Positron emission tomography studies of frontal lobe function: relevance to psychiatric disease

The frontal lobes in man include about one-third of the total cortical area of the cerebrum, a considerably greater proportion than in other primates. It is likely that the frontal lobes subserve the most complex of cognitive functions including will and consciousness. During the performance of willed actions (spontaneous selection of actions without help from external cues) an increase of activity can be observed in dorsolateral prefrontal cortex. Critically, there is no increased activity in this location when the same actions are performed routinely. Such observations, which systematically use positron emission tomography (PET) in conjunction with specific cognitive activations, should make it possible (a) to specify more precisely the cognitive components comprising 'frontal' attributes such as willed behaviour and planning, (b) to relate these components to particular frontal lobe areas, and (c) to show how these frontal lobe areas interact with other parts of the brain. Psychotic patients typically show abnormalities of willed behaviour (e.g. poverty of speech and action) and consciousness (e.g. hallucinations, delusions of control). PET studies of frontal lobe function in patients with these signs and symptoms should not only provide information about the pathophysiology of these disorders, but also increase our knowledge of the brain systems underlying the most complex human faculties.