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The specific contribution of focal damage of the prefrontal cortex and the cognitive mechanisms accounting for communicative-pragmatic disorders remains unclear. The objective of the current study was to investigate the impact of focal prefrontal cortex damage on the ability to understand indirect speech or hints and to identify the prefrontal neural mechanisms involved. We also examined the underlying cognitive mechanisms of disorders of indirect speech understanding particularly theory of mind and executive functions. Thirty patients with focal prefrontal cortex damage and 30 control subjects were compared on their performances on the Hinting task assessing pragmatic language skills, the "Faux-Pas" task and the Reading the Mind in the Eyes task assessing Theory of Mind and a battery of executive tasks. Patients were significantly impaired compared with control subjects on all these abilities. Both deficits of executive functions and theory of mind were able to predict impaired ability of patients in understanding non-literal meanings on the Hinting task. Finally, using voxel-based lesion analysis we identified a partially shared neural prefrontal network involved in all these abilities centered on the dorsomedial and ventral regions of the prefrontal cortex., Competing Interests: Declaration of competing interest No potential conflict of interests was reported by the authors with respect to the authorship and/or publication of this article. Funding sources of financial support for the paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Objective: Conflicting evidence has arisen from the few correlational studies that have examined the relationship between the ability to decode social emotional cues through the eyes and executive functions in individuals with prefrontal cortex damage. The objective of the current study was (1) to investigate the impact of both focal prefrontal and parietal cortex damage on both of these domains; (2) to examine whether impaired ability to decode social emotion cues through the eyes was predicted by executive function deficits and; (3) to explore the neural correlates of both of these components., Method: Thirty individuals with prefrontal cortex damage, 15 individuals with parietal cortex damage and 30 matched healthy comparison subjects were subjected to a battery of executive tasks assessing inhibition, flexibility, and planning processes and the Reading the Mind in the Eyes Task (RMET) assessing ability to decode social emotion cues through the eyes., Results: Compared to both comparison groups, individuals with prefrontal cortex damage were impaired in performing RMET and almost all executive tasks. Regression analysis showed that for individuals with prefrontal cortex damage, performance on the Stroop and Hayling tasks predicted scores on the RMET, while for the healthy comparison group, only the verbal fluency performance predicted scores on the RMET. The Voxel lesions-symptom mapping technique showed that both components rely partly on the same neural substrates, reflecting beyond the neural network of RMET per se that of the cognitive processes elicited by this multi-determinant task., Conclusion: These findings suggest that the ability to read mental states of mind depends on the inhibition and flexibility executive mechanisms.

Objective Patients with prefrontal cortex damage often transgress social rules and show lower accuracy in identifying and explaining inappropriate social behavior. The objective of this study was to examine the relationship between the ability to perceive other unintentional transgressions of social norms and both decision making and emotion recognition as these abilities are critical for appropriate social behavior. Method We examined a group of patients with focal prefrontal cortex damage (N  = 28) and a group of matched control participants (N  = 28) for their abilities to detect unintentional transgression of social norms using the "Faux-Pas" task of theory of mind, to make advantageous decisions on the Iowa gambling task, and to recognize basic emotions on the Ekman facial affect test. Results The group of patients with frontal lobe damage was impaired in all of these tasks compared with control participants. Moreover, all the "Faux-Pas", Iowa gambling, and emotion recognition tasks were significantly associated and predicted by executive measures of inhibition, flexibility, or planning. However, only measures from the Iowa gambling task were associated and predicted performance on the "Faux-Pas" task. These tasks were not associated with performance in recognition of basic emotions. These findings suggest that theory of mind, executive functions, and decision-making abilities act in an interdependent way for appropriate social behavior. However, theory of mind and emotion recognition seem to have distinct but additive effects upon social behavior. Results from VLSM analysis also corroborate these data by showing a partially overlapped prefrontal circuitry underlying these cognitive domains. [ABSTRACT FROM AUTHOR]