eMedicine Specialties > Neurology > Behavioral Neurology and Dementia

Frontal Lobe Syndromes: Treatment & Medication

Author: Alberto J Espay, MD, MSc, Assistant Professor, Department of Neurology, University of Cincinnati
Coauthor(s): Daniel H Jacobs, MD, Associate Professor of Neurology, University of Central Florida College of Medicine
Contributor Information and Disclosures

Updated: Dec 10, 2009

Treatment

Medical Care

Medical care depends entirely on the pathology present.

Consultations

Consultation with a neuropsychologist and/or behavioral neurologist is indicated to determine the nature and extent of the cognitive deficits present and to help work with the patients and families.

Formal consultation with a neuropsychologist is often advantageous to clarify the extent of the brain damage and to make appropriate cognitive treatment plans. Neuropsychologists are also exceedingly helpful because of their psychological background in dealing with patients and their families.

The patient and family frequently deny or minimize the importance of the deficit. Consultation can help ensure that the home setting is truly appropriate for the patient and/or family.

If a home setting is agreed on, these consultants can determine the need for assistance. Assistants can include physical, occupational, and/or speech therapists; home health aides; visiting nurses; respite care staff; and adult day-care staff, who are trained to help the patient succeed in the desired setting. Consultation with a social worker may also be helpful.

Activity

Patients with frontal lesions and deficits frequently need supervision because of their lack of impulse control and their inability to form and follow plans and strategies.

Medication

No medications are available to help frontal injuries.

Drugs that help memory in Alzheimer dementia are rarely of benefit for frontal lobe deficits or problems.

More on Frontal Lobe Syndromes

Overview: Frontal Lobe Syndromes
Differential Diagnoses & Workup: Frontal Lobe Syndromes
Treatment & Medication: Frontal Lobe Syndromes
Follow-up: Frontal Lobe Syndromes
Multimedia: Frontal Lobe Syndromes
References
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References

  1. Mesulam MM. The Human Frontal Lobes: Transcending the Default Mode through Continent Encoding. In: DT Stuss and RT Knight. Principles of Frontal Lobe Function. Oxford: 2002:8-30.

  2. Bonelli RM, Cummings JL. Frontal-subcortical circuitry and behavior. Dialogues Clin Neurosci. 2007;9(2):141-51. [Medline].

  3. Dubois B, Slachevsky A, Litvan I, Pillon B. The FAB: a Frontal Assessment Battery at bedside. Neurology. Dec 12 2000;55(11):1621-6. [Medline].

  4. Nasreddine ZS, Phillips NA, Bedirian V, et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. Apr 2005;53(4):695-9. [Medline].

  5. Reitan RM. The relation of the trail making test to organic brain damage. J Consult Psychol. Oct 1955;19(5):393-4. [Medline].

  6. Moll J, de Oliveira-Souza R, Moll FT, Bramati IE, Andreiuolo PA. The cerebral correlates of set-shifting: an fMRI study of the trail making test. Arq Neuropsiquiatr. Dec 2002;60(4):900-5. [Medline].

  7. Pendleton MG, Heaton RK, Lehman RA, Hulihan D. Diagnostic utility of the Thurstone Word Fluency Test in neuropsychological evaluations. J Clin Neuropsychol. Dec 1982;4(4):307-17. [Medline].

  8. Müller-Vahl KR, Kaufmann J, Grosskreutz J, Dengler R, Emrich HM, Peschel T. Prefrontal and anterior cingulate cortex abnormalities in Tourette Syndrome: evidence from voxel-based morphometry and magnetization transfer imaging. BMC Neurosci. 2009;10:47. [Medline].

  9. Baker M, Mackenzie IR, Pickering-Brown SM, et al. Mutations in progranulin cause tau-negative frontotemporal dementia linked to chromosome 17. Nature. Aug 24 2006;442(7105):916-9. [Medline].

  10. Bech-Azeddine R, Hogh P, Juhler M, Gjerris F, Waldemar G. Idiopathic normal-pressure hydrocephalus: clinical comorbidity correlated with cerebral biopsy findings and outcome of cerebrospinal fluid shunting. J Neurol Neurosurg Psychiatry. Feb 2007;78(2):157-61. [Medline].

  11. Benson DF, Miller BL. Frontal lobes, clinical and anatomic aspects. In: Feinberg TE, Farah MJ, eds. Behavioral Neurology and Neuropsychology. New York: McGraw Hill; 1997:401-8.

  12. Cairns NJ, Bigio EH, Mackenzie IR, et al. Neuropathologic diagnostic and nosologic criteria for frontotemporal lobar degeneration: consensus of the Consortium for Frontotemporal Lobar Degeneration. Acta Neuropathol. Jul 2007;114(1):5-22. [Medline].

  13. Damasio AR. The frontal lobes. In: Heilman KM, Valenstein E, eds. Clinical Neuropsychology. 3rd ed. New York: Oxford Univerisity Press; 1993:409-60.

  14. Kennerley SW, Wallis JD. Evaluating choices by single neurons in the frontal lobe: outcome value encoded across multiple decision variables. Eur J Neurosci. May 2009;29(10):2061-73. [Medline].

  15. Laisney M, Matuszewski V, Mezenge F, Belliard S, de la Sayette V, Eustache F. The underlying mechanisms of verbal fluency deficit in frontotemporal dementia and semantic dementia. J Neurol. Apr 14 2009;[Medline].

  16. Lezak MD. Neuropsychological Assessment. 3rd ed. New York: Oxford; 1995.

  17. Luria AR. The Working Brain. In: An Introduction to Neuropsychology. Haig B, trans. New York: Basic Books; 1973.

  18. Marmarou A, Bergsneider M, Klinge P, Relkin N, Black PM. The value of supplemental prognostic tests for the preoperative assessment of idiopathic normal-pressure hydrocephalus. Neurosurgery. Sep 2005;57(3 Suppl):S17-28; discussion ii-v. [Medline].

  19. Mesulam MM. Principles of Behavioral Neurology. 2nd ed. New York: Oxford; 2000.

  20. Nagaratnam N, Bou-Haidar P, Leung H. Confused and disturbed behavior in the elderly following silent frontal lobe infarction. Am J Alzheimers Dis Other Demen. Nov-Dec 2003;18(6):333-9. [Medline].

  21. Neumann M, Sampathu DM, Kwong LK, et al. Ubiquitinated TDP-43 in frontotemporal lobar degeneration and amyotrophic lateral sclerosis. Science. Oct 6 2006;314(5796):130-3. [Medline].

  22. Nyatsanza S, Shetty T, Gregory C, Lough S, Dawson K, Hodges JR. A study of stereotypic behaviours in Alzheimer's disease and frontal and temporal variant frontotemporal dementia. J Neurol Neurosurg Psychiatry. Oct 2003;74(10):1398-402. [Medline].

  23. Ondo WG, Chan LL, Levy JK. Vascular parkinsonism: clinical correlates predicting motor improvement after lumbar puncture. Mov Disord. Jan 2002;17(1):91-7. [Medline].

  24. Stout JC, Wyman MF, Johnson SA, Peavy GM, Salmon DP. Frontal behavioral syndromes and functional status in probable Alzheimer disease. Am J Geriatr Psychiatry. Nov-Dec 2003;11(6):683-6. [Medline].

  25. Takahashi YK, Roesch MR, Stalnaker TA, Haney RZ, Calu DJ, Taylor AR. The orbitofrontal cortex and ventral tegmental area are necessary for learning from unexpected outcomes. Neuron. Apr 30 2009;62(2):269-80. [Medline].

  26. Vecera SP, Rizzo M. Spatial attention: normal processes and their breakdown. Neurol Clin. Aug 2003;21(3):575-607. [Medline].

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Further Reading

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Keywords

frontal lobe syndromes, frontal lobe, frontal-lobe syndromes, mental status examinations, MMSE, neuropsychology, precentral cortex, prefrontal cortex, orbitofrontal cortex, Alzheimer disease, amyloid angiopathy, aphasia, apraxia

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Contributor Information and Disclosures

Author

Alberto J Espay, MD, MSc, Assistant Professor, Department of Neurology, University of Cincinnati
Alberto J Espay, MD, MSc is a member of the following medical societies: American Academy of Neurology and Movement Disorders Society
Disclosure: Boehringer-Ingelheim Consulting fee Consulting; Codman Grant/research funds Other; Medtronic Honoraria Speaking and teaching; Medtronic Grant/research funds Other; Allergan Grant/research funds Other; UCB-Schwarz Pharm Honoraria Speaking and teaching; Novartis  Speaking and teaching

Coauthor(s)

Daniel H Jacobs, MD, Associate Professor of Neurology, University of Central Florida College of Medicine
Daniel H Jacobs, MD is a member of the following medical societies: American Academy of Neurology, American Society of Neurorehabilitation, and Society for Neuroscience
Disclosure: Teva Pharmaceutical Grant/research funds Consulting; Biogen Idex Grant/research funds Independent contractor; Serono EMD Royalty Speaking and teaching; Pfizer Royalty Speaking and teaching; Berlex Royalty Speaking and teaching

Medical Editor

Joseph Quinn, MD, Assistant Professor, Department of Neurology, Portland VA Medical Center, Oregon Health Sciences University
Joseph Quinn, MD is a member of the following medical societies: American Academy of Neurology, Society for Neuroscience, and Society for Pediatric Radiology
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Richard J Caselli, MD, Professor, Department of Neurology, Mayo Medical School, Rochester, MN; Chair, Department of Neurology, Mayo Clinic of Scottsdale
Richard J Caselli, MD is a member of the following medical societies: American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, American Medical Association, American Neurological Association, and Sigma Xi
Disclosure: Nothing to disclose.

Chief Editor

Howard A Crystal, MD, Professor, Departments of Neurology and Pathology, State University of New York Downstate; Consulting Staff, Department of Neurology, University Hospital and Kings County Hospital Center
Howard A Crystal, MD is a member of the following medical societies: American Academy of Neurology and American Neurological Association
Disclosure: Medivations Honoraria Consulting

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