Dorsolateral prefrontal cortex — MRCPsych Paper A MCQ

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ModerateNeuroanatomyDorsolateral prefrontal cortexMRCPsych Paper A

A 51-year-old man with schizophrenia has stable hallucinations and delusions. Cognitive assessment shows marked difficulty holding and manipulating information, shifting between rules and organising multistep tasks. Registration and delayed recall of newly learned information are relatively preserved. Dysfunction of which brain region best accounts for this cognitive profile?

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Correct answer: E — Dorsolateral prefrontal cortex

The correct answer is E, the dorsolateral prefrontal cortex. Holding and manipulating information describes working memory, while rule-shifting and multistep planning are executive functions. These functions depend strongly on dorsolateral prefrontal cortical networks, which are implicated in the cognitive dysfunction of schizophrenia. The relatively preserved delayed recall makes primary hippocampal dysfunction less likely. Orbitofrontal dysfunction more typically causes disinhibition, impaired reward evaluation and socially inappropriate behaviour. The anterior cingulate contributes to motivation, conflict monitoring and allocation of attention but does not best explain this combined working-memory and planning profile. The amygdala is principally involved in emotional salience and fear-related learning.

Reference: Smucny J, Dienel SJ, Lewis DA, Carter CS. Mechanisms underlying dorsolateral prefrontal cortex contributions to cognitive dysfunction in schizophrenia. Neuropsychopharmacology. 2022;47:292–308. https://pubmed.ncbi.nlm.nih.gov/34285373/