Utilization behavior after lesions restricted to the frontal cortex

Utilization behavior, which refers to the tendency of patients to use objects presented to them out of context and in the absence of instructions to use them, has been ascribed to dysfunction of the frontal cortex. However, careful examination of the reports of patients presenting utilization behavior shows that these patients had sustained widespread cerebral lesions extending beyond the frontal cortex and often involving massive subcortical damage. The present study examined whether utilization behavior can be observed in patients with lesions restricted to the prefrontal cortex and no more than the immediately subjacent white matter. All patients had surgical excisions, except for three patients in the frontal group who had sustained a cerebrovascular accident. A group of patients with excisions in the temporal lobe and a group of healthy participants were also studied for comparison. The investigation of utilization behavior took place in the context of a broader neuropsychological examination. There was no difference in the presence of utilization behavior in patients with lesions restricted to the prefrontal cortex in comparison with patients with temporal lobe lesions and carefully matched neurologically intact individuals. The results suggest that, in previous studies, the exhibition of utilization behavior by patients with extensive damage to the anterior part of the brain may have been due to damage to subcortical structures or to the prefrontal cortex in conjunction with subcortical damage.