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How does looking the other way portray executive dysfunction in frontotemporal degeneration?

In Heilman and Valenstein's1 widely used text, Clinical Neuropsychology , standing alone among the chapters dedicated to neurobehavioral syndromes (aphasia, agnosia, apraxia) is one entitled “The frontal lobes.” This label subsumes executive cognitive functions, comportment, and the control and execution of motor activity, which includes both somatomotor and oculomotor systems. The oculomotor control system for saccades mediates reflexive responses influenced by the superior colliculus and volitional movements controlled by the frontal eye fields (FEF).2 As initially reported over 30 years ago, the antisaccade task assesses a central feature of executive control, the ability to inhibit an automatic or prepotent response to a novel visual stimulus.3 Test performance involves 2 separate tasks: 1) suppressing a reflex prosaccade toward a novel visual stimulus presented on one side, and 2) diverting gaze in the opposite direction by executing a volitional antisaccade.4 A number of variations of this basic paradigm have been developed to evaluate neuropsychological processes such as visual attention, spatial memory, working memory, motivation, and decision-making across a variety of neurologic and psychiatric disorders.5