A patient with a lesion of the left dorsolateral prefrontal cortex is asked to perform the Wisconsin Card Sorting Test. He perseveres with a previously correct sorting rule even after being told it is now wrong, continuing to sort by the old rule. Which cognitive function is impaired?

• A Declarative memory consolidation
• B Cognitive flexibility and set-shifting ✓
• C Language comprehension
• D Procedural motor learning

Explanation

The dorsolateral prefrontal cortex mediates executive functions including cognitive flexibility, set-shifting, and working memory. The Wisconsin Card Sorting Test specifically assesses the ability to shift cognitive strategies when rules change. Perseveration, the hallmark DLPFC lesion deficit, is the inability to abandon a previously correct rule despite negative feedback. This is distinct from declarative memory (hippocampus), procedural memory (basal ganglia/cerebellum), or language (temporal/parietal cortex).

Reference: Ganong's Review of Medical Physiology, 26th ed.

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