Abstract
Neuropsychological group study methodology is considered one of the primary methods to further understanding of the organisation of frontal ‘executive’ functions. Typically, patients with frontal lesions caused by stroke or tumours have been grouped together to obtain sufficient power. However, it has been debated whether it is methodologically appropriate to group together patients with neurological lesions of different aetiologies. Despite this debate, very few studies have directly compared the performance of patients with different neurological aetiologies on neuropsychological measures. The few that did included patients with both anterior and posterior lesions.We present the first comprehensive retrospective comparison of the impact of lesions of different aetiologies on neuropsychological performance in a large number of patients whose lesion solely affects the frontal cortex. We investigated patients who had a cerebrovascular accident (CVA), high (HGT) or low grade (LGT) tumour, or meningioma, all at the post-operative stage. The same frontal ‘executive’ (Raven's Advanced Progressive Matrices, Stroop Colour-Word Test, Letter Fluency-S; Trail Making Test Part B) and nominal (Graded Naming Test) tasks were compared. Patients' performance was compared across aetiologies controlling for age and NART IQ scores. Assessments of focal frontal lesion location, lesion volume, global brain atrophy and non-specific white matter (WM) changes were undertaken and compared across the four aetiology.We found no significant difference in performance between the four aetiology subgroups on the ‘frontal’ executive and nominal tasks. However, we found strong effects of premorbid IQ on all cognitive tasks and robust effects of age only on the frontal tasks. We also compared specific aetiology subgroups directly, as previously reported in the literature. Overall we found no significant differences in the performance of CVA and tumour patients, or LGT and HGT patients or LGT, HGT and meningioma's on our four frontal tests. No difference was found with respect to the location of frontal lesions, lesion volume, global brain atrophy and non-specific WM changes between the subgroups.Our results suggest that the grouping of frontal patients caused by different aetiologies is a pragmatic, justified methodological approach that can help to further understanding of the organisation of frontal executive functions.
Highlights
Neuropsychological group study methodology is considered one of the primary methods to further understanding of the n Correspondence to: Box 37, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK
Post hoc analysis revealed that the Meningioma group were significantly older than all other aetiology subgroups (CVA, p 1⁄4.009; LGT, p o.001; HGT, p 1⁄4.006) and there was a trend for LGT to be somewhat younger cerebrovascular accident (CVA) (p 1⁄4.09)
Despite the rather high variability in the scores, we found a significant difference between the four aetiology subgroups in both periventricular hyper/hypo intensity (PVH) and deep white matter hyper/hypo intensity signal (DWMH) subscales (PVH: χ2 (3, N 1⁄4 80)1⁄4 13.843, p 1⁄4.003; DWMH: χ2 (3, N 1⁄480) 1⁄412.392, p 1⁄4.006)
Summary
Neuropsychological group study methodology is considered one of the primary methods to further understanding of the n Correspondence to: Box 37, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK. To obtain sufficient power with this methodology it is necessary to recruit rather large numbers of neurological patients. If too few patients are used, the results are inevitably inconclusive. To investigate neuro-cognitive architectures, patients with different aetiologies such as vascular (CVA) or tumour (different types of brain tumours) are often combined. A typical example of this approach is given by research investigating the organisation of frontal ‘executive’ functions.
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