Frontal lobe syndrome

Disease/Disorder

Definition: An organic disorder of the brain affecting cognitive ability, personality, and behavior.

Anatomy or system affected: Frontal lobe of the brain, disinhibition, impulsivity, personality, regulation of emotion, attention, awareness, execution of sequential tasks

Key terms:

aneurysm: an expansion of a segment of blood vessel that causes damage to the surrounding areas, sometimes causing additional damage when the weak area bursts, resulting in internal bleeding; brain injury is sustained from both the pressured displacement of brain structures and deterioration of brain tissue caused by blood contact with the brain

anterior: a term of location meaning "toward the front"

Broca area: part of the motor cortex that controls speech; it is typically located in the left hemisphere, just anterior to the ear; lesions to this are associated with speech dysfunction

embolism: a blockage of a blood vessel that interrupts blood flow; a cerebral embolism is likely to cause a stroke

frontal lobe: the cerebral cortex of the brain is divided into two sections called hemispheres: the left hemisphere and right hemisphere; each hemisphere is further divided into quadrants called lobes: the frontal lobe is the most anterior lobe, located just behind the eyes; the other lobes are the parietal, occipital, and temporal; the frontal lobe is associated with executive function, thought process, personality, and execution of intentional voluntary physical movement

lesion: a term used to described injury or abnormal change in an area of the brain

motor cortex: the primary, secondary and tertiary motor cortex is part of the frontal lobe that controls movement; this includes speech

Causes and Symptoms

Frontal lobe syndrome is a collection of symptoms caused by damage to or dysfunction of the frontal lobe. This damage or dysfunction may have a number of possible causes, including traumatic brain injury (TBI), such as a blow to the head or repeated exposure to intense blasts from explosives at a close range; a transient ischemic attack (TIA); a cerebrovascular event, such as an embolism, aneurysm, or stroke; dementia; and alcohol or drug abuse, among others.

Symptoms may include changes in mood, affect, and personality traits; shortened attention span; hypomania; impulsiveness; inability to make decisions; memory deficits; difficulty with abstract or sequential thought; lack of planning abilities; disinhibition and social inappropriateness; apathy; inability to communicate ideas; and behavioral symptoms such as perseveration (repetition of a response in the absence of the associated stimulus). Because both communication and memory may be impacted, it can be unclear if an individual patient is suffering from memory deficits or simply lacks the ability or motivation to communicate ideas and memories.

Treatment and Therapy

Pharmacological treatment can be combined with neuropsychotherapy and behavioral therapy. The neuropsychological approach often addresses the patient's impairment by developing strategies for working around deficits in function to facilitate an improved quality of life. The treatment often also emphasizes psychoeducation for people who interact with the patient to help them contextualize the patient's functioning level, behavior, and personality changes. Behavioral therapy may also be helpful depending on the level of impairment. Other treatments address the psychological symptoms associated with each particular case by implementing the appropriate corresponding treatment.

Perspective and Prospects

One of the first documented cases of frontal lobe syndrome was in 1848. The patient was Phineas Gage, a railway worker who survived having an iron pole driven through his skull. The primary area of damage was his brain's left frontal lobe, just behind the left eye. He survived, but those who were familiar with him reported his behavior and personality as uncharacteristic of the person they once knew.

In recent texts, the phrase "frontal lobe syndrome" is used to indicate a group of syndromes or specific diagnoses whose symptoms are indicative of damage to the frontal lobe. Such damage is frequently associated with drug and alcohol abuse, chemical exposure, infection, physical trauma, or aging. Practitioners and researchers have pointed out the inherent problems with having an anatomical structure also be the name of a disorder; for example, some research has suggested that the symptoms associated with frontal lobe syndrome may not correlate with lesions to the frontal lobe alone. The diagnosis code for frontal lobe syndrome in the US version of the International Classification of Diseases, ninth revision (ICD-9-CM), was removed in the tenth revision (ICD-10-CM) and replaced with the broader diagnosis of "personality change due to known physiological condition."

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published in 2013, changed the previous version's category of "Dementia, Delirium, Amnestic, and Other Cognitive Disorders" to simply "Neurocognitive Disorders." This category includes the diagnosis "major or mild frontotemporal neurocognitive disorder," which it defines as "a number of syndromic variants characterized by the progressive development of behavioral and personality change and/or language impairment." Patients presenting with the behavioral variant are said to exhibit "varying degrees of apathy or disinhibition," as characterized by "[loss of] interest in socialization, self-care, and personal responsibilities" and "socially inappropriate behaviors," respectively. Symptoms include "lack of planning and organization, distractibility, and poor judgment," as well as "deficits in executive function."

Bibliography

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Vega, Jose. "Frontal Lobe Damage: Symptoms, Causes, and Treatments." VeryWell Mind, 16 Nov. 2023, www.verywellhealth.com/the-brains-frontal-lobe-3146196. Accessed 15 Nov. 2024.

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