The stone in the undertaker’s head
Mrs. M. was known for her absolutely serious and professional management skills. These characteristics are especially important for the success of Mrs. M.’s undertaker’s business. Its services comprise not only the complete care of the deceased, such as the salvage, transportation, and transfer of the corpse, dressing it and embedding it into a coffin, but also the organization of the funeral process from the music selection to the funeral decoration.
Mrs. M. was 55 years old and successfully running her undertaker’s business when her headaches started. But it weren’t the headaches which led to her business problems. These problems were due to her sudden, and for her age unusual, decrease in cognitive abilities. Difficulties arose in the performance of Mrs. M.’s daily tasks, errors slipped in, and somehow she forgot to integrate the latest and correct information into her current task sequence.
Otherwise Mrs. M. seemed to not have any deficiencies regarding her perception. She could see, hear, and normally understand any issue or matter. Yet, it was first her family, and not Mrs. M. herself, who reported to her GP that her behaviour was a bit odd. Then also her colleagues began to express surprise about her more and more frequent mistakes that were unusual for Mrs. M.’s normal working functioning. Imagine the consequences of such mistakes in the context of her business, when carrying out the requests of the immediate family of a deceased person in such a delicate situation: sending a hearse to the same address twice, confusing the coffins of two different corpses, et cetera. This all happened because Mrs. M. would now forget certain tasks, unless she took notes of every single step.
Her struggling can be described as effects of executive dysfunctions. In particular, neuropsychological test results indicated deficits in the updating of working memory. Her impairments increased to the point where a team consisting of medical doctors and neuropsychologists took decisive action.
“Looking back at my first times confronted with the topic of executive dysfunctions as a psychology student, I noticed that quite often not only physical health is taken for granted, but also the ability to successfully plan, solve problems, and reason.”
I still remember how fascinated I was during lectures: learning how complex the brain’s computations are when implementing cognition and how fragile the brain can be, but also how adaptively it can respond from a neuroplastic perspective, and that executive dysfunctions are actually common in various psychiatric and neuropsychological disorders.
After finishing my psychology studies, I decided to specialize in this topic during my PhD time and investigate the basic neural underpinnings of specific executive functions. I studied conflict monitoring and inhibition and analyzed the timing of specific brain areas contributing to their implementation (Enriquez-Geppert et al. 2010). Evidence showed that the brain’s morphology affected performance of executive functions in both patients with brain abnormalities and healthy people. In particular, the midcingulate cortex – also known as anterior cingulate cortex, a brain region situated above the corpus callosum, shows such structure-function associations and seems to be a crucial area of the brain network for implementing executive functions (Huster, Enriquez-Geppert et al., 2014a).
In my post-doctoral time, executive dysfunctions remained my topic, and I was engaged with questions if the knowledge about how the brain carries out cognitive tasks could help scientists develop new neuropsychological interventions for the improvement of those functions (Enriquez-Geppert et al. 2013; Enriquez-Geppert et al. 2014b). As an assistant professor in Groningen, I further investigate whether neuroscientific interventions could be beneficial as novel therapeutic tools for patients with neuropsychological impairments, as in the case of Mrs. M.
About one year ago, I received a message from Mrs. M.’s neurosurgeon: “Stefanie, are you ready to attend a surgery this Saturday?”
The team caring for Mrs. M. decided it was time to remove the growing meningioma in her prefrontal cortex. Meningiomas are tumours arising from the meninges, membranous layers which envelop the brain. The symptoms observed in Mrs. M. were consequences of either an irritation of the underlying cortex, a compression of the brain or cranial nerves, an invasion of the soft brain tissues near the tumour, vascular injuries to brain areas supporting cognition or a combination of these options.
At the time I received the message about Mrs. M. I spent a research stay abroad to study pathological declines of executive functions. I determined effects of brain surgeries on EEG measurements and so I was ready to attend Mrs. M.’s surgery. The surgical procedure was difficult and time consuming, and the team was astonished to find out about the strong calcification of the tumour.
“This meningioma is a stone” were the words of the neurosurgeon.
It was located directly on the midcingulate cortex, the brain area that was such a long time the object of my research.
While I have conducted research on executive functions for several years now, the confrontation with cases such as Mrs. M.´s continues to leave their trace on me. When I now introduce the topic of executive dysfunctions in my talks and lectures, I have Mrs. M.’s case in mind.
“Executive dysfunctions are no longer an abstract topic, pure textbook knowledge, or hard scientific facts. Behind this term are people, whose lives can all of a sudden be turned upside-down. This is something we as researchers should never forget.”
Huster, R.J.*, Enriquez-Geppert, S.*, Pantev, C., Bruchmann, M. (2014a). Variations in midcingulate morphology are associated with interindividual differences in cognitive control. Brain Structure and Function, 219, 49-60. (*shared first authorship)
Enriquez-Geppert, S., Huster, R.J., Figge, C., Herrmann C.S. (2014b). Self-regulation of frontal-midline theta facilitates memory updating and mental set shifting. Frontiers in Behavioral Neuroscience, 8, 420.
Enriquez-Geppert, S., Huster, R.J., Herrmann C.S. (2013). Boosting brain functions: Improving executive functions with behavioral trainings, neurostimulation, and neurofeedback. International Journal of Psychophysiology, 88, 1-16.
Enriquez-Geppert, S., Konrad, C., Pantev, C., Huster, R.J. (2010). Conflict and inhibition differentially affect the N200/P300 complex in a combined go/nogo and stop-signal task. NeuroImage, 51, 877-887.