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What Happens if the Prefrontal Cortex Is Damaged?

Doctors may not be able to identify damages to the prefrontal cortex at first sight, and the outcomes for the patient can be everlasting.

By Kelly Santana Banks
May 19, 2023 1:00 PM
Brain exam
(Credit: sfam_photo/Shutterstock)


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As one of our most important organs, the brain oversees vital functions, ranging from our thoughts and emotions to our movements and how we respond to stimuli, among many other tasks.

Not surprisingly, when a person suffers an injury to the brain, how their physiology responds to it depends on the part of the brain affected. Since the brain comprises of billions of neurons that take part in different functions of high-level regions and subregions, what happens if the prefrontal cortex (PFC) is damaged? What is the PFC anyway?

What Does the Prefrontal Cortex Do?

The PFC consists of the front part of the frontal lobe in the cerebral cortex. It’s located right behind the eyes and is the part of the brain responsible for executive functions.

Executive functions are top-level control processes or vital activities that regulate cognitive and social behavior, personality and decision-making — the latter being one of the most important executive functions.

The PFC is part of the brain that commands our actions and thoughts and ensures they align with our values and goals. Unfortunately, for being involved in sophisticated high-level functions, the PFC is also more likely to suffer the brunt of stressors.

The Prefrontal Cortex Subregions

The PFC is divided into three subsections: dorsolateral prefrontal cortex (DLPFC), orbitofrontal cortex (OFC), and ventromedial prefrontal cortex (vmPFC). Overall, these subregions are involved in several cognitive processes. But because they connect with different brain parts, each has its specificities.

  • Dorsolateral Prefrontal Cortex

The DLPFC is the uppermost area of the PFC that oversees cognitive processes such as planning, problem-solving and attention to the task at hand (working memory). Still, as it establishes strong interconnection with the motor and sensory cortices, DLPFC also controls our thoughts and actions. For instance, during working memory activation, this part of the brain connects with the hippocampus to process long-term memories.

  • Orbitofrontal Cortex

The OFC is the brain area responsible for decision-making, emotional regulation and social attachments. It is closely related to the limbic system (in charge of processing emotions). Not surprisingly, the decisions processed in the OFC are rooted in emotional data.

  • Ventromedial Prefrontal Cortex

The vmPFC is the most sophisticated subregion regarding responsibilities. It connects with several brain areas, including the amygdala, thalamus, olfactory system, temporal lobe and ventral segmental area. Like the orbitofrontal cortex, the vmPFC plays an essential role in decision-making derived from emotions.

Both regions work collaboratively to help us regulate our emotional responses, including negative ones. But on the other hand, while making decisions, the vmPFC also considers the bigger picture, which makes its role vital in social situations. Take, for example, our ability to make sound judgments, learn from mistakes, and show courage or guilt.

What Can Happen If the Prefrontal Cortex Is Damaged?

If the PFC is damaged, you would have your executive functions, including decision-making, self-control, judgment and goal-oriented behavior, impaired. Still, there is more to that.

Specialists have difficulty identifying immediate signs of damage to the PFC. That’s because individuals don't present the usual symptoms of lesions to the brain, such as motor skills impairment or sensory and perception issues. Nevertheless, people in the patient’s inner circle notice drastic changes as time passes — especially regarding personality and emotional responses.

Patients with damaged PFC tend to show irritability, short-term memory loss, lack of empathy, difficulty planning, impulsiveness and inflexibility. Overall, when the PFC is damaged, the individual presents issues with complex cognitive skills, including planning, behavior and emotional expressions.

Risks of Prefrontal Cortex Damage

The most famous example is Phineas Gage, a railroad foreman who had a good part of his PFC destroyed after a terrible work explosion in 1848. According to reports, his personality and behavior noticeably changed after the accident — for example, from hard-working and well-mannered, he became disdainful and a troublemaker. He also became unable to regulate emotions (or impulses), showing a significant decline in executive functions.

And the signs can be more pronounced if they happen during childhood. Researchers have shown that the damaged layers of the brain (anatomical and functional) engage with the psychosocial environment — depending on the age, the child’s personality may still be in development — altering the regulation of nervous activities. But that’s not all.

According to a study in the Neuropsychopharmacology journal, “disruption, or even a slight slowing of the rate of neuronal production, migration and synaptogenesis by genetic or environmental factors, can induce gross as well as subtle changes that eventually can lead to cognitive impairment.”

How to Strengthen the Prefrontal Cortex

Individuals with PFC damage have a hard time functioning in unstructured environments. There are some exercises or a series of simple activities that you can do to strengthen your cognitive functions and, consequently, the prefrontal cortex. Some of these activities include:

  • Task-Sequencing

Pick an everyday task and write down the steps needed to complete it on separate pieces of paper. Then, shuffle these notes and try to organize the task in the correct order. This activity is excellent for working on planning skills and enhancing cognitive function.

  • Establishing a Routine

By creating a regimen, it’s easier to take the initiative to do tasks or things you need to do daily. In addition, for individuals whose PFC is damaged, the routine prevents them from spending a lot of mental energy on day-to-day activities.

  • Exercise

Working out is another way to strengthen the prefrontal cortex. A study published in the Behavioral Sciences journal suggests that exercise intensity influences PFC oxygenation, which contributes to improvement in cognitive performance. What’s more, if you enjoy working out frequently, your brain has a slight advantage, as exercise helps boost memory.

  • Working on Memory Games

Playing memory games — including mnemonics, puzzles and math memory games — helps improve concentration, problem-solving and memory skills. Thus, as injury to the PFC can result in short-term memory loss, amnesia and impairment of executive functions, memory games are valuable ways to support brain cognition and neuroplasticity.

  • Cooking

If you like to put your culinary skills to the test, this may be one of the best exercises to strengthen the prefrontal cortex. That is because you enlist the five senses, which use several brain regions during cooking. Also, cooking demands planning and concentration while enlisting the working memory to execute the task at hand.

It should be noted that treating this area is no easy feat. Most of the time, patients need the help of a behavioral specialist.

Read More: Could Brain Injuries Explain King Henry VIII’s Tyrant Behavior?

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