Qualitatively different memory impairments across frontal lobe subgroups

Recall impairments in patients with lesions to the prefrontal cortex (PFC) have variously been attributed to problems with organisation at encoding, organisation at retrieval and monitoring at retrieval. Neuroimaging and recent theoretical work has associated the left lateral PFC with organisation and strategy production at encoding, and the right lateral PFC with organisation, error detection and monitoring at retrieval. However few lesion studies have been anatomically specific enough to test the direct predictions made by this work. Proactive interference, response to prompting, monitoring and organisational strategies were examined in 34 patients with frontal lobe lesions and 50 healthy controls using a structured verbal recall task, and the fractionation of deficits according to specific frontal lesion site was explored. Recall impairments were observed in the Right Lateral and Medial frontal subgroups. The Medial recall impairment was unaffected by manipulations at encoding or retrieval and was attributed to a "pure" memory deficit arising from disruption of the limbo-thalamic system. The Right Lateral recall impairment was ameliorated by the provision of prompts at retrieval, indicating a strategic retrieval deficit. This intervention also resulted in an unusual pattern of intrusions, namely an increase in proactive interference responses compared with extra-list intrusions. However contrary to predictions no monitoring impairment was found. We offer two explanations for the pattern of performance in the Right Lateral group: failure of a right lateralised error detection and checking system, or an impairment in the active uncued initiation of a supervisory operation.