Neuropsychological assessment of the orbital and ventromedial prefrontal cortex

Assessment of the functions of the orbitofrontal cortex and ventromedial prefrontal cortex has proven to be a unique challenge for neuropsychologists. Orbitomedial damage occurs in a range of disorders including traumatic brain injury, ruptured aneurysms, surgical resection, and frontotemporal dementia. We review the effects of orbitomedial damage on a range of neuropsychological tasks, including tasks measuring object alternation and reversal learning, decision-making (gambling), facial emotion recognition, theory of mind, olfactory recognition, autobiographical memory and behavioral rating measures. At present, there is no singular gold standard measure of orbitomedial dysfunction, and assessment requires an integrative approach that reflects the heterogeneity of the region. The heterogeneous neuropsychological deficits arising from orbitomedial damage are difficult to ascribe to a unitary function or process, but appear to reflect a set of processes necessary for monitoring and adapting to changing reinforcement contingencies.