur.1982.00510130017003 · Cited by 375 · see citing works
Higher-Order Cognitive Impairments and Frontal Lobe Lesions in Man
Shallice, T., & Burgess, P. W. (1991) · Oxford University Press eBooks · doi:10.1093/oso/9780195062847.003.0006 · Cited by 375 · see citing works
Mesulam, M. ‐. (1986) · Annals of Neurology · doi:10.1002/ana.410190403 · Cited by 363 · see citing works
Frontal lobe damage produces episodic memory impairment
Wheeler, M., Stuss, D., & Tulving, E. (1995) · Journal of the International Neuropsychological Society · doi:10.1017/s1355617700000655 · Cited by 362 · see citing works
Awareness of deficit after brain injury : clinical and theoretical issues
Prigatano, G. P., & Schacter, D. L. (1991) · Cited by 351 · see citing works
Cognitive Impairment and the Brain Dopaminergic System in Parkinson Disease
Rinne, J. O., Portin, R. I., Ruottinen, H., Nurmi, E., Bergman, J. R., Haaparanta‐Solin, M., & Solin, O. H. (2000) · Archives of Neurology · doi:10.1001/archneur.57.4.470 · Cited by 337 · see citing works
The temporal lobe is a target of output from the basal ganglia.
Middleton, F. A., & Strick, P. L. (1996) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.93.16.8683 · Cited by 301 · see citing works
Arithmetic Skills in Patients with Unilateral Cerebral Lesions
Jackson, M., & Warrington, E. K. (1986) · Cortex · doi:10.1016/s0010-9452(86)80020-x · Cited by 295 · see citing works
Cognitive functions and corticostriatal circuits: insights from Huntington's disease
Lawrence, A. D., Sahakian, B. J., & Robbins, T. W. (1998) · Trends in Cognitive Sciences · doi:10.1016/s1364-6613(98)01231-5 · Cited by 252 · see citing works
The anatomy of aphasia revisited
Kreisler, A., Godefroy, O., Delmaire, C., Debachy, B., Leclercq, M., Pruvo, J., & Leys, D. (2000) · Neurology · doi:10.1212/wnl.54.5.1117 · Cited by 219 · see citing works
Acute Caudate Vascular Lesions
Kumral, E., Evyapan, D., & Balkır, K. (1999) · Stroke · doi:10.1161/01.str.30.1.100 · Cited by 215 · see citing works
Manic-depressive and pure manic states after brain lesions
STARKSTEIN, S. E., Fedoroff, P., Berthier, M. L., & Robinson, R. G. (1991) · Biological Psychiatry · doi:10.1016/0006-3223(91)90043-l · Cited by 212 · see citing works
Bilateral paramedian thalamic artery infarcts: report of eight cases.
Gentilini, M., Renzi, E. D., & Crisi, G. (1987) · Journal of Neurology Neurosurgery & Psychiatry · doi:10.1136/jnnp.50.7.900 · Cited by 205 · see citing works
Pure psychic akinesia with bilateral lesions of basal ganglia.
Laplane, D., Baulac, M., Widlöcher, D., & Dubois, B. (1984) · Journal of Neurology Neurosurgery & Psychiatry · doi:10.1136/jnnp.47.4.377 · Cited by 190 · see citing works
The case of aphasia or neglect after striatocapsular infarction
Weiller, C., Willmes, K., Reiche, W., Thron, A. K., Isensee, C., Buell, U., & Ringelstein, E. B. (1993) · Brain · doi:10.1093/brain/116.6.1509 · Cited by 148 · see citing works
Ziegler, W. (1997) · Neuropsychologia · doi:10.1016/s0028-3932(97)00040-7 · Cited by 121 · see citing works
Dynamic Aphasia: The Selective Impairment of Verbal Planning
Costello, A. D. L., & Warrington, E. K. (1989) · Cortex · doi:10.1016/s0010-9452(89)80010-3 · Cited by 116 · see citing works
Garraux, G., Salmon, E., Degueldre, C., Lemaire, C., Laureys, S., & Franck, G. (1999) · NeuroImage · doi:10.1006/nimg.1999.0463 · Cited by 109 · cited 1× · see citing works
“…role in the cognitive loss of Huntington’s (Berent et al., 1988; Lawrence et al., 1998) and Parkinson’s disease (Holthoff-Detto et al., 1997; Rinne et al., 2000), and possibly also in obsessive compulsive disorder (Baxter et al., 1992) and cognitive aging (Garraux et al., 1999; Rubin, 1999).”
BackgroundFrontal Lobe Syndrome in a Patient With Bilateral Globus Pallidus Lesions
Strub, R. L. (1989) · Archives of Neurology · doi:10.1001/archneur.1989.00520450096027 · Cited by 107 · see citing works
Functional Effects of Striatal Dysfunction in Parkinson Disease
Holthoff‐Detto, V., Kessler, J., Herholz, K., Bönner, H., Pietrzyk, U., Würker, M., Ghaemi, M., Wienhard, K., Wagner, R. L., & Heiss, W. ‐. (1997) · Archives of Neurology · doi:10.1001/archneur.1997.00550140025008 · Cited by 104 · see citing works
Mega, M. S., & ALEXANDER, M. P. (1994) · Neurology · doi:10.1212/wnl.44.10.1824 · Cited by 99 · see citing works
Non-spatial attention disorders in patients with frontal or posterior brain damage
Godefroy, O., Lhullier, C., & Rousseaux, M. (1996) · Brain · doi:10.1093/brain/119.1.191 · Cited by 98 · see citing works
Neurological syndrome following bilateral damage to the head of the caudate nuclei
Richfield, E. K., Twyman, R. E., & Berent, S. (1987) · Annals of Neurology · doi:10.1002/ana.410220615 · Cited by 98 · see citing works
Memory without context: amnesia with confabulations after infarction of the right capsular genu.
Schnider, A., Gutbrod, K., Hess, C. W., & Schroth, G. (1996) · Journal of Neurology Neurosurgery & Psychiatry · doi:10.1136/jnnp.61.2.186 · Cited by 90 · see citing works
Chukwudelunzu, F. E. (2001) · Journal of Neurology Neurosurgery & Psychiatry · doi:10.1136/jnnp.71.5.658 · Cited by 79 · see citing works
Behavioral Neurology of Movement Disorders
Weiner, W. J. (1995) · Medical Entomology and Zoology · Cited by 74 · see citing works
Long-term Cognitive Impairment Associated With Caudate Stroke
Bokura, H., & Robinson, R. G. (1997) · Stroke · doi:10.1161/01.str.28.5.970 · Cited by 71 · see citing works
Calculation and number processing: Assessment battery; role of demographic factors
Deloche, G., Seron, X., Larroque, C., Magnien, C., Metz‐Lutz, M., Noël, M., Riva, I., Schils, J. P., Dordain, M., Ferrand, I., et al. (1994) · Journal of Clinical and Experimental Neuropsychology · doi:10.1080/01688639408402631 · Cited by 70 · see citing works
Degos, J. D., da Fonseca, N., Gray, F., & Césaro, P. (1993) · Brain · doi:10.1093/brain/116.6.1541 · Cited by 66 · see citing works
Frontal-Striatal Circuits in Cognitive Aging: Evidence for Caudate Involvement
Rubin, D. C. (1999) · Aging Neuropsychology and Cognition · doi:10.1076/1382-5585(199912)06:04;1-b;ft241 · Cited by 65 · see citing works
THE MECHANISM OF 'DYNAMIC APHASIA'
Luria, A. R., & Tsvetkova, L. S. (2014) · De Gruyter eBooks · doi:10.1515/9783111350219.187 · Cited by 63 · see citing works
Frontal Lobe Functions and Dysfunctions
Niedermeyer, E. (1998) · Clinical Electroencephalography · doi:10.1177/155005949802900206 · Cited by 51 · see citing works
Memory loss from a subcortical white matter infarct.
Kooistra, C. A., & Heilman, K. M. (1988) · Journal of Neurology Neurosurgery & Psychiatry · doi:10.1136/jnnp.51.6.866 · Cited by 49 · see citing works
Subtraction Bugs in an Acalculic Patient
Girelli, L., & Delazer, M. (1996) · Cortex · doi:10.1016/s0010-9452(96)80011-6 · Cited by 49 · see citing works
Self-citationCopland, D. A., Chenery, H. J., & Murdoch, B. E. (2000) · Cortex · doi:10.1016/s0010-9452(08)70541-0 · Cited by 47 · see citing works
Mantovan, M. C., Delazer, M., Ermani, M., et al. (1999) · Cortex · doi:10.1016/s0010-9452(08)70783-4 · Cited by 46 · see citing works
Self-citationCopland, D. A., Chenery, H. J., & Murdoch, B. E. (2001) · Journal of Clinical and Experimental Neuropsychology · doi:10.1076/jcen.23.4.538.1233 · Cited by 46 · see citing works
Neuronal activity of human caudate nucleus and prefrontal cortex in cognitive tasks
Abdullaev, Y. G. (1998) · Behavioural Brain Research · doi:10.1016/s0166-4328(98)00037-0 · Cited by 46 · see citing works
Neuropsychological changes related to unilateral lenticulostriate infarcts.
Godefroy, O., Rousseaux, M., Pruvo, J., Cabaret, M., & Leys, D. (1994) · Journal of Neurology Neurosurgery & Psychiatry · doi:10.1136/jnnp.57.4.480 · Cited by 45 · see citing works
A follow-up study of cognitive impairment due to inferior capsular genu infarction
MADUREIRA, S., Guerreiro, M., & Ferro, J. M. (1999) · Journal of Neurology · doi:10.1007/s004150050452 · Cited by 41 · see citing works
Asymmetries of visual attention after circumscribed subcortical vascular lesions
Fimm, B. (2001) · Journal of Neurology Neurosurgery & Psychiatry · doi:10.1136/jnnp.71.5.652 · Cited by 38 · see citing works
Remote Effects of Caudate Hemorrhage: A Clinical and Functional Study
Pozzilli, C., Passaffume, D., Bastianello, S., et al. (1987) · Cortex · doi:10.1016/s0010-9452(87)80046-1 · Cited by 36 · see citing works
Verbal Memory Deterioration After Unilateral Infarct of the Internal Capsule in an Adolescent
Markowitsch, H. J., von Cramon, D. Y., Hofmann, E., et al. (1990) · Cortex · doi:10.1016/s0010-9452(13)80309-7 · Cited by 31 · see citing works
[Disorders of voluntary motor activity and lesions of caudate nuclei].
Trillet, M., Croisile, B., Tourniaire, D., et al. (1990) · PubMed · Cited by 29 · see citing works
MODELS OF SUBCORTICAL FUNCTIONS IN LANGUAGE: CURRENT STATUS
Crosson, B., Zawacki, T. M., Brinson, G., et al. (1997) · Journal of Neurolinguistics · doi:10.1016/s0911-6044(97)00018-3 · Cited by 27 · see citing works
Cambier, J., Elghozi, D., & Strube, E. (1979) · PubMed · Cited by 21 · see citing works
SYMPTOMATOLOGY OF SUBCORTICAL APHASIA
Wallesch, C. (1997) · Journal of Neurolinguistics · doi:10.1016/s0911-6044(97)00019-5 · Cited by 18 · see citing works
Hemichorea and its denial in a case of caudate infarction diagnosed by magnetic resonance imaging.
Kawamura, M., Takahashi, N., & Hirayama, K. (1988) · Journal of Neurology Neurosurgery & Psychiatry · doi:10.1136/jnnp.51.4.590 · Cited by 17 · see citing works
Crews, W. D., Manning, C. A., & Skalabrin, E. J. (1996) · Neurocase · doi:10.1080/13554799608402415 · Cited by 4 · see citing works
Khan (2000) · doi:10.1002/1531-8249(200008)48:2
Flagged first, then by citations
Cited by
Sorted by citations
Brain dopamine transporter levels in treatment and drug naive adults with ADHD
Volkow, N. D., Wang, G.-J., Newcorn, J., Fowler, J. S., Telang, F., Solanto, M. V., Logan, J., Wong, C., Ma, Y., Swanson, J. M., et al. (2007) · NeuroImage · doi:10.1016/j.neuroimage.2006.10.014 · Cited by 249 · see citing works
del Campo, N., Fryer, T. D., Hong, Y. T., Smith, R., Brichard, L., Acosta-Cabronero, J., Chamberlain, S. R., Tait, R., Izquierdo, D., Regenthal, R., et al. (2013) · Brain · doi:10.1093/brain/awt263 · Cited by 113 · see citing works
Camerino, I., Ferreira, J., Vonk, J. M., Kessels, R. P. C., de Leeuw, F.-E., Roelofs, A., Copland, D., & Piai, V. (2024) · Neuropsychology Review · doi:10.1007/s11065-022-09570-3 · Cited by 27 · see citing works
- Authors
- Benke, T., Delazer, M., Bartha, L., & Auer, A.
- Affiliations
- Universität Innsbruck (AT)
- Venue
- Neurocase
- Publisher
- Informa UK Limited
- Published
- 2003-02
- Volume
- 9
- Issue
- 1
- Pages
- 70-85
- ISSN
- 1355-4794 (ISSN-L)
- 1465-3656
- OpenAlex
- W2061344556
- Cited by
- 102
- References
- 68
- Citations by year
- 2025: 3 · 2024: 1 · 2023: 2 · 2022: 3 · 2021: 1 · 2020: 1 · 2019: 2 · 2018: 5 · 2017: 6 · 2016: 3 · 2015: 3 · 2014: 2 · 2013: 8 · 2012: 12
- FWCI
- 1.30
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Neurocase (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Life Sciences › Neuroscience › Cognitive Neuroscience › Neural and Behavioral Psychology Studies
- Health Sciences › Medicine › Neurology › Neurological disorders and treatments
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Neurological and metabolic disorders
- Keywords
- basal ganglia lesions, caudate nucleus, abulia, executive dysfunction, attention deficits, amnestic syndrome, putamen, globus pallidus, cognitive impairment
- MeSH terms
- Basal Ganglia, Behavior, Caudate Nucleus, Cerebral Hemorrhage, Cognition Disorders, Female, Follow-Up Studies, Frontal Lobe, Humans, Intelligence, Language, Magnetic Resonance Imaging, Male, Mathematics, Memory, Mental Processes, Middle Aged, Nerve Net, Neuropsychological Tests, Psychomotor Performance
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
