An Overview of Frontal Lobe Damage

Damage to the frontal lobe of the brain causes a range of symptoms, including motor weakness and behavioral problems. The frontal lobe is a relatively large lobe of the brain, extending from the front of the brain almost halfway towards the back of the brain. A variety of conditions can damage the frontal lobe, including stroke, head trauma, and dementia.

The brain has two hemispheres, the left and the right. The frontal lobe is also referred to as a hemisphere, which can be confusing. This terminology stems from the fact that the early brain develops into three sections prior to birth: the forebrain, the midbrain, and the hindbrain. Each of these sections has specific functions.

• The hindbrain controls respiration and heart rate.
• The midbrain controls reflex actions such as eye movement.
• The forebrain controls emotional perceptions, emotional responses, involuntary movements, sleep patterns, memory, and organizational ability.

The forebrain eventually develops into the cerebrum, the outer layer of which is called the cerebral cortex. The frontal lobe is one of the four lobes of the cerebral cortex, which also includes the temporal lobe, the parietal lobe, and the occipital lobe. Each of these regions carries out specific functions, and damage to any of these lobes results in corresponding impairment.

The frontal lobe plays a substantial role in decision making, self-control, and emotional regulation, providing the ability to behave appropriately in interpersonal situations and to regulate behavior in a socially acceptable manner.

The frontal lobe also integrates thinking skills by maintaining attention, high-level thinking and problem-solving. It is believed that humans' large frontal lobes are responsible for advanced thinking and innovation, as well as the ability to imagine situations.

There are some differences between the right and left frontal lobes. The back of the frontal lobe is a region called the motor strip, which controls and directs the body's voluntary (purposeful) physical movements. The left motor strip controls movements of the right side of the body, while the right motor strip controls movements of the left side of the body.

There are also functions that are predominantly controlled by the left frontal lobe or the right frontal lobe. Along with the neighboring parietal and temporal lobes, the dominant (usually the left side) frontal lobe is involved in language, rational, quantitative, and logical thinking, and analytical reasoning, while the right frontal lobe is involved with creativity, imagination, intuition, curiosity, musical and artistic ability.

Symptoms of damage to the frontal lobe can vary because there are so many functions carried out by the frontal lobes. These symptoms may include one or more of the following:

• Weakness on one side of the body or one side of the face
• Falling
• Inability to problem solve or organize tasks
• Reduced creativity
• Impaired judgment
• Reduced sense of taste or smell
• Depression
• Changes in behavior
• Low motivation
• Low attention span, easily distracted
• Reduced or increased sexual interest or peculiar sexual habits
• Impulsive or risky behavior

Damage to the frontal lobe is most commonly caused by degenerative (worsening) disease or a stroke, and there are other, less common conditions that affect the frontal lobes as well.

The second-most common cause of dementia in people under 65 is frontotemporal dementia (FTD), a group of disorders affecting the frontal and temporal lobes of the brain. People with FTD usually present with behavior and personality changes and/or aphasia (language difficulties).

FED can also be seen during the course of Alzheimer’s disease (particularly in a subset of patients with a frontal variant) and in patients with Lewy body dementia.

Strokes and transient ischemic attacks (TIAs), can also impair the function of the frontal lobe. When blood flow through one or more of the blood vessels that provides blood to an area of the frontal lobe becomes interrupted or bleeds, the corresponding region of the brain suffers and cannot function as it should.

Vascular dementia, often triggered by the cumulative effect of several small strokes, is the most common cause of frontal lobe impairment. It is believed to inextricably linked to Alzheimer's disease and other neurodegenerative disorders.

Other causes of damage or injury to the frontal lobe may include the following:

• Huntington’s disease
• Cerebral Palsy
• Parkinson’s disease
• Brain tumors
• Infections
• Traumatic brain injury

A computed tomography (CT) or magnetic resonance imaging (MRI) scan of the brain can detect a frontal lobe stroke, and possibly an infection. However, when there is another cause, such as dementia or a concussion, then a brain imaging test often shows either atrophy or may not detect the frontal lobe damage at all.

Generally speaking, an MRI and CT are equally effective in diagnosing vascular dementia. The only exception is in cases of chronic cerebral hemorrhage for which MRIs may be superior.

To assess your damage to the frontal lobe, your doctor might send you for concussion testing or a complete neuropsychological evaluation. Testing involves skills of speech, motor skills, social behavior, spontaneity, impulse control, memory, problem-solving, and language.

Treatment of frontal lobe damage can include a number of strategies, depending on the cause. For example, an infection can be treated with antibiotics and brain tumors can be surgically removed or treated with chemotherapy or radiation.

Degenerative diseases, such as Parkinson's disease, Huntington's disease, and dementia are usually treated symptomatically, but, at this time, there is little that can be done to prevent conditions from worsening.

When frontal lobe damage manifests as motor weakness, rehabilitation can help you optimize your existing motor function. Rehabilitation involves strengthening and optimizing your existing motor skills.

Rehabilitation is more challenging for cognitive and social deficits, and the focus of cognitive and behavioral therapy emphasizes regulating emotions and curbing impulsive behavior.

Any type of brain damage can certainly cause a great deal of stress. Whether you or a loved one has experienced damage to the frontal lobe, you should be aware that people can experience some degree of recovery, depending on the cause of damage.

Behavioral and cognitive deficits can cause a great deal of angst and often interfere with healthy relationships. If you or a loved one is living with frontal lobe impairment, it can help to understand the symptoms and to tailor your expectations. Sometimes, taking the time to patiently explain why certain behaviors are not appropriate can help, and sometimes patience does not help, and acceptance may be the only option.