The ability to use working memory
Working memory is an integral part of executive control and the processing of new information.
Working memory, which typically operates in the medial temporal region (where the hippocampus is located) for the formation of new memories, is utilized by the prefrontal cortex to help integrate stored knowledge from the long term memory with new stimulus and sensory information to allow learning, behavior regulation and executing goal-related behaviors (Gazzaniga et al., 2019).
The ability to use working memory to execute intentional goal-related behaviors, including learning, is known as cognitive control (Gazzaniga et al., 2019).
The executive function and use of working memory to execute goal-related behaviors require the use of the pre-frontal cortex (PFC). Without the PFC, it is difficult to link relevant stimuli to stored knowledge; working memory relies on this function in order to execute many tasks (Gazzaniga et al., 2019).
Often, patients with PFC damage will continue to repeat a response that they have been told is incorrect, known as perseveration (Gazzaniga et al., 2019).
Additionally, they may be unable to make decisions, apathetic, distractible, and unable to understand the consequences of their actions or follow rules (Gazzaniga et al., 2019).
Much of this stems from the inability of the working memory function. If a person is unable to integrate stored knowledge with sensory information then they essentially lack the ability to modify their behavior to adjust to the current situation (Gazzaniga et al., 2019).
They also suffer from an inability to initiate intentional and goal-related behaviors because the PFC does not function properly to engage working memory in coordinating conceptual thoughts and ideas with real-time feedback of what is going on in the world (Gazzaniga et al., 2019).
The end result is a patient that has no noticeable deficits in intelligence or relative function but lacks the ability to use their intelligence to form and follow through with goals or make reasonable decisions (Gazzaniga et al., 2019).