Further Outpatient Care

Outpatient care monitors what tasks a patient can accomplish in his home or residential facility and what tasks are sources of difficulty for the patient and his caregivers. Assessing how patients spend their time each day is useful.

Further Inpatient Care

Excluding rare cases in which surgical care may be indicated (eg, tumors, subdural hematomas), most care is directed at providing a safe, secure environment for the patient and at supporting caregivers.

Family education about the patient's deficit is essential.

Discharge planning and family meetings may be necessary if the family remains unrealistic about the possibility of home discharge. In such a meeting, team members, including therapists, nurses, and physicians, can elaborate on the patient's needs and impress on the family the sometimes-unrealistic nature of their expectations.

Services, as described in Consultations, can be arranged for patients.

Prognosis

The prognosis depends on the underlying pathology.

Patient Education

For patients in whom frontal lobe dysfunction is the result of strokes, visit eMedicineHealth's Brain and Nervous System Center. Also, see eMedicineHealth's patient education article Stroke.

Questions

Mesulam MM. The Human Frontal Lobes: Transcending the Default Mode through Continent Encoding. DT Stuss and RT Knight. Principles of Frontal Lobe Function. Oxford: 2002. 8-30.
Bonelli RM, Cummings JL. Frontal-subcortical circuitry and behavior. Dialogues Clin Neurosci. 2007. 9(2):141-51. [QxMD MEDLINE Link].
Cruz-Oliver DM, Malmstrom TK, Allen CM, Tumosa N, Morley JE. The Veterans Affairs Saint Louis University Mental Status Exam (SLUMS Exam) and the Mini-Mental Status Exam as Predictors of Mortality and Institutionalization. J Nutr Health Aging. 2012. 16(7):636-41. [QxMD MEDLINE Link].
Dubois B, Slachevsky A, Litvan I, Pillon B. The FAB: a Frontal Assessment Battery at bedside. Neurology. 2000 Dec 12. 55(11):1621-6. [QxMD MEDLINE Link].
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. 2005 Apr. 53(4):695-9. [QxMD MEDLINE Link].
Kopp B, Rösser N, Tabeling S, Stürenburg HJ, de Haan B, Karnath HO, et al. Performance on the Frontal Assessment Battery is sensitive to frontal lobe damage in stroke patients. BMC Neurol. 2013 Nov 16. 13:179. [QxMD MEDLINE Link]. [Full Text].
Munoz DP, Everling S. Look away: the anti-saccade task and the voluntary control of eye movement. Nat Rev Neurosci. Mar 5, 2004. 5:218-28. [QxMD MEDLINE Link]. [Full Text].
Reitan RM. The relation of the trail making test to organic brain damage. J Consult Psychol. 1955 Oct. 19(5):393-4. [QxMD MEDLINE Link].
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. 2002 Dec. 60(4):900-5. [QxMD MEDLINE Link].
Pendleton MG, Heaton RK, Lehman RA, Hulihan D. Diagnostic utility of the Thurstone Word Fluency Test in neuropsychological evaluations. J Clin Neuropsychol. 1982 Dec. 4(4):307-17. [QxMD MEDLINE Link].
Wu LJ, Sitburana O, Davidson A, Jankovic J. Applause sign in Parkinsonian disorders and Huntington's disease. Mov Disord. 2008 Dec 15. 23(16):2307-11. [QxMD MEDLINE Link].
Hama S, Yamashita H, Shigenobu M, Watanabe A, Kurisu K, Yamawaki S. Post-stroke affective or apathetic depression and lesion location: left frontal lobe and bilateral basal ganglia. Eur Arch Psychiatry Clin Neurosci. 2007 Apr. 257(3):149-52. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link]. [Full Text].
Seltman RE, Matthews BR. Frontotemporal lobar degeneration: epidemiology, pathology, diagnosis and management. CNS Drugs. 2012 Oct 1. 26(10):841-70. [QxMD MEDLINE Link].
Gorno-Tempini ML, Brambati SM, Ginex V, Ogar J, Dronkers NF, Marcone A. The logopenic/phonological variant of primary progressive aphasia. Neurology. 2008 Oct 14. 71(16):1227-34. [QxMD MEDLINE Link].
Ismail Z, Nguyen MQ, Fischer CE, Schweizer TA, Mulsant BH. Neuroimaging of delusions in Alzheimer's disease. Psychiatry Res. 2012 May 31. 202(2):89-95. [QxMD MEDLINE Link].
Kerklaan BJ, van Berckel BN, Herholz K, Dols A, van der Flier WM, Scheltens P, et al. The added value of 18-fluorodeoxyglucose-positron emission tomography in the diagnosis of the behavioral variant of frontotemporal dementia. Am J Alzheimers Dis Other Demen. 2014 Nov. 29(7):607-13. [QxMD MEDLINE Link].
Tsai RM, Boxer AL. Treatment of frontotemporal dementia. Curr Treat Options Neurol. 2014 Nov. 16(11):319. [QxMD MEDLINE Link].
Baker M, Mackenzie IR, Pickering-Brown SM, et al. Mutations in progranulin cause tau-negative frontotemporal dementia linked to chromosome 17. Nature. 2006 Aug 24. 442(7105):916-9. [QxMD MEDLINE Link].
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. 2007 Feb. 78(2):157-61. [QxMD MEDLINE Link].
Benson DF, Miller BL. Frontal lobes, clinical and anatomic aspects. Feinberg TE, Farah MJ, eds. Behavioral Neurology and Neuropsychology. New York: McGraw Hill; 1997. 401-8.
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. 2007 Jul. 114(1):5-22. [QxMD MEDLINE Link]. [Full Text].
Damasio AR. The frontal lobes. Heilman KM, Valenstein E, eds. Clinical Neuropsychology. 3rd ed. New York: Oxford Univerisity Press; 1993. 409-60.
Kennerley SW, Wallis JD. Evaluating choices by single neurons in the frontal lobe: outcome value encoded across multiple decision variables. Eur J Neurosci. 2009 May. 29(10):2061-73. [QxMD MEDLINE Link]. [Full Text].
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. 2009 Apr 14. [QxMD MEDLINE Link].
Lezak MD. Neuropsychological Assessment. 3rd ed. New York: Oxford; 1995.
Luria AR. The Working Brain. An Introduction to Neuropsychology. Haig B, trans. New York: Basic Books; 1973.
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. 2005 Sep. 57(3 Suppl):S17-28; discussion ii-v. [QxMD MEDLINE Link].
Mesulam MM. Principles of Behavioral Neurology. 2nd ed. New York: Oxford; 2000.
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. 2003 Nov-Dec. 18(6):333-9. [QxMD MEDLINE Link].
Neumann M, Sampathu DM, Kwong LK, et al. Ubiquitinated TDP-43 in frontotemporal lobar degeneration and amyotrophic lateral sclerosis. Science. 2006 Oct 6. 314(5796):130-3. [QxMD MEDLINE Link].
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. 2003 Oct. 74(10):1398-402. [QxMD MEDLINE Link].
Ondo WG, Chan LL, Levy JK. Vascular parkinsonism: clinical correlates predicting motor improvement after lumbar puncture. Mov Disord. 2002 Jan. 17(1):91-7. [QxMD MEDLINE Link].
Stout JC, Wyman MF, Johnson SA, Peavy GM, Salmon DP. Frontal behavioral syndromes and functional status in probable Alzheimer disease. Am J Geriatr Psychiatry. 2003 Nov-Dec. 11(6):683-6. [QxMD MEDLINE Link].
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. 2009 Apr 30. 62(2):269-80. [QxMD MEDLINE Link]. [Full Text].
Vecera SP, Rizzo M. Spatial attention: normal processes and their breakdown. Neurol Clin. 2003 Aug. 21(3):575-607. [QxMD MEDLINE Link].

Media Gallery

Axial brain MRI of a patient with progressive tremorless parkinsonism and frontal-predominant dementia (Mini Mental State Examination = 23/30; Frontal Assessment Battery = 10/18; abnormal clock drawing task and additional constructional impairment) with moderate ideomotor apraxia. The MRI demonstrates predominantly frontal (A) and anterior temporal atrophy (B) suggestive of frontotemporal dementia.

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Author

Stephen L Nelson, Jr, MD, PhD, FAACPDM, FAAN, FAAP, FANA Professor of Pediatrics, Neurology, Neurosurgery, and Psychiatry, Medical Director, Tulane Center for Autism and Related Disorders, Tulane University School of Medicine; Pediatric Neurologist and Epileptologist, Ochsner Hospital for Children; Professor of Neurology, Louisiana State University School of Medicine

Stephen L Nelson, Jr, MD, PhD, FAACPDM, FAAN, FAAP, FANA is a member of the following medical societies: American Academy for Cerebral Palsy and Developmental Medicine, American Academy of Neurology, American Academy of Pediatrics, American Epilepsy Society, American Medical Association, American Neurological Association, The Society of Federal Health Professionals (AMSUS), Child Neurology Society, Southern Pediatric Neurology Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Jasvinder Chawla, MD, MBA Chief of Neurology, Hines Veterans Affairs Hospital; Professor of Neurology, Loyola University Medical Center

Jasvinder Chawla, MD, MBA is a member of the following medical societies: American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, American Clinical Neurophysiology Society, American Medical Association

Disclosure: Nothing to disclose.

Additional Contributors

Joseph Quinn, MD, MD Assistant Professor, Department of Neurology, Portland VA Medical Center, Oregon Health Sciences University

Joseph Quinn, MD, MD is a member of the following medical societies: American Academy of Neurology, Society for Neuroscience, Society for Pediatric Radiology

Disclosure: Nothing to disclose.

Acknowledgements

Alberto J Espay, MD, MSc Associate Professor, Director of Clinical Research, Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati College of Medicine

Alberto J Espay, MD, MSc is a member of the following medical societies: American Academy of Neurology and Movement Disorders Society

Disclosure: Abbott Consulting fee Consulting; Chelsea therapeutics Consulting fee Consulting; Novartis Honoraria Speaking and teaching; TEVA Consulting fee Consulting; NIH Grant/research funds K23 Career Development Award; Eli Lilly Consulting fee Consulting; Great Lakes Neurotechnologies Other; Michael J Fox Foundation Grant/research funds Other; Lippincott Williams & Wilkins Royalty Book; American Academy of Neurology Honoraria Speaking and teaching