Skip to main content Accessibility help

Script Generation and Executive Dysfunction in Patients with Anterior and Posterior Brain Lesions

  • Anna Emmanouel (a1), Danielle Boelen (a1) (a2) (a3), Eirini Mouza (a4), Phillipe Allain (a5) (a6), Roy P.C. Kessels (a1) (a2) (a7) and Luciano Fasotti (a1) (a3)...


Introduction: Studies on script processing have shown inconsistent relations between deficits in script action generation and frontal lobe pathology. Therefore, we investigated which difficulties in script action generation are linked to anterior lesions. Moreover, we explored whether verbal script generation can be predicted by specific executive processes.

Methods: Fifty-two patients with acquired brain injury (mean age: 44.23 years, 30 male/22 female) were included, of whom 30 had anterior and 22 had posterior lesions. Several indices of the Everyday Description Task were investigated: relevant central actions (RCAs); relevant trivial actions (RTAs); relevant and irrelevant intrusions (RI & IRI); sequencing (SEs) and perseverative (PEs) errors. Additionally, five z-composite scores representing planning, response generation, working memory, inhibition and shifting were calculated. Correlations and multiple linear regression analyses were computed.

Results: Anteriorly lesioned patients produced significantly less RCAs and more PEs and SEs compared to posteriorly damaged patients. No differences were found with RTAs, RI and IRI. RCAs were predicted by planning, response generation and working memory, RI by response generation and working memory, IRI by inhibition, PEs and SEs by response generation and shifting. None of these executive processes predicted RTAs.

Conclusions: Difficulties in RCAs, PEs and SEs are sensitive indicators of anterior brain damage and script generation demands various executive abilities.


Corresponding author

Address for correspondence: Anna Emmanouel, Radboud University and Donders Institute for Brain, Cognition and Behaviour, Radboud University, Montessorilaan 3 6525 HR Nijmegen, Nijmegen, 6500 HE Nijmegen, The Netherlands.


Hide All
Allain, P., Etcharry-Bouyx, F., & Le Gall, D. (2001). A case study of selective impairment of the central executive component of working memory after focal frontal lobe damage. Brain and Cognition, 45 (1), 2143. DOI: 10.1006/brcg.2000.1249.
Allain, P., Gaura, V., Fasotti, L., Chauvire, V., Prundean, A., Sherer-Gagou, C., . . . Remy, P. (2011). The neural substrates of script knowledge deficits as revealed by a PET study in Huntington's disease. Neuropsychologia, 49 (9), 26732684. DOI: 10.1016/j.neuropsychologia.2011.05.015.
Allain, P., Fasotti, L., Roy, A., Chauvire, V., Etcharry-Bouyx, F., & De Le Gall, D. (2012). Script-event representation in patients with severe traumatic brain injury. Cortex, 48 (9), 11551164. DOI: 10.1016/j.cortex.2011.05.016.
Alvarez, J.A., & Emory, E. (2006). Executive function and the frontal lobes: A meta-analytic review. Neuropsychological Review, 16, 1742. DOI: 10.1007/s11065-006-9002-x.
Barcelo, F. (2001). Does the wisconsin card sorting test measure prefrontal function? Spanish Journal of Psychology, 4, 79100. Downloaded (open access) on 23 March 2013. Retrieved from:
Barcelo, F., & Knight, R.T. (2002). Both random and perseverative errors underlie WCST deficits in prefrontal patients. Neuropsychologia, 40, 349356. DOI: 10.1016/S0028-3932(01)00110-5.
Bennett, P.C., Ong, B., & Ponsford, J. (2005). Assessment of executive dysfunction following traumatic brain injury: Comparison of the BADS with other clinical neuropsychological measures. Journal of the International Neuropsychological Society, 11, 606613. DOI:
Bertens, D., Frankenmolen, N., Boelen, D.H., Kessels, R.C.P., & Fasotti, L. (2015). Validity of an adapted scoring method for a modified six elements test in individuals with brain injury. Archives of Clinical Neuropsychology, 30 (2), 122129, DOI: 10.1093/arclin/acu093.
Boelen, D.H.E., Allain, P., Spikman, J.M., & Fasotti, L. (2011). Script generation and dysexecutive syndrome in patients with brain injury. Brain Injury, 25 (11), 10911100. DOI: 10.3109/02699052.2011.608207.
Brown, G.G., Kindermann, S.S., Siegle, G.J., Granholm, E., Wong, E.C., & Buxton, R.B. (1999). Brain activation and pupil response during covert performance of the stroop colour word task. Journal of the International Neuropsychological Society, 5 (4), 308319. Downloaded on 12 June 2013. Retrieved from:
Burgess, P.W., Alderman, N., Emslie, H., Evans, J., & Wilson, B.A. (1998). The ecological validity of tests of executive function. Journal of the International Neuropsychological Society, 4, 547558. Downloaded (free access) on 12 October 2009. Retrieved from:
Cazalis, F., Azouvi, P., Sirigu, A., Agar, N. & Burnod, Y. (2001). Script knowledge after severe traumatic brain injury. Journal of the International Neuropsychological Society, 7, 795804.
Chevignard, M., Pillon, B., Pradat-Diehl, P., Taillefer, C., Rousseau, S., Le Bras, C., & Dubois, B. (2000). An ecological approach to planning dysfunction : Script execution. Cortex, 36, 649669. Retrieved from
Clark-Carter, D. (1997). Doing quantitative psychological research: From design to report. Hove: Psychology Press.
Cooper, R.P., & Shallice, T. (2000). Contention scheduling and the control of routine activities. Cognitive Neuropsychology, 17, 297338. Downloaded (open access) on 12 October 2009. Retrieved from:
Cohen, J. (1988). Statistical power analysis for the behavioural sciences (2nd ed.). Hillsdale, NY: Lawrence Erlbaum Associates.
Cosentino, S., Chute, D., Libon, D., Moore, P., & Grossman, M. (2006). How does the brain support script comprehension? A study of executive processes and semantic knowledge in dementia. Neuropsychology, 20 (3), 307318. DOI: 10.1037/0894-4105.20.3.307.
Dimoska-Di Marco, A., McDonald, S., Kelly, M., Tate, R., & Johnstone, S. (2011). A meta-analysis of response inhibition and Stroop interference control deficits in adults with traumatic brain injury (TBI). Journal of Clinical and Experimental Neuropsychology, 33 (4), 471485. Downloaded (free access) on 18 December 2014 from Research Online. Retrieved from:
Dritschel, B.H., Kogan, L., Burton, A., Burton, E., & Goddard, F. (1998). Everyday planning difficulties following traumatic brain injury: A role for autobiographical memory. Brain Injury, 12, 875886. DOI: 10.1080/026990598122098.
Duncan, J., Emslie, H., Williams, P., Johnson, R., & Freer, C. (1996). Intelligence and the frontal lobe: The organization of goal-directed behavior. Cognitive Psychology, 30, 257303. DOI: 10.1006/cogp.1996.0018.
Emmanouel, A., Kessels, R.P.C., Mouza, E., & Fasotti, L. (2014). Sensitivity, specificity and predictive value of the BADS to anterior executive dysfunction. Neuropsychological Rehabilitation, 24 (1), 125. DOI: 10.1080/09602011.2013.863731.
Espinosa, A., Alegret, M., Boada, M., Vinyes, G., Valero, S., Martinez-Lage, P., . . . Tarraga, L. (2009). Ecological assessment of executive functions in mild cognitive impairment and mild Alzheimer's disease. Journal of the International Neuropsychological Society, 15 (5), 751757. DOI: 10.1017/S135561770999035X.
Field, A. (2005). Discovering statistics using SPSS (2nd ed.). London: Sage.
Fortin, S., Godbout, L., & Braun, C.M.J. (2003). Cognitive structure of executive deficits in frontally lesioned head trauma patients performing activities of daily living. Cortex, 39 (2), 273291. DOI: 10.1016/S0010-9452(08)70109-6.
Godbout, L., Cloutier, P., Bouchard, C., Braun, C.M.J., & Gagnon, S. (2004). Script generation following frontal and parietal lesions. Journal of Clinical and Experimental Neuropsychology, 26, 857873. DOI: 1380-3395/04/2607-857$16.00.
Godbout, L., & Doyon, J. (1995). Mental representation of knowledge following frontal-lobe or postrolandic lesions. Neuropsychologia, 33, 16711696. DOI: 10.1016/0028-3932(95)00047-X.
Godbout, L., & Doyon, J. (2000). Defective representation of knowledge in Parkinson‟s disease: Evidence from a script-production task. Brain and Cognition, 44, 490510. DOI: 10.1006/brcg.2000.1213.
Godbout, L., Grenier, M.C., Braun, C.M.J., & Gagnon, S. (2005). Cognitive structure of executive deficits in patients with frontal lesions performing activities of daily living. Brain Injury, 19, 337348. DOI: 10.1080/02699050400005093.
Golden, C.J., Espe-Pfeifer, P., & Wachsler-Felder, J. (2000). Neuropsychological interpretation of objective psychological tests. New York: Springer US.
Grafman, J. (1989). Plans, actions and mental sets: Managerial knowledge units in the frontal lobes. In Perecman, E. (Ed.), Integrating theory and practice in clinical neuropsychology (pp. 93138). Hillsdale, NJ: Lawrence Erlbaum Associates.
Grafman, J. (1994). Neuropsychology of the prefrontal cortex. In Zaidel, D. (Ed.), Handbook of perception and cognition (pp. 159181). San Diego: Academic Press.
Grant, M., Ponsford, J., & Bennett, P.C. (2012). The application of goal management training to aspects of financial management in individuals with traumatic brain injury. Neuropsychological Rehabilitation, 22, 852873. DOI: 10.1080/09602011.2012.693455.
Hartman, M., Steketee, M.C., Silva, S., Lanning, K., & Andersson, C. (2003). Wisconsin card sorting test performance in schizophrenia: The role of working memory. Schizophrenia Research, 63, 201217. DOI: 10.1016/S0920-9964(02)00353-5.
Hurks, P., Schrans, D., Meijs, C., Wassenberg, R., Feron, F., & Jolles, J. (2010). Developmental changes in semantic verbal fluency: Analyses of word response generation as a function of time, clustering, and switching. Child Neuropsychology, 6 (4), 366387. DOI: 10.1080/09297041003671184.
Kosmidis, M.H., Vlachou, C.H., Panagiotaki, P., & Kiosseoglou, G. (2004). The verbal fluency task in the greek population: Normative data, and clustering and switching strategies. Journal of the International Neuropsychological Society, 10, 164172. DOI:
Levin, H.S., Fletcher, J.M., Kufera, J.A., Harward, H., Lilly, M.A., Mendelsohn, D., . . . Eisenberg, H.M. (1996). Dimensions of cognition measured by the Tower of London and other cognitive tasks in head-injured children and adolescents. Developmental Neuropsychology, 12, 1734. DOI: 10.1080/87565649609540638.
Lezak, M.D. (1995). Neuropsychological assessment (3rd ed.). New York: Oxford University Press.
Lezak, M.D., Howieson, D.B., & Loring, D.W. (2004). Neuropsychological assessment (4th ed.). New York: Oxford University Press.
McWilliams, J., & Schmitter-Edgecombe, M. (2008). Semantic memory organization during the early stage of recovery from traumatic brain injury. Brain Injury, 22, 243253. DOI: 10.1080/02699050801935252.
Miller, E.K., & Cohen, J.D. (2001). An integrative theory of prefrontal cortex function. Annual Review of Neuroscience, 24, 167202. DOI: 0147-006X/01/0301-0167$14.00.
Miyake, A., Friedman, N.P., Emerson, M.J., Witzki, A.H., & Howeter, A. (2000). The unity and diversity of executive functions and their contributions to complex frontal lobe tasks: A latent variable analysis. Cognitive Psychology, 41, 49100. DOI: 10.1006/cogp.1999.0734.
Oosterman, J.M., Oosterveld, S., Rikkert, M.G., Claassen, J.A., & Kessels, R.P.C. (2012). Medial temporal lobe atrophy relates to executive dysfunction in Alzheimer's disease. International Psychogeriatrics, 24, 14741482. DOI:
Oosterman, J.M., Wijers, M., & Kessels, R.C.P. (2013). Planning or something else? Examining neuropsychological predictors of Zoo Map performance. Applied Neuropsychology: Adult, 20 (2), 103109. DOI: 10.1080/09084282.2012.670150.
Shallice, T. (2002). Fractionation of the supervisory system. In Stuss, D.T. (Ed.), Principles of frontal lobe function (pp. 261277). New York: Oxford University Press.
Sirigu, A., Cohen, L., Zalla, T., Pradat-Diehl, P., Van Eeckhout, P., Grafman, J., & Agid, Y. (1998). Distinct frontal regions for processing sentence syntax and story grammar. Cortex, 34, 771778. DOI: 10.1016/S0010-9452(08)70780-9.
Sirigu, A., Zalla, T., Pillon, B., Grafman, J., Agid, Y., & Dubois, B. (1995). Selective impairments in managerial knowledge following pre-frontal cortex damage. Cortex, 31, 301316. DOI: 10.1016/S0010-9452(13)80364-4.
Spikman, J.M. (2002). Checklist executieve stoornissen [checklist executive disorders]. Groningen: Internal Publication, University Medical Centre Groningen, the Netherlands.
Spreen, O., & Strauss, E. (1998). A compendium of neuropsychological tests: Administration, norms and commentary. New York: Oxford University Press.
Stuss, D. (2006). Frontal lobes and attention: Processes and networks, fractionation and integration. Journal of the International Neuropsychological Society, 12 (02), 61271. DOI:
Stuss, D.T., & Alexander, M.P. (2000). Executive functions and the frontal lobes: A conceptual view. Psychological Research, 63, 289298. Downloaded from (free access). Retrieved from:
Stuss, D.T., & Levine, B. (2002). Adult clinical neuropsychology: Lessons from studies of the frontal lobes. Annual Review of Psychology, 53, 401433. DOI: 0084–6570/02/0201-0401$14.00.
Stuss, D.T., Alexander, M.P., Hamer, L., Palumbo, C., Dempster, R., Binns, M., . . .Izukawa, D. (1998). The effects of focal anterior and posterior brain lesions on verbal fluency. Journal of the International Neuropsychological Society, 4, 265278. Downloaded on 12 October 2010. Retrieved from:
Stuss, D.T., Floden, D., Alexander, M.P., Levine, B., & Katz, D. (2001). Stroop performance in focal lesion patients: Dissociation of processes and frontal lobe lesion location. Neuropsychologia, 39, 771786. DOI: 10.1016/S0028-3932(01)00013-6.
Stuss, D.T., Levine, B., Alexander, M.P., Hong, J., Palumbo, C., Hamer, L., . . .Izukawa, D. (2000). Wisconsin card sorting test performance in patients with focal frontal and posterior brain damage: Effects of lesion location and test structure on separable cognitive processes. Neuropsychologia, 38, 388402. DOI: 10.1016/S0028-3932(99)00093-7.
Wechsler, D. (1997). WAIS-III administration and scoring manual. San Antonio, TX: The Psychological Corporation.
Wilson, B.A., Alderman, N., Burgess, P.W., Emslie, H., & Evans, J.J. (1996). Behavioral assessment of the dysexecutive syndrome (BADS). Bury St. Edmunds, UK: Thames Valley Test Company.
Wood, J.N., & Grafman, J. (2003). Human prefrontal cortex: Processing and representational perspectives. Nature Neuroscience Reviews, 4, 139146. DOI: 10.1038/nrn1033.
Zalla, T., Sirigu, A., Pillon, B., Dubois, B., Grafman, J., & Agid, Y. (1998). Deficits in evaluating predetermined sequences of script events in patients with Parkinson's disease. Cortex, 34, 621628. DOI: 10.1016/S0010-9452(08)70519-7.
Zalonis, I., Christidi, F., Bonakis, A., Kararizou, E., Triantafyllou, N.I., Paraskevas, G., . . . Vasilopoulos, D. (2009). The stroop effect in greek healthy population: Normative data for the Stroop neuropsychological screening test. Archives of Clinical Neuropsychology: The Official Journal of the National Academy of Neuropsychologists, 24, 8188. DOI: 10.1093/arclin/acp011.
Zalonis, I., Kararizou, E., Triantafyllou, N.I., Kapaki, E., Papageorgiou, S., Sgouropoulos, P., & Vassilopoulos, D. (2008). A normative study of the trail making test A and B in greek adults. The Clinical Neuropsychologist, 22, 842850. DOI: 10.1080/13854040701629301.
Zanini, S., Rumiati, R.I., & Shallice, T. (2002). Action sequencing deficit following frontal lobe lesion. Neurocase, 8, 8899. DOI: 10.1093/neucas/8.1.88.
Zanini, S. (2008). Generalized script sequencing deficits following frontal lobe lesions. Cortex, 44, 140149. DOI: 10.1016/j.cortex.2006.03.002.


Script Generation and Executive Dysfunction in Patients with Anterior and Posterior Brain Lesions

  • Anna Emmanouel (a1), Danielle Boelen (a1) (a2) (a3), Eirini Mouza (a4), Phillipe Allain (a5) (a6), Roy P.C. Kessels (a1) (a2) (a7) and Luciano Fasotti (a1) (a3)...


Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed