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PubMed2005

Response inhibition and set shifting in patients with frontal lobe epilepsy or temporal lobe epilepsy.

Patients with frontal lobe epilepsy (FLE), patients with temporal lobe epilepsy (TLE), and matched controls were administered a test of response inhibition and set shifting (switching) (Color Word Interference Test, CWIT). Patients with FLE were impaired relative to the controls across all conditions of the CWIT, with the FLE patients showing disproportionate impairment in the Inhibition and Inhibition/Switching conditions. In contrast, the TLE patients did not differ from controls. Further analysis of the patient groups revealed that patients with left FLE were impaired relative to those with right FLE, left TLE, and right TLE in the Inhibition condition. In the Inhibition/Switching condition, patients with left FLE and left TLE were impaired relative to their right-sided counterparts. Finally, performance by the TLE group in the Inhibition/Switching condition was correlated with seizure frequency. These data suggest that patients with FLE, but not TLE, show impaired inhibition and set shifting relative to controls. In addition, side of the seizure focus and seizure frequency may contribute to executive dysfunction in patients with epilepsy.

Adult↗
PubMed1999

Frontal lobe deficits in domestic violence offenders.

Functional frontal lobe deficits were examined in 38 men who committed domestic violence and 38 control participants. Dependent measures that examine frontal lobe deficits, including the Wisconsin Card Sorting Test (D. A. Grant & E. A. Berg, 1948), the Stroop Color-Word Test (J. R. Stroop, 1935), and Trails B (R. M. Reitan & L. A. Davidson, 1974), were used. The prediction that men who commit domestic violence would perform more poorly on neuropsychological measures related to frontal lobe deficits was only partially supported. A discriminate analysis was significant (p < .05), explaining approximately 7% of the variance; Trails B was the only contributor to that equation. The men who committed battery took significantly longer to complete Trails B than the control participants, suggesting that the men who committed battery may not have been as good as the control participants at inhibiting the competing response and therefore took longer to complete the task. The groups did not significantly differ on the other neuropsychological measures.

Adult↗
PubMed1998

Facilitory paratonia and frontal lobe functioning.

OBJECTIVE: To learn if paratonia predicts frontal cognitive impairments. BACKGROUND: Paratonia, an alteration of tone to passive movement, can be divided into oppositional paratonia ("gegenhalten," "paratonic rigidity") and facilitory paratonia. Although paratonia has been thought to be induced by frontal lobe dysfunction, previous studies suggest that paratonia does not correlate with cognitive impairment. However, only oppositional paratonia has been studied in this manner, and in these studies only the presence or absence of paratonia was assessed instead of a quantitative scale. Facilitory paratonia has not been studied for its relation to cognitive function. METHODS: Twenty-five patients evaluated for degenerative dementia were assessed on semiquantitative 5-point scales for paratonia by two independent raters. A quantifiable test--the modified Kral procedure--which assesses continued movement by the patient after cessation of passive movement was also administered for comparison with facilitory paratonia. To assess frontal lobe function, subjects were tested for echopraxia, distractibility, and word fluency. To screen for other cognitive defects, subjects were given the Mini-Mental State Examination (MMSE). RESULTS: The modified Kral procedure strongly correlated with subjective rating of facilitory paratonia. This correlation was significantly stronger than the correlation with oppositional paratonia. The modified Kral procedure was also highly predictive of echopraxia, but was less predictive of other frontal lobe tests. Facilitory paratonia, oppositional paratonia, and the modified Kral procedure each strongly predicted scores on the MMSE. CONCLUSIONS: Both facilitory and oppositional paratonia strongly predict general cognitive performance. The modified Kral procedure is a reliable indicator of facilitory paratonia and a predictor of impaired performance on frontal lobe tests.

Aged↗
PubMed1997

Identification of frontal lobe epileptic foci in children using positron emission tomography.

PURPOSE: Presurgical evaluation for intractable frontal lobe epilepsy (FLE) is difficult and invasive, partly because anatomic neuroimaging studies with computed tomography (CT) and magnetic resonance imaging (MRI) typically do not show a discrete lesion. In adult patients with FLE, functional neuroimaging of glucose metabolism with positron emission tomography (PET) is less sensitive in detecting focal metabolic abnormalities than in temporal lobe epilepsy (TLE). Comparable data on children with FLE are not available. METHODS: We used high-resolution PET scanning of glucose metabolism to evaluate 13 children (age 17 months to 17 years; mean age 9.5 years) with intractable FLE being considered for surgical treatment. Only children with normal CT and MRI scans were included. RESULTS: Hypometabolism including the frontal lobe was evident in 12 of the 13 children, was unilateral in 11 of 13, and was restricted to the frontal lobe in 8 of 13. One child showed bilateral frontal cortex hypometabolism and another had an ictal PET scan demonstrating unilateral frontal cortex hypermetabolism surrounded by hypometabolism. Additional hypometabolic areas outside the frontal cortex were observed in 5 children in parietal and/or temporal cortex. Localization of seizure onset on scalp EEG was available in 10 children and corresponded to the location of frontal lobe PET abnormality in 8. However, in 4 of the 10 children, the extent of hypometabolism exceeded the epileptogenic region indicated by ictal EEG. In 2 of the 13 children, the abnormality evident on EEG was more extensive than that evident on PET. In the remaining 3 children for whom only interictal EEG data were available, the PET foci did not correspond in location to the interictal EEG abnormalities. In 11 of the 13 children, the presumed region of seizure onset in the frontal lobe, as based on analysis of seizure semiology, corresponded to the locations of frontal lobe glucose metabolism abnormalities. CONCLUSIONS: Although high-resolution PET appears to be very sensitive in localizing frontal lobe glucose metabolic abnormalities in children with intractable FLE and normal CT/MRI scans, the significance of extrafrontal metabolic disturbances requires further study; these may represent additional epileptogenic areas, effects of diaschisis, seizure propagation sites, or secondary epileptogenic foci.

Adolescent↗
PubMed2005

Pituitary apoplexy: an unusual cause of frontal lobe syndrome.

Pituitary apoplexy presenting as frontal lobe syndrome is rare. Interestingly, in our patient the frontal lobe infarct was as a result of intense anterior cerebral artery spasm consequent to nonaneurysmal subarachnoid haemorrhage. The mechanisms of cerebral infarct associated with pituitary apoplexy are discussed.

Adenoma↗
PubMed2001

The frontal lobes are necessary for 'theory of mind'.

Patients with limited focal frontal and nonfrontal lesions were tested for visual perspective taking and detecting deception. Frontal lobe lesions impaired the ability to infer mental states in others, with dissociation of performance within the frontal lobes. Lesions throughout the frontal lobe, with some suggestion of a more important role for the right frontal lobe, were associated with impaired visual perspective taking. Medial frontal lesions, particularly right ventral, impaired detection of deception. The former may require cognitive processes of the lateral and superior medial frontal regions, the latter affective connections of the ventral medial frontal with amygdala and other limbic regions.

Brain Mapping↗
PubMed2006

Behavioural and neuropsychological correlates of frontal lobe features in dementia.

BACKGROUND: In order to characterize frontal lobe features and their behavioural and cognitive correlates across diagnostic categories, we performed a cross-sectional analysis of behavioural and neuropsychological data from a large, prospective Belgian study on behavioural and psychological signs and symptoms of dementia (BPSD). METHOD: Patients with probable Alzheimer's disease (AD) (n=170), frontotemporal dementia (FTD) (n=28), mixed dementia (MXD) (n=29) and dementia with Lewy bodies (DLB) (n=21) were included and underwent neuropsychological and behavioural assessment by means of a battery of tests and scales. Frontal lobe symptoms were quantified by means of the Middelheim Frontality Score (MFS). RESULTS: In AD (and to a lesser extent in MXD), MFS total scores were negatively correlated with scores on MMSE (Spearman: r=-0.36, p<0.001) and a Verbal Fluency Task (r=-0.38, p<0.001) and were associated with increased severity and frequency of psychosis (r=0.24, p<0.01), activity disturbances (r=0.44, p<0.001) and aggressiveness (r=0.43, p<0.001). In DLB, MFS total scores were negatively correlated with MMSE scores (r=-0.50, p=0.020). No associations were found in FTD patients. CONCLUSIONS: A cross-sectional analysis of frontal lobe features, behavioural characteristics and neuropsychological data demonstrated that, in AD (and to a lesser extent in MXD) patients, frontal lobe symptoms were associated with more pronounced cognitive deficits (of frontal origin), with increased severity and frequency of agitated and aggressive behaviour, and with increased severity of psychosis and depressive symptoms. Given the small sample sizes of the DLB and FTD patient groups, negative findings in these patient groups should be interpreted cautiously.

Aged↗
PubMed2004

Dissociable concurrent activity of lateral and medial frontal lobe during negative feedback processing.

External feedback on results of one's behavior guides flexible adaptation to changing environments. It has been suggested that the lateral and medial parts of the frontal lobe are responsible for cognitive and emotional functions, respectively. In the present fMRI study, multiple mental components evoked by the presentation of negative feedback were dissociated along the cognitive-emotional axis in set-shifting paradigms. The double dissociation of the concurrent feedback-related activity was observed in the right frontal lobe: the lateral frontal lobe was associated with the inferential component, whereas the medial frontal lobe was associated with the emotional component. However, among the multiple right lateral frontal regions, a region of interest (ROI) analysis indicated that the inferential component was not dominant in the region near the inferior frontal junction. The medial frontal activations were observed ventral and anterior to the presupplementary motor area, and dorsal and posterior to the anterior cingulate cortex. The double dissociation in the right frontal lobe suggests that the lateral and medial frontal lobe cooperatively but differentially contributes to the negative feedback processing, demonstrating the lateral-medial dichotomy of the frontal lobe functions suggested by previous neuropsychological studies. At the same time, the functional heterogeneity in the lateral and medial frontal lobe demands modifications of the traditional view of the functional organization of the frontal lobe.

Adult↗
PubMed1994

Repetitive and compulsive behavior in frontal lobe degenerations.

The authors review the relationship of repetitive behaviors to frontal lobe degenerations and report the repetitive and compulsive behaviors, radiologic imaging findings, and neuropathology of 3 patients with dementia secondary to frontal lobe degeneration. These 3 patients and 78% of 46 proven pathologic cases of frontal lobe degeneration described in the literature demonstrate repetitive behaviors ranging from motor stereotypies to complex obsessive-compulsive disorder. This review suggests that combined damage to the frontal lobe, caudate nucleus, and globus pallidus may account for the repetitive behaviors seen in frontal lobe degenerations, idiopathic obsessive-compulsive disorder, and other neuropsychiatric diseases.

Adult↗
PubMedDate not supplied

[Executive system and frontal lobe lesions in childhood].

INTRODUCTION AND DEVELOPMENT: Frontal lobe syndrome in adulthood is characterised by executive function deficits leading to altered behavioural control with difficulties in social interactions and in maintaining stable jobs and interpersonal relationships. Generalisation of this concept to children with early frontal lobe damage is not straightforward. There are complex interactions between the effects of the lesion itself and the effects in other interconnected regions, timing of lesion, how long it was since the lesion occurred to the time of evaluation, and how old the child is at examination. These facts lead to consider that there might be a number of 'frontal syndromes' in childhood rather than a unique one. We report 9 cases of children with early frontal lobe lesions who were followed up for an average of 10 years. CONCLUSION: A variety of different outcomes suggests that prognosis for these patients might be better that previously reported.

Adult↗
PubMed1989

Psychological, topographic EEG, and CT scan correlates of frontal lobe function in schizophrenia.

This study examined frontal lobe function in a group of 20 patients with schizophrenia, on and off medication, compared to 20 normals matched for age, sex, handedness, intelligence, and educational level. Schizophrenic patients generally did not perform as well as normals on the Wisconsin Card Sorting Test (WCST). Patients off medication performed less well on this test than those on medication. Those on medication did not perform as well as those off medication on the design and word fluency tests, which suggested that medications may affect various aspects of frontal lobe function differently. During the WCST, normal subjects demonstrated an increase in beta mean frequency of the electroencephalogram in frontal and centrotemporal regions which was not statistically significant in either schizophrenic group. This shift in beta mean frequency was found to correlate positively with performance on the WCST in normals, but not in patients. Patients with more negative symptoms tended to show a smaller increase in beta mean frequency during the WCST. Performance on the WCST was correlated negatively with ventricle-brain ratio in all subjects, suggesting that frontal lobe function might be related to computed tomographic measures in the normal population as well as in schizophrenic patients. There was no correlation with performance on the WCST and length of illness.

Adult↗
PubMed2001

Distinct patterns of word retrieval in right and left frontal lobe patients: a multidimensional perspective.

Several studies have shown that patients with frontal lobe damage (FL) generate fewer words than control participants in verbal fluency tasks. In the current study, we were interested in assessing the quality of such verbal fluency data. Multidimensional exploratory techniques, namely, hierarchical clustering (HC) and correspondence analysis (CoA), were performed on verbal fluency data collected from 13 FL patients and 11 age-matched controls. HC of individual word-profiles distinguished between patients with left frontal lobe (LFL) and right frontal lobe (RFL) lesions. CoA revealed that LFL patients generated unusual word-profiles, as evidenced by their peripheral location on a CoA map, while RFL patients produced highly typical word-profiles. We would like to suggest that preserved functioning of the left frontal lobe might have constrained the responses of the RFL group resulting in typical word combinations, whereas preserved right frontal lobe functioning might have mediated greater diversification in the responses of the LFL group. The present study shows that HC and CoA can be applied to neuropsychological data to reveal complex relationships between cognitive performance and cerebral lesion sites.

Aged↗
PubMed1990

Memory for the temporal order of events in patients with frontal lobe lesions and amnesic patients.

Patients with frontal lobe lesions, amnesic patients with Korsakoff's syndrome, other (non-Korsakoff) amnesic patients, and control subjects were given tests of memory for temporal order. In the first experiment, subjects were presented with a list of 15 words and then asked to reproduce the list order from a random array of the words. In the second experiment, they were asked to arrange in chronological order a random display of 15 factual events that occurred between 1941 and 1985. In both experiments, patients with frontal lobe lesions were impaired in placing the items in the correct temporal order, despite normal item memory (i.e. normal recall and recognition memory for the words and facts). The two groups of amnesic patients exhibited impaired memory for temporal order as well as impaired item memory. Patients with Korsakoff's syndrome exhibited poorer temporal order memory than the other amnesic patients, despite similar levels of item memory. These findings demonstrate that patients with frontal lobe lesions have difficulty organizing information temporally. Patients with Korsakoff's syndrome, who have both diencephalic and frontal damage, have memory impairment together with a disproportionate deficit in memory for temporal order.

Alcohol Amnestic Disorder↗
PubMed2002

MRI parcellation of the frontal lobe in boys with attention deficit hyperactivity disorder or Tourette syndrome.

Dysfunction of frontal-striatal-thalamic-frontal circuitry has been hypothesized to underlie both attention deficit hyperactivity disorder (ADHD) and Tourette syndrome (TS). Several research groups have therefore used anatomic magnetic resonance imaging (aMRI) to obtain volumetric measurements of subregions of the frontal lobe in these disorders. Most previous studies have relied on subparcellation methods that utilize callosal landmarks to derive subregions of the frontal lobe. In contrast, we present here an investigation of frontal lobe morphometry in ADHD and TS based on a reliable frontal subparcellation protocol that combines contiguous sulcal/gyral boundaries to derive frontal lobe modules based on prior functional studies. This highly reliable procedure subdivides the frontal lobe into five major modules: prefrontal, premotor, motor (precentral gyrus), anterior cingulate, and deep white matter. The first four modules are also segmented into gray and gyral white matter compartments. The protocol was applied to T1-weighted, SPGR coronal MRI images of 13 school-aged boys with ADHD, 13 boys with TS, and 13 age- and gender-matched controls. In ADHD, we found volumetric reductions in both the gray and white matter of the prefrontal cortex. These findings, in conjunction with previous reports on basal ganglia abnormalities, suggest that prefrontal-striatal pathways may be anomalous in ADHD. In TS, we found volumetric decreases in the left deep frontal white matter. Decreases in deep white matter suggest the presence of abnormalities in long associational and projection fiber bundles in TS. The findings of this study both confirm and extend our knowledge of the neurobiology of ADHD and TS, indicating that the reliable parcellation method presented has the potential of increasing our understanding of the role of the frontal lobe in developmental and psychiatric disorders.

Adult↗
PubMed1998

Interpreting ambiguous advertisements: the effect of frontal lobe damage.

Despite intact primary language processes patients with frontal lobe deficits often have impaired communication skills including impaired capacity to understand conversational inference. This study examined the ability of three patients with demonstrated frontal lobe pathology to interpret lexically ambiguous advertisements. When compared to a nonbrain-damaged control group it was found that the frontal lobe patients were poorer at comprehending the abstract or inferred meanings inherent in the advertisements. The pattern of performance across the patients did, nevertheless, differ despite a similar end result. These findings are discussed in relation to theories concerning the contribution of the frontal lobes to language function.

Adult↗
PubMed2005

Cognitive deficits in obsessive-compulsive disorder on tests of frontal lobe functions.

Individuals with obsessive-compulsive disorder (OCD) display frontal lobe deficits, but there are inconsistencies between various tests of frontal lobe functions and between the results from different studies. The objective of this work was to characterize frontal lobe dysfunctions in OCD patients. Fifteen patients and 17 control subjects matched for age, sex and intelligence were tested on classic tests of frontal lobe functions [Wisconsin Card Sorting Test (WCST) and tests of fluency], a smell identification test and one computerized test: the Intra/Extra Dimension test. The Intra/Extra Dimension test showed a significant difference between the two groups in reversal of response. The test of Figural fluency showed a significant difference between the two groups in numbers of produced figures. There were no differences on the WCST, verbal fluency and the smell identification test.

Adult↗
PubMed1992

Interictal EEG topography of frontal lobe epilepsy.

Ictal localization of seizure discharges in the frontal lobe is difficult and not easily resolved by simple translation of techniques that have proved useful for localization within the temporal lobe. There is need for improved interictal localization of functional abnormalities within the frontal lobe utilizing CET and other methods of functional localization including magnetoencephalography, cerebral blood flow, and cerebral metabolism. It is likely that improved localization within the frontal lobe and clarification of clinical syndromes of frontal epilepsy will be obtained through the use of a combination of these interictal methods, aided by the results of intracranial ictal recording and surgical extirpation (7a,b,10a,b,15a-c).

Adult↗
PubMed1989

Cognitive impairment following frontal lobe damage and its relevance to human amnesia.

Whether frontal lobe pathology can account for some of the cognitive impairment observed in amnesic patients with Korsakoff's syndrome was investigated. Various cognitive and memory tests were given to patients with circumscribed frontal lobe lesions, patients with Korsakoff's syndrome, non-Korsakoff amnesic patients, and control Ss. Patients with frontal lobe lesions were not amnesic. Nevertheless they exhibited 2 deficits that were also exhibited by patients with Korsakoff's syndrome but not by other amnesic patients: (a) impairment on the Wisconsin Card Sorting Test and (b) impairment on the Initiation and Preservation subscale of the Dementia Rating Scale. Thus, frontal lobe pathology can explain some of the cognitive deficits observed in patients with Korsakoff's syndrome.

Adult↗