Frontal Lobe Disorder

Most recently developed area of the brain Underdeveloped in children Boundaries Central sulcus Sylvian fissure Corpus callosum Role in executive functions Motivation Planning Social behavior Sets humans apart as living organisms William James ?The uniqueness of the human mind?the ability to pursue goals? Impairment of the frontal lobes Deficits in Goal-Directed Behaviors Flexibility Working memory Ability to think abstractly Daily functioning Closed-head or open-head injuries Focal damage Tumor Cerebrovascular accidents (stroke) Degenerative diseases Dementia (Alzheimer?s Disease) Parkinson?s Disease Huntington?s Disease Neurotoxicity Alcoholism Psychiatric disorders Schizophrenia Depression Frontal lobotomies: removal of frontal lobe Results often worse than original illness Used to treat schizophrenia, depression, anxiety and obsessive neuroses Leukotomies: frontal lobe partially dis- connected from cortex Frequent supervision No available medications Cognitive Poor working memory Difficulty in planning and reasoning Environmental Dependence Syndrome Emotional Difficulty inhibiting emotions Possible depression Behavioral Perseveration Inappropriate social interactions Disinhibition In 1848 while working on a railroad, he had a tamping iron impact his his skull through the frontal lobe region Led to major personality and behavioral changes Damage to ventromedial PFC ??devised many plans of future operation, which are no sooner arranged than they are abandoned in turn for others appearing more feasible.? Ability to stay on task, determine what steps to take, and self-monitor performance to reach a goal Volition: voluntary thought and action (driven by goals) Frontal lobe damage ? Wander off task Difficulty monitoring and evaluating performance Frontal release/Disinhibition Psychological Tests Anti-saccade task problems Tower of London task problems Ability to look at situations from a multiplicity of vantage points and/or produce a variety of behaviors Frontal lobe damage ? Deficit in adapting behaviors to new situations Deficit enabling novel behaviors William James?s analogy: ?Romeo wants Juliet as the filings want the magnet? Psychological Tests Trail-making test problems Ability to hold short-term information while it is being manipulated Frontal lobe damage ? Inability to plan ahead Difficulty directing behavior toward a goal Frontal amnesia ?Forgetting to remember? Psychological Tests Delayed response task problems http://www.youtube.com/watch?v=X3k57INqRew Ability to use concepts and make/use generalizations Frontal lobe damage ? Deficit in abstract processing Poor theory of mind Psychological Tests WCST problems Verbal task problems (meanings of proverbs) Difficulty with abstract estimations Frontal lobe damage ? Debilitating impact on everyday activities Behavioral/personality symptoms Often lack originality, are inattentive, and have inappropriate emotional reactions ?Behavioral Assessment of the Dysexecutive Syndrome? Inefficient Break rules Fail to complete tasks Psychological Tests Difficulty with tests of fluency Go/No-Go task problems 35 year old, female Underwent an operation to remove most of her left prefrontal lobe after sustaining major head trauma to that area and moderately severe damage to the right frontal lobe. Premorbid findings: Intelligent woman with degree in English literature Elementary school teacher Married, two children ?She was a practical, positive person who didn?t suffer fools gladly. She could do three things at once and hardly ever seemed to get tired or uptight, even when the kids were acting up and she had another 2 hours` marking to do.? Recovered quickly from physical damages but suffered from a mild right side weakness Disinhibition Yelled at anyone who passed her; if they did not talk with her, she would yell profanities at them She would also undress in public areas She suffered from right-sided neglect as shown by the Rey Complex Figure task She would also embellish her drawings When asked to draw the Complex Figure from memory, she reported no knowledge of what the experimenter was speaking and instead doodled on the page Tactile Neglect Task She would insist on looking under the cloth and wouldn?t listen to the experimenter Rule-breaking behaviors Perseveration in Rhythm task Word pairing Lacked ability to make verbal abstractions On formal verbal and memory tests, she would not conform to the directions given making it hard to test her abilities. On the tasks/tests she did perform, she scored below average (even though she holds a degree in English) Memory for faces was good, but poor for names of people Possibly result of poor attention and motivation Often confabulated stories of her past Unaware of any psychological damage she suffered from but was aware of why she was in the hospital Her primary treatment was physical therapy Over 4 months the right-sided weakness resolved somewhat Rehab can be impossible due to behaviors associated with FLD Eventually placed in an institution She was ambivalent toward her husband and children Not many treatment options Therapy for family on dealing with the disorder 45 y/o male Brain aneurysm Infarct of left anterior cerebral artery(orbitomedial PFC) Deficits Reduplicative paramnesia Motor stereotypies Perseverative card sorting Anterograde amnesia Some rehab alleviated motor problems http://www.youtube.com/watch?v=rIX5YTPtKCs http://emedicine.medscape.com/article/1135866-overview Understanding symptoms of medial frontal lobe disorder: A clinical case study. Journal of clinical psychology in medical settings [1068-9583] Osmon, David C. yr: 1996 vol:3 iss:1 pg:23-39