The effects of frontal lobe damage on everyday problem solving.

The prefrontal cortex plays an especially important role in human social-cognitive behavior. It has been difficult to quantify deficits in this domain in patients with frontal lobe lesions using standardized psychological instruments. We administered the Everyday Problem Solving Inventory (EPSI), which is composed of a range of scenarios depicting everyday social problems and their possible solutions, to a group of patients with frontal lobe lesions who were required to rate each of 4 possible solutions to each problem for their effectiveness. Our sample consisted of 27 normal controls (NCs), 33 patients with focal frontal lobe lesions (FLL), and 3 patients with frontal lobe dementia (FLD). The performance of the FLL patients on the EPSI instrument was also compared with their performance on traditional neuropsychological tests. The results indicated that the FLD patients' EPSI rank ordering of social problem solutions was uncorrelated with the performance of NCs and about half of the FLL patients EPSI rank orderings of solutions also varied substantially from those of the NCs. These same FLL patients also had the lowest scores, compared to FLL patients whose judgements on the EPSI were similar to that of the NCs, on a set of neuropsychological tasks sensitive to frontal lobe dysfunction. There was no obvious relationship between locus of lesion within the frontal lobes and performance on the EPSI. These results suggest that some patients with prefrontal lobe lesions may have impaired social judgement that can be directly revealed through the use of a conventional psychological inventory such as the EPSI.