[Dysexecutive syndrome and disorders of motor control in prefrontal mediobasal and cingulate lesions]

Disorders of executive function and motor control are considered to be classical consequences of prefrontal lesions. The aim of this study was to investigate these disorders and their evolution in a series of patients presenting with prefrontal and cingulate lesion following rupture of an anterior communicating artery aneurysm. Twenty one subjects were included, and assessed in the secondary and late post stroke phases. We have used the following tests to assess planning and/or execution time and performance: Trail Making test, Wisconsin Card Sorting Test, London Tower Test, Shopping Test of Martin, sequential gestual test and contradictory responses test from Luria. Correlations between these parameters were used to evaluate subjects strategy. In evaluation of execution time, patients were slower than controls, and the difference was more marked using the Trail Making Test (p0.01) and the London Tower Test (p0.01). Furthermore, the initiation time was increased in the London Tower Test (p0.01), this suggesting that they were slower than impulsive. Groups analysis showed that their performance level was most often similar to that of of controls, even in the secondary phase, with the exception of the number of problems solved whatever number of moves in the London Tower test (p0.01) and of the percentage of errors in the sequential motor task (p0.03). Similar results were observed in the evaluation of single cases. Correlations between execution time and performance were most often significant and negative, in patients and controls. These results suggest that the management of the speed-accuracy compromise was relatively similar, and that impulsivity, which associates reduction of time to poor performance, was absent or mild. Cingulate, and caudate lesions were identified as the source of most cognitive disorders.