LOBE FUNCTIONS

Dr. Pooja R Raikar

Consultant Psychiatrist
Manasa Nursing Home
Shimoga

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 Layout:
 INTRODUCTION
 ANATOMY
 FUNCTIONS
 LESIONS
 TESTS
 CONCLUSION

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  General aspects of cerebral cortex
 Two cerebral hemispheres
 Surface extent - 4000 cm2 about the size of a full sheet
of newsprint (right and left pages).
 Surface has series of grooves or sulci separated by
intervening areas - Gyri

 It has many billions of neurons (estimated at 10 to 30

billion)
 The intercellular synaptic connections number in the
trillions.

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  Clinically, Cerebrum is divided into four lobes - based on the
fissures
 Frontal lobe –
 Anterior to central sulcus,
 Above posterior ramus of the lateral sulcus

 Parietal lobe –
 Lies behind central sulcus
 Below by posterior ramus of lateral sulcus
 Behind by upper part of first imaginary line

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  Occipital lobe –
 Lies behind first imaginary line

 Temporal lobe –
 Below posterior ramus of lateral sulcus and second imaginary
line
 Separated from occipital lobe by the lower part of first
imaginary line

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 Frontal lobe:

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 Functional areas of Brain
 Best known scheme – Brodmann

 Represented different areas by numbers

 Functional areas do not follow boundaries of sulci and gyri

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 FRONTAL LOBES

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 Frontal lobe:

 Anatomic and Physiologic Considerations

 Seat of highest mental function – most recent to evolve

 Larger in humans (30 percent of the cerebrum) than in any other

primate.

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 Frontal lobes

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 Frontal lobes
 Motor Area: Area 4
 Precentral gyrus on superolateral surface of hemisphere
 Anterior part of paracentral lobule on medial suface
 Movements in specific parts of the body
 Paracentral lobule – lower limbs
 Upper part of precentral gyrus – trunk and upper limb
 Lower part of precentral gyrus - Face and head
 Not proportional to size of part rather intricacy of
movements

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  Premotor Area:
 Ant to Motor area
 Post part of Sup, Middle and inf frontal gyri
 Area 6 and 8
 Part of Inf gyrus – Area 44 & 45 – Motor speech area of
Broca
 functions of the lips, tongue, larynx, and pharynx
 bilateral lesions - paralysis of articulation, phonation, and
deglutition.

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  Frontal eye field:
 Middle frontal gyrus – ant to precentral gyrus
 Area 6, 8 & 9
 Both eyes move to opp side – conjugate movements

 The medial-orbital gyri and anterior parts of the cingulate

gyri, the frontal components of the limbic system,
 Control of respiration, blood pressure, peristalsis

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 Frontal lobes
 Presumed to govern personality, character,
motivation, and unique capacities for abstract
thinking, introspection, and planning.

 Initiation of planned action and executive control of all

mental operations, including emotional expression.

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 Clinical Effects of Frontal Lobe Lesions
1) Motor Abnormalities:
 Voluntary movement

 Spastic paralysis of the contralateral face, arm, and leg.

 Supplementary motor areas - mutism, contralateral motor neglect

 Seizure activity in this area causes a tonic deviation of the head and
eyes to the opposite side

 Bilateral lesions - quadriplegia or quadriparesis with severe weakness

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  Prefrontal lesions
 Grasping & groping responses
 Imitation
 Abulia - reduced and delayed motor and mental
activity/response
 Motor perseveration or impersistence (with left and right
hemispheric lesions, respectively)

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 2) Dysphasia - Broca's aphasia
Other Speech and language deficits are-
 Lack of spontaneity of speech,
 Telegraphic speech (agrammatism),
 Loss of fluency,
 Perseveration of speech,
 A tendency to whisper instead of speaking aloud
 Dysarthria.

3)Incontinence - loss of control of mictuirition and defecation.

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 4) Cognitive and Intellectual Changes
 Organ of civilization
 Lack of initiation, changes in mood (euphoria), and
inattention
 Loss of capacity for abstract thought
 Social indifference
 Emotional out-bursts.

 negligible impairment of memory function or cognitive

function
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  Luria proposed the role of the frontal lobes in intellectual
activity.
 He postulated that problem solving (perceptual,
constructive, arithmetical) proceeds in four steps:
1. The specification of a problem
2. Formulation of a plan of action or strategy - in orderly
sequence
3. Execution - implementation and control of the plan
4. Checking or comparing the results against the original plan
to see if it was adequate.

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 5) Executive Function:
 Ability to integrate and organize the morass of stimuli to problem
solve, focus,plan, remain flexible in their thinking, inhibit
impulses and regulate their behavior(Tasman ).
 Overall control of other cognitive functions
 Ability to adapt to changes in circumstance.
 Self-monitoring - guides selection of strategies to solve problems,
inhibition of incorrect responses, ability to deal with change in
focus and novelty in tasks, to generalize from experience.
 Deterioration in problem solving, by repetitiousness and
stereotypies

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 6) Other Alterations of Behavior and personality
a) Lack of initiative and spontaneity.
Mild forms - idleness of thought, speech, and action
Questions directed to such patients may evoke only brief,
unqualified answers.

b) Stimulus boundedness - Once started on a task, they may

persist in it ("stimulus bound")

c) Failure to maintain events in serial order and to intigrate new

events and information with previously learned data.
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  Extensive reduction in psychomotor activity.

 Akinetic Mutism - non paralyzed, alert patient capable of

movement and speech, lies or sits motionless and silent for
days and weeks.

 Insomnia

 Social inappropiateness - silly inappropriate joke, uninhibited

and lack awareness of their behavior.

 Disturbed gait

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 SPECIAL NEUROPSYCHOLOGIC TESTS OF FRONTAL LOBE
INCLUDING EXECUTIVE FUNCTIONS:
Planning –
Tower of London test (Shallice 1982)
 Mental speed-
 Digit symbol substitution test- (Weschler)
 Sustained attention –
 Digit Vigilance test – (Lesak 1995)
 Trail making test A and B
 Fluency Tests:
 Controlled oral word association test(COWA) –(Benton and Hamsher
1989)
 Animal Names test- (Lesak 1995)
 Thurston word fluency

 Non verbal fluency –design fluency test

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  Language comprehension-
 Token test
 Spelling
 Phonetic discrimination
 Boston naming test
Woking memory-self ordering
Verbal N back test - ( Smith and Jonides 1999)
Visual N back test
 Vigilance test- Paced Auditory Serial Addition Test
(PASAT)
“A” random letter test

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  Motor cordination and strength tests
 Hand dynamometry (grip strength)
 Finger tapping
 Grooved pegboard
Abstraction and shift paradigms
 Milan Sorting Test
 Halstead CategoryTest
 Wisconsin Card-SortingTest
 Raven’s progressive matrices
 Tests of response Inhibition
 Stroop test (Perret 1974)
 Wisconsin card sorting test (Milner 1964)
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  Comprehensive fixed Batteries:
 Halstead –Reitan battery
 Luria –Nebraska battery
 NIMHANS neuropsychological battery
 Cambridge Neuropsychological Test Automated
Battery (CANTAB)

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 TEMPORAL LOBE

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 Anatomy of temporal lobe

 Subcortical Temporal Lobe Structures

 Limbic cortex
 Amygdala
 Hippocampal Formation
 Insula
 Area under Sylvan Fissure
 Gustatory Cortex
 Auditory association cortex

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  Subdivisions of the Temporal Cortex
 Lateral surface
 Auditory areas
 Brodmann’s areas 41,42, and 22
 Ventral Stream of Visual Information -
 Infero temporal cortex

 Multimodal Cortex or Polymodal Cortex

 Area under Superior Temporal Sulcus
 Receives input from auditory, visual, and
somatic regions

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 Temporal lobe cont….
 Functions-
 Integration of "sensations, emotions, and behavior”
 Language, handedness, memory and learning
functions, and the emotion
 Spatial orientation, estimation of depth and
distance, stereoscopic vision, and hue perception.

 Superior part -receptive aspects of language.

 Middle and inferior convolutions -visual discriminations

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  Clinical Effects of Temporal Lobe lesions
 Disorders of the special senses –(visual, auditory, olfactory, and
gustatory), time perception language, memory, emotion, and
Behavior.

 1)Visual Disorders –
 Anopia
 Visual hallucinations of complex form (autoscopy), appear during
temporal lobe seizures.
 Distortes visual perception;
 Macropsia or Micropsia, too close or far away, or unreal.

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  2) Auditory disorders

 2a) Cortical deafness:

 2b)Auditory agnosias :
 Lesions of the secondary (unimodal association) zones of
auditory cortex - area 22 and part of area 21 have no effect on
the perception of sounds and pure tones.
 Perception of complex combinations of sounds - severly
impaired.
 Inability to recognize sounds, different musical notes, or

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  Recognition of harmony and melody (in the absence of
words)

 Word-Deafness (Auditory Verbal Agnosia ): It is a

failure in decoding the acoustic signals of speech and
convening them into understandable words.

 2c) Auditory Illusions:

 Sounds are perceived as being louder or less loud than
normal.

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  2d) Auditory Hallucinations:
 These may be elementary (murmurs, blowing, sound of
running water or motors, whistles) or complex (musical
themes, choruses, voices).

 Usually sounds and musical themes are heard more clearly

than voices.

 3) Disturbances of Smell :
 Seizure foci in the medial part of the temporal lobe -
olfactory hallucinations.

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  4) Distrubances of Taste:
 Rare
 Stimulation of the posterior insular area elicited a sensation
of taste along with disturbances of alimentary function.

 5). Disturbances of Time Perception

 Ttime may seem to stand still or to pass with great speed.

 6).Disorders of Memory, Emotion, and Behavior

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  Tests of Temporal lobe disorders:
 1) Figure of Rey Test
 2) Benton Visual Retention Test
 3) Illinois Nonverbal Sequential Memory Test
 4) Recurring Nonsense Figures of Kimura
 5) Facial Recognition Test as modality-specific memory
tests
 6) Milner's Maze Learning Task

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  7) Lhermitte-Signoret amnesic syndrome tests for general
retentive memory
 8) Seashore Rhythm Test
 9) Speech-Sound Perception Test from the Halstead-Reitan
battery,
 10) Environmental Sounds Test
 11) Austin Meaningless Sounds Test as measures of auditory
perception

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 Parietal lobes

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 PARIETAL LOBE

 Anatomic and Physiologic Considerations :

 This Lobe lies behind the central sulcus and above the sylvian
fissure.

 Parietal Lobes boundaries:

 Anterior border - Central Fissure
 Ventral border - Sylvan Fissure
 Dorsal border- Cingulate gyrus
 Posterior border - Parieto-occipital sulcus

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 Subdivisions of the Parietal Lobes
 Postcentral Gyrus
 Brodmann’s areas 1,2, and
3
 Superior Parietal Lobule
 Brodmann’s areas 5 and 7
 Parietal Operculum
 Brodmann’s area 43
 Supramarginal Gyrus
 Brodmann’s area 40
 Angular Gyrus Inferior Parietal Lobule
 Brodmann’s area 39

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  The inferior parietal lobule is composed of the supramarginal
gyrus (area 40) and the angular gyrus (area 39).

 The architecture of the post-central convolution is typical of

all primary receptive areas

 The rest of the parietal lobe resembles the association cortex

of the frontal and temporal lobes.

 Larger in humans than in any of the other primates and are

relatively slow in attaining their fully functional state (beyond
the seventh year of age).

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 Parietal lobe cont…
 Functions-
 Integration of somatosensory with visual and auditory
information in order to construct an awareness of one's
own body (body schema) and its relation to extra
personal space.

 Mechanisms for tactile percepts.

 Discriminative tactile functions

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  Connections with the frontal and occipital lobes provide
 Proprioceptive and visual information for movement of the
body and
 Manipulation of objects and for certain constructional
activities.

 Understanding of spoken and written words

 Recognition and utilization of numbers, arithmetic

principles, and calculation

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 Clinical Effects of Parietal Lobe Lesions
1. Agnosia - Loss of recognition of an entity not attributed to
a defect in the primary sensory modality.

 Results in number of intriguing deficits,

 Disturbed map of the body schema and of external topographic
space,
 Ability to calculate
 Differentiate left from right
 Write words

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  2)Apraxia - Complex motor deficit that cannot be attributed
to primary cerebral functions and does not arise from pt's
failure to understand the nature of the task

 Types of apraxia:

1. Ideational apraxia.
2. Ideomotor apraxia.

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  Ideomotor Apraxia: Commands to perform a specific motor act
(cough, blow a candle)
 to pantomime the use of a common tool (comb, brush)
 In the absence of real object cannot be followed

 Ideational Apraxia:
 Deficit in execution of a goal directed sequence of movements in
patients who have no difficulty in executing the individual
components of the sequence.
 eg., picking pen and writing - disrupted
 The patient holds the implement awkwardly or seems at a loss to
begin the act.

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 3.Constructional Apraxia
 Cannot copy pictures, build puzzles, or copy a series of facial
movements

4. Limb kinetic apraxia.

 Specific motor disability of one limb in the absence of gross
weakness or ataxia.

5. Buccofacial apraxia.
 Patient cannot perform learned skilled movements of the mouth,
lips, cheeks, tongue and throat in the absence of motor paralysis of
concerned muscles.

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  3)Cortical Sensory Syndromes
 a) Tactile localization
 b)Astereognosis: Distinguish objects by their size, shape, and
texture while eyes are closed; to recognize figures written on
the skin(graphesthesia);
 c)Two-point discrimination

 In contrast, the perception of pain, touch, pressure, vibratory

stimuli, and thermal stimuli is relatively intact.

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  d)The disregard of stimuli on the affected side when the
healthy side is stimulated simultaneously (tactile inattention
or extinction

 e)Tactile hallucinations

 f) Optic ataxia :
 g) Asomatognosias - Inability to recognize part of one's
body.

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  Dressing apraxia:
 Neglect of one side of the body in dressing and grooming,
recognition only on the intact side of bilaterally and
simultaneously presented stimuli-
 sensory extinction,
 deviation of head and eyes to the side of the lesion,
 torsion of the body in the same direction (failure of directed
attention to the body and to extra personal space on the side,
opposite the lesion).

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  The patient may fail to shave one side of the face, apply
lipstick or comb the hair only on one side, or find it
impossible to put on eye glasses, insert dentures, or put on a
shirt or gown when one sleeve has been turned inside out.

j) Visual Disorders

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  i)Gerstmann syndrome:Bilateral asomatognosia
 Inferior parietal lobule
 The characteristic features includes:
 Finger agnosia - inability to designate or name the different
fingers of the two hands
 Right –left disorientation
 Dyscalculia-inability to calculate
 Dysgraphia- inability to write .

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  Visual Disorientation and Disorders of Spatial
(Topographic) Localization :
 Spatial orientation depends on the integration of visual,
tactile, and kinesthetic perceptions
 Topographagnosia: inability to orient themselves in an
abstract spatial setting .
 Such patients cannot draw the floor plan of their house and
cannot describe a familiar route, as from home to work, or
find their way in familiar surroundings.

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  K) Auditory Neglect :
 This defect in appreciation of the left side of the environment

 Unresponsive to voices or noises on the left side

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  Tests of Parietal lobe disorders

 1) Figure of Rey
 2) Wechsler Block Design tests of
constructional
praxis
 3) Object Assembly
 4) Benton Figure Copying Test
 5) Halstead-Reitan Tactual Performance Test
 6) Fairfield Block Substitution Test

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  7) Several mathematical and logico grammatical tests as tests
of spatial synthesis
 8) Cross-modal association tests as tests of supra sensory
integration
 9) Benson-Barton Stick Test
 10) Cattell's Pool Reflection Test
 11) Money's Road Map Test, as tests of spatial perception and
memory

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 Occipital lobes

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 OCCIPITAL LOBE

 Anatomic and Physiologic Considerations

 This is hindmost part of the brain has a large medial surface
and smaller lateral and inferior surfaces.
 The parieto occipital fissure of the lobe creates -medial
boundary with the parietal lobe, but laterally- it merges with
the parietal and temporal lobes.
 The large calcarine fissure courses from the pole of the
occipital lobe to the splenium of the corpus callosum; area
17, Primary visual receptive cortex, is on its banks.

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 Clinical Effects of Occipital Lobe
Lesions

 A) Visual Field Defects

 ii) Cortical Blindness:

 Bilateral lesions of the occipital lobes (area 17), - loss of sight
and a loss of reflex closure of the eyelids to a bright light or
threat.
 The pupillary light reflexes are preserved, since they depend
upon visual fibers that terminate in the midbrain, short of the
geniculate bodies.
 Usually no changes are detectable in the retinas.

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  iii)Visual anosognosia :
 Denial of blindness
 The person may act as though he could see, and in attempting
to walk, collides with objects, even to the point of injury.
 Rarely, the opposite condition arises: a patient is able to see
small objects but claims to be blind.

 iv)Visual illusions (Metamorphopsia):

 Distortions of form, size, movement, color or combination
of them.
 Shared occipito-parietal or occipito-temporal lesions.

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  v)Visual Hallucinations:
 May be elementary or complex

 They may be stationary or moving (zigzag, oscillations,

vibrations, or pulsations).

 Complex - lesions in the visual association areas or their

connections with the temporal lobes.
 natural size, Lilliputian, or grossly enlarged.

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  vi)The Visual Agnosias
 Visual Object Agnosia :
 Is a failure to name and indicate the use of a seen object by
spoken or written word or by gesture.
 Visual acuity is intact, the mind is clear, and the person is not
aphasic
 If the object is palpated, it is recognized at once, and it can
also be identified by smell or sound if it has an odor or makes
a noise.
 In the framework of gestalt psychology, the patient could
recognize the parts but not the whole.

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  B).Prosopagnosia:
 Cannot identify a familiar face by looking at either the person
or a picture, even though he knows that a face is face and can
point out its features.
 They also cannot learn to recognize new faces.
 They may also be unable to interpret the learning of facial
expressions or to judge the ages or distinguish the genders of
faces.

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  C).Color Agnosia:
 Impairment of correct perception of color (color-blindness)
or the naming of a color.

 The disturbance is of hue discrimination

 Pattern cannot sort a series of colored wools according to
hue (Holmgren (Check Spelling) test) and may complain that
colors have lost their brightness or that everything looks gray.

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  Tests for Occipital lobe disorders
 1) Color naming
 2) Color form association
 3)Visual irreminiscence, as tests of visual perception;
 4)Recognition of faces of prominent people-map drawing.

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 Disconnection syndromes :
 Corpus callosum lesions
 Language and perception areas of the left hemisphere are
isolated from the right hemisphere.
 Patients with such lesions, if blindfolded, are unable to
match an object held in one hand with that in the other.
 Objects placed in the right hand are named correctly, but not
those in the left.
 If rapid presentation is used to avoid bilateral visual
scanning, such patients cannot match an object seen in the
right half of the visual field with one in the left half.

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 Cont…..
 They are also alexic in the left visual field, since the verbal
symbols that are seen there and are projected to regions of
the right hemisphere have no access to the language areas of
the left hemisphere.
 If given a verbal command, such patients will execute it
correctly with the right hand but not with the left; if asked to
write from dictation with the left hand, they will produce
only an illegible scrawl.

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 CONCLUSION :

 Cerebral lobes are the Seats of Higher Mental Functions.

 Each lobe has Specific functions characteristic to it. These
can be tested by specific Neurologic Tests(which mentioned
above).
 Results of the tests help in Localisation of the sites of lesion.

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 References :
 Richard S.Snell clinical Neuroanatomy 7 th edition
 Lange clinical Neuroanatomy 25th edition.
 Lishman organic Psychiatry 4th edition.
 Bryan Kolb & Ian Q. Whishaw’s Fundamentals of Human Neuropsychology 6th
edition
 Comprehensive textbook of psychiatry, 9th edition , by B. Sadock
 Principles of Neurology, 10th edition , by Adams Victor
 Strub and Black Mental staus examination in neurology 4th edition.

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