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[[Category:Neuropsychological profiles]]
'''Elliot (Prefrontal Patient):
'''

== Elliot’s Lifestyle Prior to Brain Damage:
 ==
Elliot was a good father and husband who held a good job with a business firm.  He was smart and had many skills.  According to the author, Elliot “had attained an enviable personal, professional, and social status.” (A Modern Phineas Gage, 35) He was in his 30’s.
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== Elliot’s Medical Symptoms Pre-Surgery: ==

Elliots symptoms first presented as trouble concentrating and headaches.  He was diagnosed with a benign brain tumor called a Meningioma, which began growing in the midline area above his nasal passages and eye sockets.  “As the tumor grew bigger, it compressed the frontal lobes upward from below.” (35) Although the tumor was benign, it could still have proven fatal if it was not removed because of the increasing compression on the brain.  When Elliot was first diagnosed, the tumor was already the size of a small orange.  Doctors decided to surgically remove the tumor, but because some of the tissue around the tumor was damaged, they had to remove part of his frontal lobe.  
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== Elliot’s Neurological Symptoms and Lifestyle Post-Surgery: ==

During Elliot’s physical recovery, he and his family noticed drastic personality changes.  Although his intellect, motor skills, and language use remained intact, Elliot had clearly changed since the surgery.  

Elliot had trouble getting started in the morning and preparing for work.  He had trouble managing his time while at work and could not operate on a schedule.  While at work, Elliot had trouble reaching his main goals because he would get caught up in a single task for an unnecessary amount of time.  He continually lost sight of his main priorities because of his irrational amount of detail on subsidiary tasks.  One could say Elliot had trouble “shifting gears” despite advice and warnings from his employer.  He was, expectedly, fired from his job at the business firm and was unable to hold other jobs. Despite Elliot’s intelligence, business background, and warnings from friends and family, he began risky business ventures and ended up in bankruptcy.

He began a collecting habit—but it was a collection of junk.  Elliot’s wife divorced him for his foolish decision-making, and he had a brief marriage with another woman (who his family disliked), who also divorced him.  

Overall, “his ability to reach decisions was impaired, as was his ability to make an effective plan for the hours ahead of him, let alone plan for the months and years of his future.” (37) Normal people make bad decisions, but Elliot’s behavior was clearly a sign of disease.  He could no longer operate as a normal social being, and could no longer live an independent existence. 

After surgery, Elliot became emotionally blunted.  When one would typically expect an emotional response, he showed none.  
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== Location of Damage (as shown in computerized tomography and magnetic resonance imaging): ==

o	Prefrontal damage due to removal of tissue in his frontal lobe

o	Damage was more extensive on his right side than left

o	Damage on the left side was within the orbital and medial sectors of the frontal lobe

o	Damage on the right side was in the same areas, but the white matter (the core of the lobe) on the right side was “destroyed”

o	The motor and premotor regions were not damaged

o	Language related cortices (Broca’s areas) were not damaged

o	Basal forebrain was intact (necessary for learning and memory)

o	Temporal, occipital, and parietal regions in both hemispheres were intact
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== Results of Neuropsychological Tests: ==

IQ was superior

[[Wechsler Adult Intelligence Scale]]: no abnormality

Immediate memory of digits was superior

Short-term verbal memory was superior

Visual memory of geometric designs was superior

[[Rey’s word list]] (delayed recall) and complex figures were normal

[[Multilingual Aphasia Examination]] (assesses language comprehension and production) were normal

Benton’s tests (facial discrimination, line orientation, geographic orientation, 2 & 
3-dimensional block construction) were normal

Rey-Osterrieth complex figure-copying task was normal
memory tests with interference procedures were normal (which is interesting because most patients with frontal lobe damage do not perform at that level)

Attention and working memory were intact

[[Wisconsin Card Sorting Task]] was normal, even though most patients with similar damage would fail.  Elliot was able to “shift gears” in the sorting task even though he could not shift gears in real life.

Making estimates based on incomplete knowledge (using inference) and conjuring up connections unconnected facts using logic were normal.  These tasks require normal logical competence, working memory, and attention. 

MMPI (personality) generated a valid profile

Answers to ethical dilemmas (social conventions) followed the same principles as examiners

Solutions to hypothetical social predicaments (as well as offering alternative solutions) elicited answers showing no deficit

Task assessing awareness of consequences (of situations where there is temptation to transgress social conventions) was superior

Means-Ends Problem-Solving Procedure (suggesting means to achieve a social goal by offering a series of effective acts leading to the outcome) was superior
Ability to predict social consequences of interpersonal situations was normal

Standard Issue Moral Judgment Interview (developmental stage of moral reasoning) was excellent
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== Conclusions: ==

“There may be brain disease, but laboratory tests fail to measure significant impairments.  The problem here lies with the tests, not with the patients.” (40) Laboratory tests are not representative of real-life series of in-the-moment decisions.

“Elliot’s impeccable performances meant that the usual suspects could not be blamed.” (43) 

“Elliot was able to recount the tragedy of his life with a detachment that was out of step with the magnitude of the events.” (44)

'''Reduced emotional affect might play a role in the decision making process.'''
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== Source: ==

Descarte’s Error, ''A Modern Phinneas Gage''.