The role of the orbitofrontal cortex in cognition and behavior

Abstract The orbitofrontal cortex (OFC) plays a crucial role in behavior and is a common site for damage due to different types of injuries, e.g., closed head injuries, cerebrovascular accidents, tumors, neurosurgical interventions. Despite the (severe) behavioral changes following OFC lesions, persons with damage to the OFC appear to be cognitively intact, i.e., at least when assessed by means of standard neuropsychological tests. Meanwhile, neuropsychological tests addressing reversal learning, gambling, and social cognition show a decline in these patients. The goal of the present review is to link the performance of these latter neuropsychological tests to behavior. The results suggest that in patients with orbitofrontal lesions, reversal learning is more associated with behavioral disinhibition and that impairment in recognition of expressed emotion is more associated with social inappropriate behavior. The faux pas test (theory of mind) appears not to be sensitive to orbitofrontal lesions. Future studies should involve a larger numbers of patients with well-defined locations in the OFC and should integrate specific neuropsychological tests and quantitative behavioral measures to better understand the contribution of the OFC to cognition and behavior.