THE SMILEY - A GRAPHICAL EXPRESSION OF MOOD IN RIGHT ANTERIOR CEREBRAL-LESIONS

In contrast to cognitive functions, little is known about the anatomof unctional correlates of affect and mood. We investigated the anatomica l and clinical findings in 37 patients who produced a happy face (the so-called ''smiley'') instead of three dots in the copy and/or recall of the Rey-Osterrieth complex figure. In all instances comprehensive n europsychological examination was abnormal, most often pointing to fun ctional impairment of anterior structures of the right hemisphere, tha t is, impaired figural fluency, nonverbal concept identification, and figural learning and recall. Most patients (83%) showed disturbed affe ct and mood. They were distractable, affectively instable, fluctuating from elation and inconcern to irritative and sometimes aggressive beh avior, but none of the patients was depressed or obsessive-compulsive. Anatomically, the anterior part of the right hemisphere was significa ntly more frequently damaged than any other cerebral structure. Our st udy shows that, although the ''smiley'' is rare, its presence strongly suggests structural or functional damage to the anterior part of the right hemisphere. Moreover, it appears to represent a nonverbal grapho motor expression of mood combined with other symptoms of diminished im pulse control in brain-damaged patients.