frontal lobe disorder

The signs and symptoms of frontal lobe disorder can be indicated by dysexecutive syndrome{{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 }} which consists of a number of symptoms which tend to occur together.{{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}} 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{{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}} to suggest that the symptoms should not be labelled as a "syndrome" as such. Some of the latest imaging research{{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}} on frontal cortex areas suggests that executive functions may be more discrete than was previously thought. Signs and symptoms can be divided as follows:

{{columns-list|colwidth=30em|

Movement

• Tremor
• Apraxia
• Dystonia
• Gait abnormality
• Dyspraxia

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

• Aphasia
• Expressive aphasia

}}

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.{{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}}

Cerebrovascular disease may cause a stroke in the frontal lobe. Tumours such as meningiomas may present with a frontal lobe syndrome.{{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 }} Frontal lobe impairment is also a feature of Alzheimer's disease, and frontotemporal dementia.{{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 }}

The pathogenesis of frontal lobe disorders entails various pathologies, some are as follows:

{{columns-list|colwidth=30em|

• Foster Kennedy syndrome{{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}}- 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{{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}}
• 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{{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}}
• Loss of initiative, creativity and curiosity
• Pervasive emotional apathy and blandness
• Akinetic mutism

}}

File:MRI of orbitofrontal cortex.jpg]]

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.{{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}} 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.{{EMedicine|article|1135866|Frontal Lobe Syndromes}}

File:Pick's disease.png.]]

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.

• Examination

On mental state examination a person with frontal lobe damage may show speech problems, with reduced verbal fluency. 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).{{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}} With more severe impairment there may be echolalia or mutism.{{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 }} Neurological examination may show primitive reflexes (also known as frontal release signs) such as the grasp reflex.{{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 }} Akinesia (lack of spontaneous movement) will be present in more severe and advanced cases.{{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 }}

• 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.{{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 }} Frontotemporal dementia shows up as atrophy of the frontal cortex on MRI.{{EMedicine|article|1135504|Pick Disease|workup}} Frontal impairment due to head injuries, tumours or cerebrovascular disease will also appear on brain imaging.

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. 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.

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".{{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 }}

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.{{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}} The diagnosis of frontal lobe syndrome in this homicide case generated public discussions about the disorder.{{Cite news |date=22 September 2006 |title=Wife-killer case: Questions about syndrome |work=The Straits Times}}

• Attention
• Cognitive neuropsychology
• Dysexecutive syndrome
• Executive functions
• Frontal lobe
• Gourmand syndrome
• Klüver–Bucy syndrome
• Phineas Gage
• Working memory

{{Reflist}}

• {{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}}
• {{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}}

{{Medical resources

| ICD10 = {{ICD10|F|07||f|00}}

| eMedicineSubj = article

| eMedicineTopic = 1135866

}}

{{Commons}}

{{Scholia|topic}}

{{Prosencephalon}}

{{Medicine}}

{{DEFAULTSORT:Frontal Lobe Disorder}}

Category:Neurobiological brain disorders

Category:Cognitive neuroscience

Category:Frontal lobe

Category:Mental disorders due to brain damage