Frontal lobe disorder: Difference between revisions
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{{short description|Brain disorder}} |
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{{Infobox |
{{Infobox medical condition (new) |
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| name = Frontal lobe disorder |
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| synonyms = |
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| image = Frontal lobe.png |
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| eMedicineSubj = article |
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| caption = Illustration of lateral view of the right side of the [[Human brain|brain]] showing the [[frontal lobe]], other [[lobes of the brain]], and the [[cerebellum]] |
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| eMedicineTopic = 1135866 |
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| pronounce = |
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| field = neurology, psychiatry |
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| symptoms = Tremor, dystonia<ref name=nih/> |
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| complications = |
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| onset = |
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| duration = |
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| types = |
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| causes = Closed head injuries<ref name=head/> |
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| risks = |
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| diagnosis = Neuropsychological test<ref name=test/> |
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| differential = |
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| prevention = |
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| treatment = Speech therapy, supportive care<ref name="Frontal lobe syndromes" /> |
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| medication = |
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| prognosis = |
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| frequency = |
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'''Frontal lobe disorder''', also '''frontal lobe syndrome''', is an impairment of the [[frontal lobe]] of the [[brain]] due to disease or [[frontal lobe injury]].<ref name="pat">{{Cite web |date=6 November 2014 |title=Frontal Lobe Syndrome. FLS information. Frontal Lobe Lesions {{!}} Patient |url=http://patient.info/doctor/frontal-lobe-syndrome |url-status=live |archive-url=https://web.archive.org/web/20171121190851/https://patient.info/doctor/frontal-lobe-syndrome |archive-date=2017-11-21 |access-date=2016-01-30 |website=Patient |language=en-GB}}</ref> The frontal lobe plays a key role in [[executive functions]] such as motivation, planning, social behaviour, and speech production. Frontal lobe syndrome can be caused by a range of conditions including head trauma, tumours, [[neurodegenerative disease]]s, [[neurodevelopmental disorders]], neurosurgery and [[cerebrovascular disease]]. Frontal lobe impairment can be detected by recognition of typical [[signs and symptoms]], use of simple screening tests, and specialist neurological testing.<ref name="test" /><ref>{{cite journal |last1=Ruiz-Barrio |first1=Iñigo |last2=Horta-Barba |first2=Andrea |last3=Aracil-Bolaños |first3=Ignacio |last4=Martinez-Horta |first4=Saül |last5=Kulisevsky |first5=Jaime |last6=Pagonabarraga |first6=Javier |title=Predicting Disability in Progressive Supranuclear Palsy Using Bedside Frontal-Lobe Signs |journal=Movement Disorders Clinical Practice |date=March 2024 |volume=11 |issue=3 |pages=248–256 |doi=10.1002/mdc3.13958 |pmc=10928321 |pmid=38164060 |pmc-embargo-date=January 2, 2025}}</ref> |
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'''Frontal lobe disorder''' is an impairment of the frontal lobe that occurs as a result of a number of diseases as well as head trauma. The [[frontal lobe]] of the [[brain]] plays a key role in higher mental functions such as motivation, planning, social behaviour, and speech production. A frontal lobe syndrome can result from a range of causes including head trauma, tumours, degenerative diseases, neurosurgery and cerebrovascular disease. Impairment of frontal lobe functioning is also found in psychiatric patients due to prescribed medication, namely antipsychotics <ref>{{cite journal |last=Petersen |first=KA |coauthors=Pierry JN, et al |year=2005 |month=March |title=The Influence of Chronic Exposure to Antipsychotic Medications on Brain size before and after Tissue Fixation: A comparison of Haloperidol and Olanzapine in Macaque Monkeys |journal=Neuropharmacology}}</ref><ref>{{cite journal |last=Ballesteros |first=J |coauthors=Gonzalez-Pinto A, Bulbena A |year=2000 |title=Tardive dyxkinesia associated with higher mortality in paychiatric patients: results of a meta-analysis of seven independent studies |journal=Clin Psychopharmacology |volume=20 |issue=2 |pages=188-194}}</ref><ref>{{cite journal |last=Christensen |first=E |year=1970 |title=Neuropathological investigations of 28 brains from patients with dyskinesia |journal=Acta Psychiatrica Scandinavica |volume=46 |pages=14-23}}</ref><ref>{{cite journal|last=Wade|first=James|title=Tardive Dyskinesia and Cognitive Impairment|journal=Biological Psychiatry|year=1987|volume=22|pages=393-395}}</ref><ref>{{cite book|last=Whitaker|first=Robert|title=Mad in America}}</ref> . Frontal lobe impairment can be detected by recognition of typical clinical signs, use of simple screening tests, and specialist neurological testing. |
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== |
== Signs and symptoms == |
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[[File:Prefrontal cortex.png|right|220px|<div align="right">Prefrontal Cortex]]</div> |
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[[File:Human brain lateral view description.JPG|thumb|right|220px|The top blue line denotes the central sulcus]] |
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The frontal lobe has three main areas, known as the precentral cortex, prefrontal cortex and the orbitofrontal cortex. These three areas are represented in both the left and the right cerebral hemispheres. |
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The signs and symptoms of frontal lobe disorder can be indicated by [[dysexecutive syndrome]]<ref>{{cite book |last1=M.D |first1=Larry E. Davis |last2=Richardson |first2=Sarah Pirio |title=Fundamentals of Neurologic Disease |date=2015 |publisher=Springer |isbn=978-1-4939-2359-5 |page=139 }}</ref> which consists of a number of symptoms which tend to occur together.<ref>{{cite book |doi=10.1093/acprof:oso/9780199234110.001.0001 |title=The Handbook of Clinical Neuropsychology |date=2010 |editor-last1=Gurd |editor-last2=Kischka |editor-first1=Jennifer |editor-first2=Udo |last1=Marshall |first1=John |isbn=978-0-19-923411-0 }}{{pn|date=August 2024}}</ref> Broadly speaking, these symptoms fall into three main categories; cognitive (movement and speech), emotional or behavioral. Although many of these symptoms regularly co-occur, it is common to encounter patients who have several, but not all of these symptoms. This is one reason why some researchers are beginning to argue that dysexecutive syndrome is not the best term to describe these various symptoms. The fact that many of the dysexecutive syndrome symptoms can occur alone has led some researchers<ref>{{Cite journal |last=Stuss D.T., Alexander M.P. |year=2007 |title=Is there a Dysexecutive Syndrome? Philosophical transactions of the Royal Society of London |journal=Philosophical Transactions of the Royal Society of London. Series B, Biological Sciences |volume=362 |issue=1481 |pages=901–15 |doi=10.1098/rstb.2007.2096 |pmc=2430005 |pmid=17412679}}</ref> to suggest that the symptoms should not be labelled as a "syndrome" as such. Some of the latest imaging research<ref>{{Cite journal |last=Gilbert S.J., Burgess P.W. |year=2008 |title=Executive Function |journal=Current Biology |volume=18 |issue=3 |pages=110–114 |bibcode=2008CBio...18.R110G |doi=10.1016/j.cub.2007.12.014 |pmid=18269902 |s2cid=15536307 |doi-access=free}}</ref> on frontal cortex areas suggests that executive functions may be more discrete than was previously thought. Signs and symptoms can be divided as follows:<ref name=nih/> |
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The precentral cortex or [[primary motor cortex]] is concerned with the planning, initiation and control of physical movement.{{Citation needed|date=July 2008}} The dorsolateral part of the frontal lobe is concerned with planning, strategy formation, and other [[executive functions]]. The prefrontal cortex in the left hemisphere is involved with [[verbal memory]] while the prefrontal cortex in the right hemisphere is involved in [[spatial memory]]. The left frontal operculum region of the prefrontal cortex, or [[Broca's area]], is responsible for expressive language, i.e. language production. The orbitofrontal cortex is concerned with response inhibition, impulse control, and social behaviour.<ref>{{cite web |url= http://www.emedicine.com/NEURO/topic436.htm |title=Frontal lobe syndromes |accessdate=2008-07-02 |publisher=eMedicine Specialities |date=January 11, 2008}}</ref> |
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{{columns-list|colwidth=30em| |
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'''Movement''' |
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* [[Tremor]] |
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* [[Apraxia]] |
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* [[Dystonia]] |
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* [[Gait abnormality]] |
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* [[Developmental coordination disorder|Dyspraxia]] |
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'''Emotional''' |
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==Clinical assessment== |
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* Difficulty in inhibiting emotions, anger, excitement |
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===History=== |
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* [[Depression (mood)|Depression]] |
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Frontal lobe disorders may be recognized through a sudden and dramatic change in a person's [[personality psychology|personality]], for example with loss of social awareness, disinhibition, emotional instability, aggression, irritability or impulsiveness (for example sexually inappropriate behaviour or spending money impulsively). Alternatively the disorder may become apparent because of mood changes such as [[depression (mood)|depression]], [[anxiety]] or apathy.<ref name=Gelder/> |
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* Difficulty in understanding others' points of view |
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'''Behavioral''' |
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===Examination=== |
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* [[Utilization behavior]] |
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On [[mental state examination]] a person with frontal lobe damage may show reduced speech, with reduced verbal fluency and impaired expressive language. The person might have flattened or blunted [[affect (psychology)|affect]]. Typically the person is lacking in insight and judgment, but does not have marked cognitive abnormalities or memory impairment (as measured for example by the [[mini-mental state examination]]). With more severe impairment there may be [[echolalia]] or [[mutism]]. [[Neurological examination]] may show [[primitive reflexes]] (also known as frontal release signs) such as the [[grasp reflex]] or the [[rooting reflex]]. These are reflexes normally found in babies, but normally suppressed and absent in adults. [[Akinesia]] (lack of spontaneous movement) and [[urinary incontinence]] will be present in more severe and advanced cases.<ref name=Gelder/> The frontal assessment battery (FAB), which includes simple tests of sequencing, behavioural inhibition, planning and frontal release signs, can be used as a screening test to elicit typical neurological and cognitive features.<ref>{{cite journal |last=Dubois |first=B |coauthors=Slachevsky A, Litvan I, Pillon B |year=2000 |month=December |title=The FAB: a Frontal Assessment Battery at bedside |journal=Neurology |volume=55 |issue=11 |pages=1621–6 |accessdate=2008-07-02 |pmid=11113214}}</ref> |
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* [[Perseveration]] behavior |
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* Social disinhibition |
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* Compulsive eating |
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'''Language signs''' |
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===Further investigation=== |
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* [[Aphasia]] |
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A range of [[neuropsychological]] tests are available for clarifying the nature and extent of frontal lobe dysfunction. For example, [[concept formation]] and ability to shift mental sets can be measured with the [[Wisconsin Card Sorting Test]], planning can be assessed with the Mazes subtest of the [[Wechsler Intelligence Scale for Children|WISC]], switching between plans is assessed with the [[Trail-making test]], and screening out distracting stimuli is assessed with the [[Stroop test]].<ref>Gelder et al. (2000) p. 96</ref> |
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* [[Expressive aphasia]] |
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}} |
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==Causes== |
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Individuals with [[frontotemporal dementia]] and [[Pick's disease]] will show frontal cortical [[atrophy]] on [[CT scan]]s or [[MRI]]s.<ref>Gelder et al. (2000) p. 400</ref> Frontal impairment due to head injuries, tumours or cerebrovascular disease will also be apparent on brain imaging.<ref>{{cite web |url= http://www.emedicine.com/NEURO/topic436.htm |title=Frontal lobe syndromes |accessdate=2008-07-02 |publisher=eMedicine Specialities |date=January 11, 2008}}</ref> |
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The causes of frontal lobe disorders can be [[closed head injury]]. An example of this can be from an accident, which can cause damage to the orbitofrontal cortex area of the brain.<ref name="head">{{cite journal |last1=Walz |first1=Roger |title=Psychiatric disorders and traumatic brain injury |journal=Neuropsychiatric Disease and Treatment |date=September 2008 |volume=4 |issue=4 |pages=797–816 |doi=10.2147/ndt.s2653 |pmc=2536546 |pmid=19043523 |doi-access=free}}</ref> |
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[[Cerebrovascular disease]] may cause a [[stroke]] in the frontal lobe. [[Tumours]] such as [[meningiomas]] may present with a frontal lobe syndrome.<ref>{{cite book |last1=Miller |first1=Bruce L. |last2=Cummings |first2=Jeffrey L. |title=The Human Frontal Lobes: Functions and Disorders |date=2007 |publisher=Guilford Publications |isbn=978-1-59385-329-7 |pages=19, 450 }}</ref> Frontal lobe impairment is also a feature of [[Alzheimer's disease]], and [[frontotemporal dementia]].<ref name="nih">{{cite web |title=Frontotemporal Dementia and Other Frontotemporal Disorders |website=National Institute of Neurological Disorders and Stroke |url=https://www.ninds.nih.gov/health-information/disorders/frontotemporal-dementia-and-other-frontotemporal-disorders }}</ref> |
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==Dysexecutive syndrome== |
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Dysexecutive syndrome consists of a number of symptoms<ref>Halligan P.W, Kischka U. & Marshall J.C. (2004) Handbook of Clinical Neuropsychology. Oxford University Press, 2004.</ref> which tend to occur together (hence it being described as a syndrome). Broadly speaking, these symptoms fall into three main categories; cognitive, emotional and behavioural. Although many of these symptoms regularly co-occur, it is common to encounter patients who have several, but not all of these symptoms. This is one reason why some researchers are beginning to argue that dysexecutive syndrome is not the best term to describe these various symptoms (see criticisms below). The fact that many of the dysexecutive syndrome symptoms can occur alone has led some researchers<ref>Stuss, D.T. & Alexander, M.P. (2007) Is there a Dysexecutive Syndrome? Philosophical transactions of the Royal Society of London. Series B, Biological Sciences, 362 (1481), 901-15.</ref> to suggest that the symptoms should not be labelled as a "syndrome" as such. Some of the latest imaging research<ref>Gilbert, S.J. & Burgess, P.W. (2008). Executive Function. Current Biology, Vol.18, No. 3, 110–114.</ref> on frontal cortex areas suggests that executive functions may be more discrete than was previously thought. The argument is that rather than damage to the frontal cortex areas causing dysexecutive functions in general, that damage to multiple frontal cortex areas that are close together (but responsible for different cognitive functions) can cause the various symptoms of dysexecutive syndrome. |
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==Pathogenesis== |
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The counterargument is that there is a [[central executive]] corresponding to areas within the frontal lobes which is responsible for much of the [[executive system]] and [[executive function]] in general, and that damage to this area causes dysexecutive syndrome. |
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The pathogenesis of frontal lobe disorders entails various pathologies, some are as follows: |
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{{columns-list|colwidth=30em| |
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* [[Foster Kennedy syndrome]]<ref>{{Cite web |title=Foster Kennedy's Syndrome. FKS information. Patient {{!}} Patient |url=http://patient.info/doctor/Foster-Kennedy-Syndrome.htm |url-status=live |archive-url=https://web.archive.org/web/20160202184752/http://patient.info/doctor/Foster-Kennedy-Syndrome.htm |archive-date=2016-02-02 |access-date=2016-01-30 |website=Patient |language=en-GB}}</ref>- It is caused due to tumor of frontal lobe and gives rise to ipsilateral optic atrophy and contralateral papilledema. |
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* Frontal disinhibition syndrome, [[Fetal Alcohol Spectrum Disorder]], [[Rett syndrome]] and [[attention deficit hyperactivity disorder]]<ref name="pmid11202137">{{Cite journal |last=Niedermeyer |first=E |date=Jan 2001 |title=Frontal lobe disinhibition, Rett syndrome and attention deficit hyperactivity disorder |journal=Clinical Electroencephalography |volume=32 |issue=1 |pages=20–3 |doi=10.1177/155005940103200106 |pmid=11202137 |s2cid=35417045}}</ref> |
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** It is produced from frontal lobe damage due to prenatal exposure to [[teratogens]](like [[alcohol (drug)|ethanol]]), head injuries, or tumors. |
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** Socially disinhibited and shows severe impairment of judgment, insight and foresight. |
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** Antisocial behaviour is a characteristic feature of frontal disinhibition syndrome. |
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* Frontal abulic syndrome<ref name="LeadershipBerkeley2002">{{Cite book |last1=Leadership |first1=Donald T. Stuss Reva James Leeds Chair in Neuroscience and Research |url=https://books.google.com/books?id=ntOEPvcGoiYC&pg=PA13 |title=Principles of Frontal Lobe Function |last2=Berkeley |first2=Helen Wills Neuroscience Institute Robert T. Knight Evan Rauch Professor of Neuroscience and Director, Department of Psychology University of California |date=20 June 2002 |publisher=Oxford University Press |isbn=978-0-19-803083-6 |page=13}}</ref> |
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** Loss of initiative, creativity and curiosity |
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** Pervasive emotional apathy and blandness |
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** [[Akinetic mutism]] |
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}} |
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[[File:MRI of orbitofrontal cortex.jpg|thumb|OFC-[[Orbitofrontal cortex]]]] |
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=== |
===Anatomy and functions=== |
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The frontal lobe contains the precentral gyrus and prefrontal cortex and, by some conventions, the orbitofrontal cortex. These three areas are represented in both the left and the right cerebral hemispheres. The [[precentral gyrus]] or [[primary motor cortex]] is concerned with the planning, initiation and control of fine motor movements dorsolateral to each hemisphere.<ref>{{Cite book |last=Kalat |first=James |url=https://archive.org/details/biologicalpsycho00ka/page/100 |title=Biological Psychology |date=2007 |publisher=Thomas Wadsworth |isbn=978-0-495-09079-3 |edition=9 |location=Belmont, CA, USA |pages=[https://archive.org/details/biologicalpsycho00ka/page/100 100] |url-access=registration}}</ref> The dorsolateral part of the frontal lobe is concerned with planning, strategy formation, and other [[executive functions]]. The prefrontal cortex in the left hemisphere is involved with [[verbal memory]] while the prefrontal cortex in the right hemisphere is involved in [[spatial memory]]. The left frontal operculum region of the prefrontal cortex, or [[Broca's area]], is responsible for expressive language, i.e. language production. The [[orbitofrontal cortex]] is concerned with response inhibition, impulse control, and social behaviour.<ref name="Frontal lobe syndromes">{{EMedicine|article|1135866|Frontal Lobe Syndromes}}</ref> |
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* Short [[attention span]] |
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* Poor [[working memory]] |
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* Poor [[short term memory]] |
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* Difficulty in [[planning]] and [[reasoning]] |
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* [[Environmental dependence syndrome]] |
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==Diagnosis== |
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===Emotional symptoms=== |
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[[File:Pick's disease.png|thumb|350px|[[Frontotemporal dementia]].]] |
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* Difficulty in inhibiting emotions, anger, excitement, sadness etc... |
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The diagnosis of frontal lobe disorder can be divided into the following three categories: |
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* [[Depression (mood)|Depression]], possibly due to above. |
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* '''Clinical history''' |
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* Occasionally, difficulty in understanding others' points of view, leading to anger and frustration. |
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Frontal lobe disorders may be recognized through a sudden and dramatic change in a person's [[personality psychology|personality]], for example with loss of social awareness, disinhibition, emotional instability, irritability or impulsiveness. Alternatively, the disorder may become apparent because of mood changes such as [[depression (mood)|depression]], [[anxiety]] or apathy.<ref name=nih/> |
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* '''Examination''' |
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On [[mental state examination]] a person with [[frontal lobe damage]] may show speech problems, with reduced verbal fluency.<ref name="Frontal lobe syndromes" /> Typically the person is lacking in insight and judgment, but does not have marked cognitive abnormalities or memory impairment (as measured for example by the [[mini-mental state examination]]).<ref>{{Cite journal |last1=Pangman |first1=Verna C. |last2=Sloan |first2=Jeff |last3=Guse |first3=Lorna |year=2000 |title=An examination of psychometric properties of the Mini-Mental State Examination and the Standardized Mini-Mental State Examination: Implications for clinical practice |journal=Applied Nursing Research |volume=13 |issue=4 |pages=209–13 |doi=10.1053/apnr.2000.9231 |pmid=11078787}}</ref> With more severe impairment there may be [[echolalia]] or [[mutism]].<ref>{{cite journal |last1=Nagaratnam |first1=Nages |title=Mutism in the Older Adult |journal=Geriatrics and Aging |volume=8 |issue=8 |date=2005 |pages=61–68 |url=https://www.medscape.com/viewarticle/512923 }}</ref> [[Neurological examination]] may show [[primitive reflexes]] (also known as frontal release signs) such as the [[grasp reflex]].<ref>{{cite journal |last1=Schott |first1=J M |title=The grasp and other primitive reflexes |journal=Journal of Neurology, Neurosurgery & Psychiatry |date=May 2003 |volume=74 |issue=5 |pages=558–560 |doi=10.1136/jnnp.74.5.558 |pmc=1738455 |pmid=12700289 }}</ref> [[Akinesia]] (lack of spontaneous movement) will be present in more severe and advanced cases.<ref>{{cite book |last1=Bradley |first1=Walter George |title=Neurology in Clinical Practice |date=2004 |publisher=Taylor & Francis |isbn=978-0-7506-7469-0 |page=122 }}</ref> |
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* '''Further investigation''' |
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A range of [[neuropsychological]] tests are available for clarifying the nature and extent of frontal lobe dysfunction. For example, [[concept formation]] and ability to shift mental sets can be measured with the [[Wisconsin Card Sorting Test]], planning can be assessed with the Mazes subtest of the [[Wechsler Intelligence Scale for Children|WISC]].<ref name="test">{{cite journal |last1=Eling |first1=Paul |last2=Derckx |first2=Kristianne |last3=Maes |first3=Roald |title=On the historical and conceptual background of the Wisconsin Card Sorting Test |journal=Brain and Cognition |date=August 2008 |volume=67 |issue=3 |pages=247–253 |doi=10.1016/j.bandc.2008.01.006 |pmid=18328609 |s2cid=205788199 |hdl-access=free |hdl=2066/73651 }}</ref> [[Frontotemporal dementia]] shows up as [[atrophy]] of the frontal cortex on [[MRI]].<ref>{{EMedicine|article|1135504|Pick Disease|workup}}</ref> Frontal impairment due to head injuries, tumours or cerebrovascular disease will also appear on brain imaging.<ref name="Frontal lobe syndromes" /> |
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==Treatment== |
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===Behavioural symptoms=== |
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In terms of treatment for frontal lobe disorder, there is none, general supportive care is given, also some level of supervision could be needed. The prognosis will depend on the cause of the disorder, of course. A possible complication is that individuals with severe [[injuries]] may be disabled, such that, a [[caregiver]] may be unrecognizable to the person.<ref name=pat/> Another aspect of treatment of frontal lobe disorder is [[speech therapy]]. This type of therapy might help individuals with symptoms that are associated with [[aphasia]] and [[dysarthria]].<ref name="Frontal lobe syndromes" /> |
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* [[Utilization behaviour]] |
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* [[Perseveration]] behaviour |
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* Inappropriate [[aggression]] |
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* Inappropriate [[Human sexual activity|sexual behaviour]] |
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* Inappropriate humour and telling of pointless and boring stories ([[Witzelsucht]]) |
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==History== |
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[[Phineas Gage]], who suffered a severe frontal lobe injury in 1848, has been called a case of dysexecutive syndrome. But Gage's psychological changes are typically grossly exaggerated: of the symptoms listed above, the only ones Gage can even ''arguably'' be said to have exhibited (based on primary sources) are "anger and frustration", slight memory impairment, and "difficulty in planning". |
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[[Phineas Gage]], who sustained a severe frontal lobe injury in 1848, has been called a case of dysexecutive syndrome. Gage's psychological changes are almost always exaggerated{{snd}}of the symptoms listed, the only ones Gage can be said to have exhibited are "anger and frustration", slight memory impairment, and "difficulty in planning".<ref>{{cite journal |last1=Macmillan |first1=Malcolm |title=Phineas Gage – Unravelling the myth |journal=The Psychologist |volume=21 |issue=9 |date=2008 |pages=828–831 |url=https://www.bps.org.uk/psychologist/phineas-gage-unravelling-myth }}</ref> |
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In December 2005, at his [[Dover, Singapore|Dover Road]] flat in Singapore, 44-year-old caretaker [[Mohammad Zam Abdul Rashid]] attacked and battered his 38-year-old wife Ramona Johari (a production operator) to death after he accused her of getting close to a colleague. Mohammad Zam was originally charged with murder but after he was found to be suffering from frontal lobe syndrome, which went undiagnosed prior to the murder and had affected his mental responsibility at the time of the killing, Mohammad Zam was convicted of a reduced charge of manslaughter and hence sentenced to [[Life imprisonment in Singapore|life imprisonment]].<ref>{{Cite news |date=12 September 2006 |title='Unstable' wife-killer escapes the gallows |url=https://eresources.nlb.gov.sg/newspapers/digitised/article/today20060912-1.2.8.5 |url-status=live |archive-url=https://web.archive.org/web/20240312054939/https://eresources.nlb.gov.sg/newspapers/digitised/article/today20060912-1.2.8.5 |archive-date=12 March 2024 |access-date=12 March 2024 |work=Today}}</ref> The diagnosis of frontal lobe syndrome in this homicide case generated public discussions about the disorder.<ref>{{Cite news |date=22 September 2006 |title=Wife-killer case: Questions about syndrome |work=The Straits Times}}</ref> |
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In particular, the primary sources do not report utilization behaviour, depression, aggression, inappropriate sexual behaviour, or "inappropriate humour and telling of pointless and boring stories" (in fact, his audience was said to have found his stories entertaining). The oft-quoted statement by friends—that after the accident he was "no longer Gage"—admits interpretation as any number of behavioural or personality changes, not even necessarily of organic etiology. Although he was not able to return to his work for the railroad, after his physical recovery he was socially functional and self-supporting for the remainder of his life.<ref>{{cite book |author=Macmillan, M. |year=2000 |title=An Odd Kind of Fame: Stories of Phineas Gage |publisher=[[MIT Press]] |isbn=0-262-13363-6 |chapter=The Damage to Gage's Psyche (Ch.6)}}</ref><ref>{{cite web |author=Macmillan, M. (2008) |url= http://www.thepsychologist.org.uk/archive/archive_home.cfm/volumeID_21-editionID_164-ArticleID_1399-getfile_getPDF/thepsychologist%5C0908look.pdf |format=PDF |title=Phineas Gage – Unravelling the myth ''The Psychologist'' ([[British Psychological Society]]), 21(9): 828-831}}</ref> |
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== See also == |
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==Causes of frontal lobe dysfunction== |
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===Head trauma=== |
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[[Closed head injuries]], for example from [[motor vehicle]] accidents, can cause damage to the orbitofrontal cortex. Pre-frontal [[lobotomies]] and antipsychotics, severing connections between the pre-frontal cortex and the rest of the brain, are effectively a form of [[iatrogenic]] trauma resulting in a frontal lobe syndrome. |
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===Cerebrovascular disease=== |
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[[Cerebrovascular disease]] may cause a [[stroke]] in the frontal lobe. |
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===Tumours=== |
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[[Tumours]] such as [[meningiomas]] may present with a frontal lobe syndrome. |
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===Degenerative diseases=== |
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Frontal lobe impairment is a feature of [[Alzheimer's disease]], [[frontotemporal dementia]] and [[Pick's disease]].<ref name=Gelder>Gelder et al. (2000) p. 397-404</ref> |
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===Psychiatric medication=== |
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It has been proved that psychiatric drugs cause damage to pre frontal cortex. |
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Inumerable medical studies have shown, in the past 20 years, that use of neuroleptic psychiatric drugs (or [[antipsychotic]]s) is linked with structural brain changes, especially when taking high dosages for a long time. These brain changes might include actual atrophy of the higher level parts of the brain. The atrophy can be seen in MRI scans and autopsy studies. In response to industry experts who claim that this shrinkage is from the "mental illness," studies demonstrate neuroleptics lead to analogous brain changes in monkeys <ref>{{cite journal|last=Dorph-Petersen|first=KA|coauthors=Pierri JN, et al|title=The influence of chronic exposure to Antipsychotic Medications on Brain Size before and after Tissue Fixation: A comparison of Haloperidol and Olanzapine in Macaque Monkeys|journal=Neuropsychopharmacology|date=9|year=2005|month=March}}</ref>. |
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==See also== |
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* [[Frontal lobe]] |
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* [[Executive functions]] |
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* [[Attention]] |
* [[Attention]] |
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* [[Cognitive neuropsychology]] |
* [[Cognitive neuropsychology]] |
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* [[Dysexecutive syndrome]] |
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* [[Executive functions]] |
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* [[Frontal lobe]] |
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* [[Gourmand syndrome]] |
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* [[Klüver–Bucy syndrome]] |
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* [[Phineas Gage]] |
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* [[Working memory]] |
* [[Working memory]] |
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* [[Phineas Gage]] |
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==Notes== |
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{{reflist}} |
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==References== |
==References== |
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{{Reflist}} |
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* {{cite book |title=New Oxford textbook of psychiatry |last=Gelder |first=M |coauthors=López-Ibor J; Andreasen N |year=2000 |publisher=Oxford University Press |location=Oxford |isbn =0-19-852810-8}} |
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* {{cite book|last=Whitaker|first=Robert|title=Mad in America}} |
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== |
==Further reading== |
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* {{Cite journal |last=Paradiso |first=S |date=1999 |title=Frontal lobe syndrome reassessed: comparison of patients with lateral or medial frontal brain damage |journal=Journal of Neurology, Neurosurgery, and Psychiatry |volume=67 |issue=5 |pages=664–7 |doi=10.1136/jnnp.67.5.664 |pmc=1736625 |pmid=10519877}} |
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* [http://www.emedicine.com/NEURO/topic436.htm eMedicine: Frontal lobe syndromes] |
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* {{cite journal |last1=Paradiso |first1=S. |last2=Chemerinski |first2=E. |last3=Yazici |first3=K. M |last4=Tartaro |first4=A. |last5=Robinson |first5=R. G |title=Frontal lobe syndrome reassessed: comparison of patients with lateral or medial frontal brain damage |journal=Journal of Neurology, Neurosurgery & Psychiatry |date=November 1999 |volume=67 |issue=5 |pages=664–667 |doi=10.1136/jnnp.67.5.664 |pmc=1736625 |pmid=10519877}} |
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* [http://www.neuro.spc.org/vaughan/ExecutiveFunctionLecture.pdf Notes on dysexecutive syndrome and the executive system] |
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* [http://thebrain.mcgill.ca/flash/d/d_06/d_06_cr/d_06_cr_mou/d_06_cr_mou.html The Brain from Top to Bottom] |
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== External links == |
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* [http://www.mindfreedom.org/kb/psychiatric-drugs/antipsychotics/neuroleptic-brain-damage Midfreedom Brain Damage] |
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{{Medical resources |
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| ICD10 = {{ICD10|F|07||f|00}} |
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| eMedicineSubj = article |
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| eMedicineTopic = 1135866 |
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{{Scholia|topic}} |
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{{Prosencephalon}} |
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{{Medicine}} |
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{{DEFAULTSORT:Frontal Lobe Disorder}} |
{{DEFAULTSORT:Frontal Lobe Disorder}} |
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[[Category: |
[[Category:Neurobiological brain disorders]] |
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[[Category:Cognitive neuroscience]] |
[[Category:Cognitive neuroscience]] |
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[[Category: |
[[Category:Frontal lobe]] |
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[[Category:Mental disorders due to brain damage]] |
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Latest revision as of 14:56, 25 August 2024
| Frontal lobe disorder | |
|---|---|
 | |
| Illustration of lateral view of the right side of the brain showing the frontal lobe, other lobes of the brain, and the cerebellum | |
| Specialty | Neurology, psychiatry |
| Symptoms | Tremor, dystonia[1] |
| Causes | Closed head injuries[2] |
| Diagnostic method | Neuropsychological test[3] |
| Treatment | Speech therapy, supportive care[4] |
Frontal lobe disorder, also frontal lobe syndrome, is an impairment of the frontal lobe of the brain due to disease or frontal lobe injury.[5] The frontal lobe plays a key role in executive functions such as motivation, planning, social behaviour, and speech production. Frontal lobe syndrome can be caused by a range of conditions including head trauma, tumours, neurodegenerative diseases, neurodevelopmental disorders, neurosurgery and cerebrovascular disease. Frontal lobe impairment can be detected by recognition of typical signs and symptoms, use of simple screening tests, and specialist neurological testing.[3][6]
Signs and symptoms
[edit]The signs and symptoms of frontal lobe disorder can be indicated by dysexecutive syndrome[7] which consists of a number of symptoms which tend to occur together.[8] Broadly speaking, these symptoms fall into three main categories; cognitive (movement and speech), emotional or behavioral. Although many of these symptoms regularly co-occur, it is common to encounter patients who have several, but not all of these symptoms. This is one reason why some researchers are beginning to argue that dysexecutive syndrome is not the best term to describe these various symptoms. The fact that many of the dysexecutive syndrome symptoms can occur alone has led some researchers[9] to suggest that the symptoms should not be labelled as a "syndrome" as such. Some of the latest imaging research[10] on frontal cortex areas suggests that executive functions may be more discrete than was previously thought. Signs and symptoms can be divided as follows:[1]
Movement
Emotional
- Difficulty in inhibiting emotions, anger, excitement
- Depression
- Difficulty in understanding others' points of view
Behavioral
- Utilization behavior
- Perseveration behavior
- Social disinhibition
- Compulsive eating
Language signs
Causes
[edit]The causes of frontal lobe disorders can be closed head injury. An example of this can be from an accident, which can cause damage to the orbitofrontal cortex area of the brain.[2]
Cerebrovascular disease may cause a stroke in the frontal lobe. Tumours such as meningiomas may present with a frontal lobe syndrome.[11] Frontal lobe impairment is also a feature of Alzheimer's disease, and frontotemporal dementia.[1]
Pathogenesis
[edit]The pathogenesis of frontal lobe disorders entails various pathologies, some are as follows:
- Foster Kennedy syndrome[12]- It is caused due to tumor of frontal lobe and gives rise to ipsilateral optic atrophy and contralateral papilledema.
- Frontal disinhibition syndrome, Fetal Alcohol Spectrum Disorder, Rett syndrome and attention deficit hyperactivity disorder[13]
- It is produced from frontal lobe damage due to prenatal exposure to teratogens(like ethanol), head injuries, or tumors.
- Socially disinhibited and shows severe impairment of judgment, insight and foresight.
- Antisocial behaviour is a characteristic feature of frontal disinhibition syndrome.
- Frontal abulic syndrome[14]
- Loss of initiative, creativity and curiosity
- Pervasive emotional apathy and blandness
- Akinetic mutism
Anatomy and functions
[edit]The frontal lobe contains the precentral gyrus and prefrontal cortex and, by some conventions, the orbitofrontal cortex. These three areas are represented in both the left and the right cerebral hemispheres. The precentral gyrus or primary motor cortex is concerned with the planning, initiation and control of fine motor movements dorsolateral to each hemisphere.[15] The dorsolateral part of the frontal lobe is concerned with planning, strategy formation, and other executive functions. The prefrontal cortex in the left hemisphere is involved with verbal memory while the prefrontal cortex in the right hemisphere is involved in spatial memory. The left frontal operculum region of the prefrontal cortex, or Broca's area, is responsible for expressive language, i.e. language production. The orbitofrontal cortex is concerned with response inhibition, impulse control, and social behaviour.[4]
Diagnosis
[edit]
The diagnosis of frontal lobe disorder can be divided into the following three categories:
- Clinical history
Frontal lobe disorders may be recognized through a sudden and dramatic change in a person's personality, for example with loss of social awareness, disinhibition, emotional instability, irritability or impulsiveness. Alternatively, the disorder may become apparent because of mood changes such as depression, anxiety or apathy.[1]
- Examination
On mental state examination a person with frontal lobe damage may show speech problems, with reduced verbal fluency.[4] Typically the person is lacking in insight and judgment, but does not have marked cognitive abnormalities or memory impairment (as measured for example by the mini-mental state examination).[16] With more severe impairment there may be echolalia or mutism.[17] Neurological examination may show primitive reflexes (also known as frontal release signs) such as the grasp reflex.[18] Akinesia (lack of spontaneous movement) will be present in more severe and advanced cases.[19]
- Further investigation
A range of neuropsychological tests are available for clarifying the nature and extent of frontal lobe dysfunction. For example, concept formation and ability to shift mental sets can be measured with the Wisconsin Card Sorting Test, planning can be assessed with the Mazes subtest of the WISC.[3] Frontotemporal dementia shows up as atrophy of the frontal cortex on MRI.[20] Frontal impairment due to head injuries, tumours or cerebrovascular disease will also appear on brain imaging.[4]
Treatment
[edit]In terms of treatment for frontal lobe disorder, there is none, general supportive care is given, also some level of supervision could be needed. The prognosis will depend on the cause of the disorder, of course. A possible complication is that individuals with severe injuries may be disabled, such that, a caregiver may be unrecognizable to the person.[5] Another aspect of treatment of frontal lobe disorder is speech therapy. This type of therapy might help individuals with symptoms that are associated with aphasia and dysarthria.[4]
History
[edit]Phineas Gage, who sustained a severe frontal lobe injury in 1848, has been called a case of dysexecutive syndrome. Gage's psychological changes are almost always exaggerated – of the symptoms listed, the only ones Gage can be said to have exhibited are "anger and frustration", slight memory impairment, and "difficulty in planning".[21]
In December 2005, at his Dover Road flat in Singapore, 44-year-old caretaker Mohammad Zam Abdul Rashid attacked and battered his 38-year-old wife Ramona Johari (a production operator) to death after he accused her of getting close to a colleague. Mohammad Zam was originally charged with murder but after he was found to be suffering from frontal lobe syndrome, which went undiagnosed prior to the murder and had affected his mental responsibility at the time of the killing, Mohammad Zam was convicted of a reduced charge of manslaughter and hence sentenced to life imprisonment.[22] The diagnosis of frontal lobe syndrome in this homicide case generated public discussions about the disorder.[23]
See also
[edit]- Attention
- Cognitive neuropsychology
- Dysexecutive syndrome
- Executive functions
- Frontal lobe
- Gourmand syndrome
- Klüver–Bucy syndrome
- Phineas Gage
- Working memory
References
[edit]- ^ a b c d "Frontotemporal Dementia and Other Frontotemporal Disorders". National Institute of Neurological Disorders and Stroke.
- ^ a b Walz, Roger (September 2008). "Psychiatric disorders and traumatic brain injury". Neuropsychiatric Disease and Treatment. 4 (4): 797–816. doi:10.2147/ndt.s2653. PMC 2536546. PMID 19043523.
- ^ a b c Eling, Paul; Derckx, Kristianne; Maes, Roald (August 2008). "On the historical and conceptual background of the Wisconsin Card Sorting Test". Brain and Cognition. 67 (3): 247–253. doi:10.1016/j.bandc.2008.01.006. hdl:2066/73651. PMID 18328609. S2CID 205788199.
- ^ a b c d e Frontal Lobe Syndromes at eMedicine
- ^ a b "Frontal Lobe Syndrome. FLS information. Frontal Lobe Lesions | Patient". Patient. 6 November 2014. Archived from the original on 2017-11-21. Retrieved 2016-01-30.
- ^ Ruiz-Barrio, Iñigo; Horta-Barba, Andrea; Aracil-Bolaños, Ignacio; Martinez-Horta, Saül; Kulisevsky, Jaime; Pagonabarraga, Javier (March 2024). "Predicting Disability in Progressive Supranuclear Palsy Using Bedside Frontal-Lobe Signs". Movement Disorders Clinical Practice. 11 (3): 248–256. doi:10.1002/mdc3.13958. PMC 10928321. PMID 38164060.
- ^ M.D, Larry E. Davis; Richardson, Sarah Pirio (2015). Fundamentals of Neurologic Disease. Springer. p. 139. ISBN 978-1-4939-2359-5.
- ^ Marshall, John (2010). Gurd, Jennifer; Kischka, Udo (eds.). The Handbook of Clinical Neuropsychology. doi:10.1093/acprof:oso/9780199234110.001.0001. ISBN 978-0-19-923411-0.[page needed]
- ^ Stuss D.T., Alexander M.P. (2007). "Is there a Dysexecutive Syndrome? Philosophical transactions of the Royal Society of London". Philosophical Transactions of the Royal Society of London. Series B, Biological Sciences. 362 (1481): 901–15. doi:10.1098/rstb.2007.2096. PMC 2430005. PMID 17412679.
- ^ Gilbert S.J., Burgess P.W. (2008). "Executive Function". Current Biology. 18 (3): 110–114. Bibcode:2008CBio...18.R110G. doi:10.1016/j.cub.2007.12.014. PMID 18269902. S2CID 15536307.
- ^ Miller, Bruce L.; Cummings, Jeffrey L. (2007). The Human Frontal Lobes: Functions and Disorders. Guilford Publications. pp. 19, 450. ISBN 978-1-59385-329-7.
- ^ "Foster Kennedy's Syndrome. FKS information. Patient | Patient". Patient. Archived from the original on 2016-02-02. Retrieved 2016-01-30.
- ^ Niedermeyer, E (Jan 2001). "Frontal lobe disinhibition, Rett syndrome and attention deficit hyperactivity disorder". Clinical Electroencephalography. 32 (1): 20–3. doi:10.1177/155005940103200106. PMID 11202137. S2CID 35417045.
- ^ Leadership, Donald T. Stuss Reva James Leeds Chair in Neuroscience and Research; Berkeley, Helen Wills Neuroscience Institute Robert T. Knight Evan Rauch Professor of Neuroscience and Director, Department of Psychology University of California (20 June 2002). Principles of Frontal Lobe Function. Oxford University Press. p. 13. ISBN 978-0-19-803083-6.
{{cite book}}: CS1 maint: multiple names: authors list (link) - ^ Kalat, James (2007). Biological Psychology (9 ed.). Belmont, CA, USA: Thomas Wadsworth. pp. 100. ISBN 978-0-495-09079-3.
- ^ Pangman, Verna C.; Sloan, Jeff; Guse, Lorna (2000). "An examination of psychometric properties of the Mini-Mental State Examination and the Standardized Mini-Mental State Examination: Implications for clinical practice". Applied Nursing Research. 13 (4): 209–13. doi:10.1053/apnr.2000.9231. PMID 11078787.
- ^ Nagaratnam, Nages (2005). "Mutism in the Older Adult". Geriatrics and Aging. 8 (8): 61–68.
- ^ Schott, J M (May 2003). "The grasp and other primitive reflexes". Journal of Neurology, Neurosurgery & Psychiatry. 74 (5): 558–560. doi:10.1136/jnnp.74.5.558. PMC 1738455. PMID 12700289.
- ^ Bradley, Walter George (2004). Neurology in Clinical Practice. Taylor & Francis. p. 122. ISBN 978-0-7506-7469-0.
- ^ Pick Disease~workup at eMedicine
- ^ Macmillan, Malcolm (2008). "Phineas Gage – Unravelling the myth". The Psychologist. 21 (9): 828–831.
- ^ "'Unstable' wife-killer escapes the gallows". Today. 12 September 2006. Archived from the original on 12 March 2024. Retrieved 12 March 2024.
- ^ "Wife-killer case: Questions about syndrome". The Straits Times. 22 September 2006.
Further reading
[edit]- Paradiso, S (1999). "Frontal lobe syndrome reassessed: comparison of patients with lateral or medial frontal brain damage". Journal of Neurology, Neurosurgery, and Psychiatry. 67 (5): 664–7. doi:10.1136/jnnp.67.5.664. PMC 1736625. PMID 10519877.
- Paradiso, S.; Chemerinski, E.; Yazici, K. M; Tartaro, A.; Robinson, R. G (November 1999). "Frontal lobe syndrome reassessed: comparison of patients with lateral or medial frontal brain damage". Journal of Neurology, Neurosurgery & Psychiatry. 67 (5): 664–667. doi:10.1136/jnnp.67.5.664. PMC 1736625. PMID 10519877.
External links
[edit]
Scholia has a topic profile for Frontal lobe disorder.
