Preserved access and processing of social knowledge in a patient with acquired sociopathy due to ventromedial frontal damage.

Acquired damage to ventromedial frontal cortices produces abnormalities of decision-making that are especially marked in the realm of social conduct. The pathogenesis of this disorder remains unexplained. One possible mechanism posits that patients with lesions of ventromedial frontal cortices, while retaining the ability to recognize the entities and events that compose social situations, lose the ability to generate an appropriate array of response options to social stimuli, and to conceptualize the future consequences of choosing a particular option. To explore the validity of this mechanism, we tested a prototypical patient with bilateral ventromedial frontal injury and social conduct disorder, along with a group of matched controls, in a series of laboratory probes designed to examine the manipulation of response options and projected outcomes to social stimuli. The experimental subject (patient E.V.R.) exhibited normal or superior performance on tasks that measure the ability to (1) generate possible response options to social situations, (2) consider the future consequences of pursuing particular response options, (3) conceptualize effective measures to achieve given social objectives, (4) predict the likely outcome of a particular configuration of social stimuli, and (5) perform moral reasoning at an advanced developmental level. These findings suggest that: (1) the base of social knowledge that E.V.R. acquired during his normal development is still intact; and that (2) his capacity to access and process components of such knowledge is also intact, in the conditions specified in our experiment.