LOBE FUNCTIONS

Dr. Pooja R Raikar

Consultant Psychiatrist
Manasa Nursing Home
Shimoga
 Layout:
INTRODUCTION
ANATOMY
FUNCTIONS
LESIONS
TESTS
CONCLUSION
General aspects of cerebral cortex
 Two cerebral hemispheres
 Surface extent - 4000 cm2 about the size
of a full sheet of newsprint (right and left
pages).
 Surface has series of grooves or sulci
separated by intervening areas - Gyri

 It has many billions of neurons

(estimated at 10 to 30 billion)
 The intercellular synaptic connections
number in the trillions.
Clinically, Cerebrum is divided into four lobes -
based on the fissures
Frontal lobe –
 Anterior to central sulcus,
Above posterior ramus of the lateral sulcus

Parietal lobe –
Lies behind central sulcus
Below by posterior ramus of lateral sulcus
Behind by upper part of first imaginary line
Occipital lobe –
Lies behind first imaginary line

Temporal lobe –
Below posterior ramus of lateral sulcus and
second imaginary line
Separated from occipital lobe by the lower
part of first imaginary line
Frontal lobe:
Functional areas of Brain
Best known scheme – Brodmann

Represented different areas by numbers

Functional areas do not follow boundaries

of sulci and gyri
FRONTAL LOBES
 Frontal lobe:

Anatomic and Physiologic Considerations

Seat of highest mental function – most recent

to evolve

Larger in humans (30 percent of the

cerebrum) than in any other primate.
Frontal lobes
Frontal lobes
Motor Area: Area 4
Precentral gyrus on superolateral surface of
hemisphere
Anterior part of paracentral lobule on
medial suface
Movements in specific parts of the body
Paracentral lobule – lower limbs
Upper part of precentral gyrus – trunk
and upper limb
Lower part of precentral gyrus - Face and
head
Not proportional to size of part rather
Premotor Area:
Ant to Motor area
Post part of Sup, Middle and inf frontal gyri
Area 6 and 8
Part of Inf gyrus – Area 44 & 45 – Motor
speech area of Broca
functions of the lips, tongue, larynx, and
pharynx
bilateral lesions - paralysis of articulation,
phonation, and deglutition.
Frontal eye field:
Middle frontal gyrus – ant to precentral
gyrus
Area 6, 8 & 9
Both eyes move to opp side – conjugate
movements

The medial-orbital gyri and anterior parts of

the cingulate gyri, the frontal components
of the limbic system,
Control of respiration, blood pressure,
peristalsis
Frontal lobes
 Presumed to govern personality,
character, motivation, and unique
capacities for abstract thinking,
introspection, and planning.

Initiation of planned action and executive

control of all mental operations, including
emotional expression.
Clinical Effects of Frontal Lobe Lesions

1) Motor Abnormalities:
Voluntary movement

Spastic paralysis of the contralateral face, arm, and leg.

Supplementary motor areas - mutism, contralateral

motor neglect

Seizure activity in this area causes a tonic deviation of

the head and eyes to the opposite side

Bilateral lesions - quadriplegia or quadriparesis with

severe weakness
Prefrontal lesions
 Grasping & groping responses
 Imitation
 Abulia - reduced and delayed motor and
mental activity/response
Motor perseveration or impersistence (with
left and right hemispheric lesions,
respectively)
2) Dysphasia - Broca's aphasia
Other Speech and language deficits are-
 Lack of spontaneity of speech,
 Telegraphic speech (agrammatism),
 Loss of fluency,
 Perseveration of speech,
 A tendency to whisper instead of speaking aloud
 Dysarthria.

3)Incontinence - loss of control of mictuirition and

defecation.
4) Cognitive and Intellectual Changes
Organ of civilization
Lack of initiation, changes in mood
(euphoria), and inattention
Loss of capacity for abstract thought
Social indifference
Emotional out-bursts.

 negligible impairment of memory function

or cognitive function
Luria proposed the role of the frontal lobes in
intellectual activity.
He postulated that problem solving (perceptual,
constructive, arithmetical) proceeds in four
steps:
1. The specification of a problem
2. Formulation of a plan of action or strategy - in
orderly sequence
3. Execution - implementation and control of the
plan
4. Checking or comparing the results against the
original plan to see if it was adequate.
 5) Executive Function:
Ability to integrate and organize the morass of
stimuli to problem solve, focus,plan, remain
flexible in their thinking, inhibit impulses and
regulate their behavior(Tasman ).
Overall control of other cognitive functions
Ability to adapt to changes in circumstance.
Self-monitoring - guides selection of strategies to
solve problems, inhibition of incorrect responses,
ability to deal with change in focus and novelty in
tasks, to generalize from experience.
Deterioration in problem solving, by
repetitiousness and stereotypies
6) Other Alterations of Behavior and personality
a) Lack of initiative and spontaneity.
Mild forms - idleness of thought, speech, and action
Questions directed to such patients may evoke only
brief, unqualified answers.

b) Stimulus boundedness - Once started on a task,

they may persist in it ("stimulus bound")

c) Failure to maintain events in serial order and to

intigrate new events and information with previously
learned data.
Extensive reduction in psychomotor activity.

Akinetic Mutism - non paralyzed, alert patient

capable of movement and speech, lies or sits
motionless and silent for days and weeks.

Insomnia

Social inappropiateness - silly inappropriate joke,

uninhibited and lack awareness of their behavior.

Disturbed gait
SPECIAL NEUROPSYCHOLOGIC TESTS OF FRONTAL LOBE INCLUDING EXECUTIVE FUNCTIONS:

Planning –
Tower of London test (Shallice 1982)
 Mental speed-
Digit symbol substitution test- (Weschler)
 Sustained attention –
Digit Vigilance test – (Lesak 1995) 
 Trail making test A and B
Fluency Tests: 
Controlled oral word association test(COWA) –(Benton and
Hamsher 1989)
 Animal Names test- (Lesak 1995)
Thurston word fluency

Non verbal fluency –design fluency test

Language comprehension-
Token test
Spelling
Phonetic discrimination
Boston naming test
Woking memory-self ordering
Verbal N back test - ( Smith and Jonides 1999)
Visual N back test
Vigilance test- Paced Auditory Serial Addition Test
(PASAT)
“A” random letter test
Motor cordination and strength tests
Hand dynamometry (grip strength)
Finger tapping
Grooved pegboard
Abstraction and shift paradigms
 Milan Sorting Test
 Halstead Category Test
 Wis­consin Card-Sorting Test
 Raven’s progressive matrices

Tests of response Inhibition

 Stroop test (Perret 1974)
 Wisconsin card sorting test (Milner 1964)
Comprehensive fixed Batteries:
Halstead –Reitan battery
Luria –Nebraska battery
NIMHANS neuropsychological battery
Cambridge Neuropsychological Test
Automated
Battery (CANTAB)
TEMPORAL LOBE
Anatomy of temporal lobe
Subcortical Temporal Lobe Structures
Limbic cortex
Amygdala
Hippocampal Formation
Insula
Area under Sylvan Fissure
Gustatory Cortex
Auditory association cortex
Subdivisions of the Temporal
Cortex
Lateral surface
Auditory areas
Brodmann’s areas 41,42, and 22
Ventral Stream of Visual
Information -
Infero temporal cortex

Multimodal Cortex or Polymodal

Cortex
Area under Superior Temporal Sulcus
Receives input from auditory, visual,
and somatic regions
Temporal lobe cont….
Functions-
Integration of "sensations, emotions, and
behavior”
Language, handedness, memory and
learning functions, and the emotion
Spatial orientation, estimation of depth and
distance, stereoscopic vision, and hue
perception.

Superior part -receptive aspects of language.

Middle and inferior convolutions -visual
discriminations
Clinical Effects of Temporal Lobe
lesions
 Disorders of the special senses –(visual, auditory,
olfactory, and gustatory), time perception
language, memory, emotion, and Behavior.

 1)Visual Disorders –
 Anopia
 Visual hallucinations of complex form
(autoscopy), appear during temporal lobe
seizures.
 Distortes visual perception;
Macropsia or Micropsia, too close or far away, or
unreal.
 2) Auditory disorders

 2a) Cortical deafness:

 2b)Auditory agnosias :
 Lesions of the secondary (unimodal association) zones
of auditory cortex - area 22 and part of area 21 have
no effect on the perception of sounds and pure tones.
 Perception of complex combinations of sounds -
severly impaired.
 Inability to recognize sounds, different musical notes,
or
Recognition of harmony and melody (in the
absence of words)

 Word-Deafness (Auditory Verbal Agnosia

): It is a failure in decoding the acoustic
signals of speech and convening them into
understandable words.

2c) Auditory Illusions:

 Sounds are perceived as being louder or less
loud than normal.
2d) Auditory Hallucinations:
These may be elementary (murmurs, blowing,
sound of running water or motors, whistles) or
complex (musical themes, choruses, voices).

 Usually sounds and musical themes are heard

more clearly than voices.

3) Disturbances of Smell :

 Seizure foci in the medial part of the temporal
lobe -olfactory hallucinations.
4) Distrubances of Taste:
Rare
Stimulation of the posterior insular area
elicited a sensation of taste along with
disturbances of alimentary function.

5). Disturbances of Time Perception

Ttime may seem to stand still or to pass
with great speed.

6).Disorders of Memory, Emotion, and

Behavior
Tests of Temporal lobe disorders:
1) Figure of Rey Test
2) Benton Visual Retention Test
 3) Illinois Nonverbal Sequential
Memory Test
4) Recurring Non­sense Figures of
Kimura
5) Facial Recognition Test as modality-
specific memory tests
6) Milner's Maze Learning Task
7) Lhermitte-Signoret amnesic syndrome
tests for general retentive memory
8) Seashore Rhythm Test
9) Speech-Sound Perception Test from the
Halstead-Reitan battery,
 10) Environmental Sounds Test
11) Austin Meaningless Sounds Test as
measures of auditory perception
Parietal lobes
PARIETAL LOBE

Anatomic and Physiologic

Considerations :
This Lobe lies behind the central sulcus and
above the sylvian fissure.

Parietal Lobes boundaries:

Anterior border - Central Fissure
Ventral border - Sylvan Fissure
Dorsal border- Cingulate gyrus
Posterior border - Parieto-occipital sulcus
Subdivisions of the Parietal Lobes
Postcentral Gyrus
Brodmann’s areas
1,2, and 3
Superior Parietal
Lobule
Brodmann’s areas
5 and 7
Parietal
Operculum
Brodmann’s area
43 Inferior Parietal
Supramarginal Lobule
Gyrus
Brodmann’s area
The inferior parietal lobule is composed of the
supramarginal gyrus (area 40) and the angular
gyrus (area 39).

The architecture of the post-central convolution is

typical of all primary receptive areas

 The rest of the parietal lobe resembles the

association cortex of the frontal and temporal lobes.

Larger in humans than in any of the other primates

and are relatively slow in attaining their fully
functional state (beyond the seventh year of age).
Parietal lobe cont…
Functions-
Integration of somatosensory with visual
and auditory information in order to
construct an awareness of one's own
body (body schema) and its relation to
extra personal space.

Mechanisms for tactile percepts.

Discriminative tactile functions

Connections with the frontal and occipital lobes
provide
Proprioceptive and visual information for movement
of the body and
Manipulation of objects and for certain
constructional activities.

Understanding of spoken and written words

Recognition and utilization of numbers, arithmetic

principles, and calculation
Clinical Effects of Parietal Lobe
Lesions
1. Agnosia - Loss of recognition of an entity
not attributed to a defect in the primary
sensory modality.

Results in number of intriguing deficits,

Disturbed map of the body schema and of
external topographic space,
Ability to calculate
Differentiate left from right
Write words
2)Apraxia - Complex motor deficit that
cannot be attributed to primary cerebral
functions and does not arise from pt's
failure to understand the nature of the task

Types of apraxia:

1. Ideational apraxia.
2. Ideomotor apraxia.
Ideomotor Apraxia: Commands to perform a specific
motor act (cough, blow a candle)
to pantomime the use of a common tool (comb, brush)
In the absence of real object cannot be followed

Ideational Apraxia:
 Deficit in execution of a goal directed sequence of
movements in patients who have no difficulty in
executing the individual components of the sequence.
eg., picking pen and writing - disrupted
The patient holds the implement awkwardly or seems at
a loss to begin the act.
3.Constructional Apraxia
 Cannot copy pictures, build puzzles, or copy a series
of facial movements

4. Limb kinetic apraxia.

Specific motor disability of one limb in the absence of
gross weakness or ataxia.

5. Buccofacial apraxia.
Patient cannot perform learned skilled movements of
the mouth, lips, cheeks, tongue and throat in the
absence of motor paralysis of concerned muscles.
3)Cortical Sensory Syndromes
a) Tactile localization
 b)Astereognosis: Distinguish objects by their
size, shape, and texture while eyes are closed;
to recognize figures written on the
skin(graphesthesia);
c)Two-point discrimination

In contrast, the perception of pain, touch,

pressure, vibratory stimuli, and thermal stimuli
is relatively intact.
d)The disregard of stimuli on the affected side
when the healthy side is stimulated
simultaneously (tactile inattention or extinction

e)Tactile hallucinations

f) Optic ataxia :

g) Asomatognosias - Inability to recognize
part of one's body.
Dressing apraxia:
Neglect of one side of the body in dressing and
grooming, recognition only on the intact side of
bilaterally and simultaneously presented
stimuli-
sensory extinction,
deviation of head and eyes to the side of the
lesion,
torsion of the body in the same direction (failure
of directed attention to the body and to extra
personal space on the side, opposite the lesion).
The patient may fail to shave one side of
the face, apply lipstick or comb the hair
only on one side, or find it impossible to put
on eye glasses, insert dentures, or put on a
shirt or gown when one sleeve has been
turned inside out.

j) Visual Disorders
i)Gerstmann syndrome:Bilateral
asomatognosia
Inferior parietal lobule
The characteristic features includes:
Finger agnosia - inability to designate or
name the different fingers of the two hands
Right –left disorientation
Dyscalculia-inability to calculate
Dysgraphia- inability to write .
Visual Disorientation and Disorders of
Spatial (Topographic) Localization :
Spatial orientation depends on the
integration of visual, tactile, and kinesthetic
perceptions
Topographagnosia: inability to orient
themselves in an abstract spatial setting .
Such patients cannot draw the floor plan of
their house and cannot describe a familiar
route, as from home to work, or find their
way in familiar surroundings.
K) Auditory Neglect :
This defect in appreciation of the left side
of the environment

 Unresponsive to voices or noises on the

left side 
Tests of Parietal lobe
disorders
1) Figure of Rey
2) Wechsler Block Design
tests of

constructional praxis
3) Object Assembly
4) Benton Figure Copying Test
5) Halstead-Reitan Tactual Performance Test
6) Fairfield Block Substitution Test
7) Several mathematical and logico
grammatical tests as tests of spatial
synthesis
8) Cross-modal association tests as tests of
supra sensory integration
9) Benson-Barton Stick Test
10) Cattell's Pool Reflection Test
11) Money's Road Map Test, as tests of
spatial perception and memory
Occipital lobes
OCCIPITAL LOBE

Anatomic and Physiologic Considerations

This is hindmost part of the brain has a large
medial surface and smaller lateral and inferior
surfaces.
The parieto occipital fissure of the lobe creates
-medial boundary with the parietal lobe, but
laterally- it merges with the parietal and
temporal lobes.
 The large calcarine fissure courses from the pole
of the occipital lobe to the splenium of the corpus
callosum; area 17, Primary visual receptive
cortex, is on its banks.
Clinical Effects of Occipital Lobe
Lesions

A) Visual Field Defects

ii) Cortical Blindness:

Bilateral lesions of the occipital lobes (area 17), -
loss of sight and a loss of reflex closure of the
eyelids to a bright light or threat.
The pupillary light reflexes are preserved, since
they depend upon visual fibers that terminate in
the midbrain, short of the geniculate bodies.
 Usually no changes are detectable in the retinas.
iii)Visual anosognosia :
Denial of blindness
The person may act as though he could see, and in
attempting to walk, collides with objects, even to the
point of injury.
Rarely, the opposite condition arises: a patient is
able to see small objects but claims to be blind.

iv)Visual illusions (Metamorphopsia):

 Distortions of form, size, movement, color or
combination of them.
Shared occipito-parietal or occipito-temporal lesions.
v)Visual Hallucinations:
May be elementary or complex

 They may be stationary or moving (zigzag,

oscillations, vibrations, or pulsa­tions).

Complex - lesions in the visual association

areas or their connections with the
temporal lobes.
natural size, Lilliputian, or grossly enlarged.
vi)The Visual Agnosias
Visual Object Agnosia :
Is a failure to name and indicate the use of a seen
object by spoken or written word or by gesture.
Visual acuity is intact, the mind is clear, and the
person is not aphasic
If the object is palpated, it is recognized at once,
and it can also be identified by smell or sound if it
has an odor or makes a noise.
In the framework of gestalt psychology, the patient
could recognize the parts but not the whole.
B).Prosopagnosia:
Cannot identify a familiar face by looking at
either the person or a picture, even though
he knows that a face is face and can point
out its features.
They also cannot learn to recognize new
faces.
They may also be unable to interpret the
learning of facial expressions or to judge the
ages or distinguish the genders of faces.
C).Color Agnosia:
 Impairment of correct perception of color
(color-blindness) or the naming of a color.

 The disturbance is of hue discrimination

Pattern cannot sort a series of colored
wools according to hue (Holmgren (Check
Spelling) test) and may complain that
colors have lost their brightness or that
everything looks gray.
 Tests for Occipital lobe disorders
1) Color naming
2) Color form association
3) Visual irreminiscence, as tests of visual
perception;
4)Recognition of faces of prominent people-
map drawing.
Disconnection syndromes :
Corpus callosum lesions
Language and perception areas of the left
hemisphere are isolated from the right hemisphere.
 Patients with such lesions, if blindfolded, are unable
to match an object held in one hand with that in the
other.
Objects placed in the right hand are named
correctly, but not those in the left.
 If rapid presentation is used to avoid bilateral visual
scanning, such patients cannot match an object
seen in the right half of the visual field with one in
the left half.
Cont…..
They are also alexic in the left visual field,
since the verbal symbols that are seen
there and are projected to regions of the
right hemisphere have no access to the
language areas of the left hemisphere.
 If given a verbal command, such patients
will execute it correctly with the right hand
but not with the left; if asked to write from
dictation with the left hand, they will
produce only an illegible scrawl.
 CONCLUSION :

Cerebral lobes are the Seats of Higher

Mental Functions.
Each lobe has Specific functions
characteristic to it. These can be tested by
specific Neurologic Tests(which mentioned
above).
Results of the tests help in Localisation of
the sites of lesion.
References :
 Richard S.Snell clinical Neuroanatomy 7 th edition
 Lange clinical Neuroanatomy 25th edition.
 Lishman organic Psychiatry 4th edition.
 Bryan Kolb & Ian Q. Whishaw’s Fundamentals of Human
Neuropsychology 6th edition
 Comprehensive textbook of psychiatry, 9th edition , by B. Sadock
 Principles of Neurology, 10th edition , by Adams Victor
 Strub and Black Mental staus examination in neurology 4th edition.