Assessment Of Frontal Lobe Dysfunction

Assessment Of Frontal Lobe Dysfunction It has been established that the frontal lobes play a major part in an individual’s decision making, planning, problem solving, social, emotional and behavioural skills. Consequently dysfunction of the frontal lobe can cause a wide range of symptoms (Kolb and Wishaw 1996) leading to relatively specific clinical dysfunction therefore a neuropsychological assessment is necessary to be carried out on the patient. The present study looks at the case of patient Mr. A who is reported to experience attention difficulties and problems with planning and organising after sustaining a head injury. Three neuropsychological tests have been used; WCST, TMT and TEA in order to identify the extent of the deficit. In line with previous research Mr. A’s performed poorly on tests and scored low in comparison to the normative scores. Other tests have also been suggested as well as strategies of rehabilitation for the patient. Frontal lobe located at the front of the cerebral hemisphere is the largest lobe in the brain associated with an individual’s personality and emotional control. The frontal lobes are responsible for planning, organising, selective attention, personality, behaviour and emotions. As well as this the frontal lobes are also involved in motor function (Passingham 1995), Spontaneity of behaviour (Kolb and Milner 1981), initiation, judgement, impulse control (Milner 1964, Miller 1985), social and sexual behaviour (Damasio 1985). More specifically the right frontal lobe is associated with an individual’s sense of humour, self awareness, self face recognition and episodic memory (Stuss 1991, Fink et al 1996, Wheeler et al 1997, Levine et al 1998, Craik et al 1999, Keenan et al 1999, Shammi and Stuss 1999). It is the orbitofrontal cortex that arbitrates empathic, civil and socially appropriate behaviour (Mega and Cummings 1994). Furthermore it is also reported that executive processes of the prefrontal lobe are responsible for planning, mon itoring, energizing, switching and inhibition (Stuss 2007). In the recent years cognitive neuroscience studies have shown that damage to the frontal lobe can affect high level of cognitive functions as well as an individual’s personality, their social behaviour, personal memories and their self awareness (Alexander et al 1979, Brazzelli et al 1994, Damasio 1994, Adolphs et al 1995, Channon and Crawford 1999, Rogers et al 1999, Stuss et al 2001). Studies have also shown that damage to the prefrontal lobe particularly damage to the ventromedial frontal is associated with poor decision making (Eslinger and Damasio 1985, Harlow 1999, Ackerly 2000). In addition to this damage to the left or right orbitofrontal results in personality changes including indifference or impaired social judgement, impaired pragmatics, deficient effective responsiveness, poor self-regulation and lack of ability to relate social situations with personal experience (Nauta 1973, Stuss and Benson 1983, Kacz marek 1984). Damage to the orbitofrontal cortex also results in the patient’s change of personality whereby they might become more irritable, labile, display lack of self restraint and fail to respond to the conventions of socially acceptable behaviour. In some case studies patients have reported descriptions of behavioural changes that are related to social difficulties such as egocentrism, insensitivity to social cues, unresponsiveness to another’s opinion, lack of self restraint, diminished foresight, impaired self monitoring, a propensity to show signs of inappropriate affect and social withdrawal (Eslinger and Damasio 1985, Eslinger et al 1992, Price et al 1990). The famous case of Phineas Gage was the first case study to highlight the impact of frontal lobe damage on an individual’s personality, decision making and social behaviour (Damasio 1994). Phineas Gage suffered an extreme injury to the frontal lobe when a 13 pound, 3-foot-long tamping rod when thro ugh his head; entering through his left cheek and exiting through the midline of his skull. Astonishingly after the event Gage still had the ability to walk, communicate and remain lucid and was examined by Dr Harlow (1848) who noticed the changes in his behaviour. In his report Harlow identified that from previously being identified as a smart, efficient, dependable and capable foreman by his employers and diligent, honest and well liked by friends, after his accident Gage became fitful, irreverent, foulmouthed liar, impatient, extravagant, anti social and profane especially when advice was given to him that he didn’t like (Harlow 1868).