This brain region has been implicated in planning complex cognitive behaviors, personality expression, and moderating correct social behavior. The basic activity of this brain region is considered to be orchestration of thoughts and actions in accordance with internal goals.
The most typical neurologic term for functions carried out by the pre-frontal cortex area is executive function. Executive function relates to abilities to differentiate among conflicting thoughts, determine good and bad, better and best, same and different, future consequences of current activities, working toward a defined goal, prediction of outcomes, expectation based on actions, and social "control" (the ability to suppress urges that, if not suppressed, could lead to socially-unacceptable outcomes).
Many authors have indicated an integral link between a person's personality and the functions of the prefrontal cortex.
The prefrontal cortex has a high number of interconnections between both the brainstem's Reticular Activating System (RAS) and the limbic system. As a result, the centers in the prefrontal cortex depend significantly on high levels of alertness, and emotional linkages with deeper brain structures related to control of pleasure, pain, anger, rage, panic, aggression (fight-flight-freeze responses), and basic sexual responses.
Perhaps the seminal case in prefrontal cortex function is that of Phineas Gage, whose personality may have changed after an 1848 accident destroyed one or both frontal lobes. The standard presentation (e.g. ) is that although Gage retained normal memory, speech and motor skills, his personality changed radically. He became irritable, quick-tempered, and impatient, characteristics that he previously did not exhibit, so that friends described him as "no longer Gage." And whereas he had previously been a capable and efficient worker, afterwards he was unable to complete the multiple tasks that he started. However, careful analysis of primary evidence shows that descriptions of Gage's psychological changes are usually exaggerated, the most striking feature being that changes described years after his death are far more dramatic than anything reported while he was alive .
Subsequent studies, on patients with prefrontal injuries, have shown that the patients verbalized what the most appropriate social responses would be under certain circumstances, yet, when actually performing, they instead pursued behavior that is aimed at immediate gratification despite knowing the longer-term results would be self-defeating.
The interpretation of this data indicates that not only are skills of comparison and understanding of eventual outcomes harbored in the prefrontal cortex but the prefrontal cortex (when functioning correctly) controls the mental option to delay immediate gratification for a better or more rewarding longer-term gratification result. This ability to wait for a reward is one of the key pieces that define optimal executive function of the human brain.
There is much current research devoted to understanding the role of the prefrontal cortex in neurological disorders. Many diseases, such as schizophrenia, bipolar disorder and ADHD, have been related to dysfunction of the prefrontal cortex, and thus this area of the brain offers the potential for new treatments of these diseases. Clinical trials have begun around certain drugs that have been shown to improve prefrontal cortex function, including guanfacine which acts through the alpha2A adrenergic receptor. A downstream target of this drug, the HCN channel, is one of the most recent areas of exploration in prefrontal cortex pharmacology.