Neuropsycholo#ia, Vol. 27, No. 8, pp. 1101 1104, 1989. 0028 3932/89 $3.00+0.00 Printed in Great Britain. ~5~ 1989 Pergamon Press plc

N O T E

P E R S E V E R A T I O N IN M E M O R Y FOR FIGURES AFTER F R O N T A L LOBE LESION

JUHANI VILKKI*

Department of Neurosurgery, University Central Hospital, Helsinki, Finland

(Received 27 October 1988; accepted 23 March 1989)

A b s t r a c ~ T h e aim was to determine whether recurrent perseveration, i.e. the tendency to incorrectly repeat previous responses, is related to the site of cerebral lesion. Sixty-seven brain-damaged patients and 35 control subjects were studied with a modified Benton Visual Retention Test. Patients with anterior lesions made a higher number of recurrent perseverations than patients with posterior lesions. The result was in disagreement with the hypothesis that recurrent perseveration is associated with left posterior lesions.

I N T R O D U C T I O N

OERSEVERATION, i.e. the unintentional and inappropriate intrusion of a previous action or response in ongoing activity, is sometimes a conspicuous consequence of frontal lobe pathology, but an increased tendency to make similar errors can also be found in a variety of other conditions [7]. GOLDBERG et al. suggested that in patients with lesions in the posterior (retro-rolandic) parts of the cerebrum perseveration is most frequently limited to specific sensory modality or a type of behaviour directly related to the site of the lesion, whereas the impact of frontal lobe pathology is broad across domains of activity [3~5]. Moreover they argued that frontal lobe pathology may lead to the disintegration of hierarchical relations among different representation levels, and that different types of perseveration may serve as markers of disintegration at specific levels of representation. GOLDBERG and TUCKER [6] identified hyperkinesia-like motor perseveration, perseveration of elements and features as well as perseveration of activities and semantic categories in brain-damaged patients' drawings. However, GOLDBERG [3] was reluctant to postulate specific associations between the types of perseveration and neuroanatomical loci.

SANDSON and ALBERT [10] presented a similar taxonomy of perseveration: continuous perseveration is the continuous and inappropriate repetition of a current behaviour; recurrent perseveration is the unintentional repetition, after cessation, of a previously emitted response to a subsequent stimulus; stuck-in-set perseveration is the continuous and inappropriate maintenance of a current set or framework (see also [3]). Moreover they proposed that stuck-in-set perseveration (perseveration of activities) is associated with frontal lobe damage, recurrent perseveration (perseveration of features and elements) with left posterior brain-damage, and continuous (hyperkinesia-fike) perseveration with basal ganglia lesion.

Subsequent results have partly supported this hypothesis, the association of recurrent perseveration of words with left posterior lesions being the strongest finding [1, 1 l, 13], but negative [12] and even contradictory [8, 9] results have also been reported. The aim of the present study was to investigate whether recurrent perseveration in reproduction from visual short term memory is related to the site of cerebral lesions. SANDSON and ALBERT'S hypothesis [10] predicts that these errors are associated with posterior left hemisphere lesions, whereas JONES- GOTMAN and MILNER'S finding [8] indicates that recurrent perseverations of drawings are related to right anterior lesions.

*Address for correspondence: Juhani Vilkki, Department of Neurosurgery, Topeliuksenkatu 5, SF-00260 Helsinki, Finland.

1101

1104 NOTE

The anterior lesions caused a more pronounced tendency to produce recurrent perseverations than posterior lesions. Consequently, Sar~t)sor~ and A~UERX'S hypothesis [10] that recurrent perseverations are more frequently produced by patients with left posterior lesions than by other brain-damaged patients is not valid in the reproduction of figures from short term memory. Moreover, KACZMAREK [93 recently reported that left frontal lobe- damaged patients produced a higher number of perseverations of propositions than patients with left posterior lesions, but the reverse was true in the production of the perseverations of words. As both of these categories of errors were recurrent perseverations, the study indicates that Sandson and Albert's hypothesis is invalid even for the verbal domain. These findings can be accommodated to a hypothesis that perseveration is usually more pronounced after frontal lobe lesions than after posterior lesions; however, left posterior lesions cause verbal disturbances in which recurrent perseverations of words are more frequent than in deficits related to other local brain lesions.

Although the present results showed that recurrent perseverations are significantly related to anterior lesions, individual differences within the groups were also large (see standard deviations in Table 3). Very skew distributions of perseverations have been reported in previous studies [1, 11, 13], indicating that few subjects produce a large proportion of the total number of perseverations. Evidently the fact that perseverations are rather infrequent signs of brain damage partly explains the inconsistency of findings concerning the relationship ofperseverations to the site of brain damage.

Acknowledgement--This study was supported by a grant from the Academy of Finland.

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Brain Lang., in press.