Frontal Symptoms Research Articles

The panoply of field-dependent behavior in 1436 stroke patients. The mirror neuron system uncoupled and the consequences of loss of personal autonomy

Evaluation of the multifaceted nature of frontal network syndromes is uniquely challenging and rarely tested in the acute/sub-acute stroke period. Field-dependent behavior such as imitation behavior, utilization behavior, and environmental dependency syndrome, as a component of altered environmental autonomy, may be a reliable bedside test. This research focused on the frequency of field-dependent behavior in stroke, the subtypes and relation to frontal lobe lesion location and stroke etiology. A validated frontal network score incorporating a 10-point imitation behavior scale was applied to alert patients without significant aphasia, encephalopathy, dementia, or substance abuse. Discriminative validity assessment with magnetic resonance imaging, diffusion weight imaging (MRI-DWI brain) was performed and correlational validity was established using standard neuropsychological tests. Of the stroke patients (n = 1436), those with frontal network symptoms (335/1203; 28%) were analyzed further. In the 73 patients with lesions restricted to the frontal lobes or the frontal subcortical circuits, 56 complied with the 10-point imitation behavior scale testing. Forty-five of 56 (80%) demonstrated imitation behavior (sensitivity 73% and specificity 94%). Correlational validity testing with four commonly used frontal lobe neuropsychological tests was good. The stroke etiology included 26 (59%) “other” causes, 9 (20%) intracerebral hemorrhages, 3 (7%) cardioembolic causes, 3 (7%) large vessel disease, 2 (4%) small vessel disease, and 2 (4%) unknown etiology. Field-dependent behaviour subtypes included imitation behavior (n = 45), utilization behavior (n = 9), environmental dependency syndrome (n = 4), and complex other forms of environmental dependence syndrome (n = 5). It was concluded that imitation behavior is a relatively common occurrence with lesions in the frontal lobes in the acute/sub-acute stroke period and is associated predominantly with non-mainstream (other) stroke causes and intracerebral hemorrhage.

Exploring motor and visual imagery in Amyotrophic Lateral Sclerosis

Amyotrophic Lateral Sclerosis (ALS) is a motor neuron disease characterized by the progressive atrophy of both the first and the second motor neurons. Although the cognitive profile of ALS patients has already been defined by the occurrence of language dysfunctions and frontal deficit symptoms, it is less clear whether the degeneration of upper and lower motor neurons affects motor imagery abilities. Here, we directly investigated motor imagery in ALS patients by means of an established task that allows to examine the presence of the effects of the biomechanical constraints. Twenty-three ALS patients and 23 neurologically unimpaired participants have been administered with the (1) hand laterality task (HLT) in which participants were asked to judge the laterality of a rotated hand and the (2) mirror letter discrimination task (MLD) in which participants were asked to judge whether a rotated alphanumeric character was in its canonical or mirror-reversed form (i.e. control task). Results show that patients present the same pattern of performance as unimpaired participants at the MLD, while at the HLT, they present only partially with the effects of biomechanical constraints. Taken together, our findings provide evidences that motor imagery abilities, related to the mental simulation of an action, are affected by this progressive disease.

Frontal systems related symptoms in cocaine dependent patients with comorbid personality disorders

The co-occurrence of cocaine dependence and personality disorders may contribute to frontal systems-related behavioral symptoms in cocaine users. This study aims to characterize apathy, disinhibition, and dysexecutive symptoms in cocaine users with comorbid personality disorders. Thirty-nine participants meeting criteria for cocaine dependence and personality disorders, 35 participants meeting criteria for cocaine dependence without comorbidities, and 29 controls matched for age, education, and IQ completed the Frontal Systems Behavior Scale (FrSBe), which provides present and retrospective assessments (of the period preceding cocaine use) about apathy, disinhibition, and dysexecutive symptoms. Additionally, relatives of cocaine patients (34 relatives from comorbid patients and 31 relatives from noncomorbid patients) completed the informant version of the FrSBe. We used one-way ANOVAs to investigate present-moment differences between the groups and related samples t tests to quantify changes between pre-disorder and present-moment symptoms. Cocaine users with personality disorders self-reported higher present-moment apathy and disinhibition symptoms than noncomorbid users and controls. Informant ratings showed that comorbid users exhibited pre-disorder elevations in apathy, disinhibition and dysexecutive symptoms, and that these symptoms did not significantly change between the pre-disorder and the present-moment assessments. In contrast, noncomorbid users exhibited increased apathy, disinhibition, and dysexecutive symptoms at present-moment compared with pre-disorder measures. The co-occurrence of cocaine dependence and personality disorders is associated with elevated frontal systems-related behavioral symptoms. Comorbid and noncomorbid users differ in frontal symptoms' trajectories, with the former showing pre-disorder stable elevations and the latter showing lower baseline symptoms but greater addiction-related elevations.

Neuropsychiatric Features of Frontal Lobe Dysfunction in Autopsy-Confirmed Patients with Lewy Bodies and “Pure” Alzheimer Disease

To compare patients with autopsy-confirmed Alzheimer disease (AD) and dementia with Lewy bodies (DLB) on the frequency of behaviors related to frontal system dysfunction and the association of these behaviors with dementia severity. We performed a cross-sectional survey of a longitudinal cohort at a university research center for AD on a volunteer sample of 19 DLB and 38 AD participants with autopsy-confirmed diagnoses, similar in age (DLB: 77.3, AD: 77.5), education (DLB: 15.2, AD: 14.7), and Mini-Mental State Examination (MMSE) score (DLB: 20.6, AD: 20.5), with impairment ranging from mild deficits to moderate dementia. The Frontal Systems Behavior Scale (FrSBe)-Family Rating Form assessing patient apathy, disinhibition, and executive dysfunction by a knowledgeable informant was used. A two-way analysis of variance with the FrSBe total as the dependent variable revealed a significant MMSE by diagnosis interaction (F(1,53)= 9.34, p= 0.004). Mean FrSBe total for AD patients showed significant impairment across the range of dementia severity, whereas it was relatively preserved for DLB patients in the early stage of disease. The interaction term showed the same pattern for the executive dysfunction (F(1,53)= 7.62, p= 0.008), disinhibition (F(1,53)= 4.90, p= 0.031), and apathy (F(1,53)= 9.77, p= 0.003) subscales. Although frontal behavioral symptoms in AD patients were present regardless of stage of dementia, DLB patients showed significant frontal dysfunction only in later stages. Results suggest that frontal subcortical circuits associated with behaviors assessed by the FrSBe are affected early in AD but not until later stages in DLB. Assessing specific behaviors related to frontal systems, coupled with stage of cognitive decline, may aid in clinical differentiation of AD and DLB.

Endoscopic orbital decompression for Graves′ orbitopathy

Aim:To study the efficacy of endonasal endoscopic orbital decompression in cases of Graves’ orbitopathy.Material and Methods:A total of 24 orbits in 12 patients underwent endoscopic orbital decompression for graves orbitopathy in the period between October 2002 and December 2010. Indications for surgery included proptosis, corneal exposure, keratitis, and compressive optic neuropathy. Decompression was accomplished by the removal of the medial and part of inferior wall of the orbit and slitting of the orbital periosteum. Pre and postoperative exophthalmometry measurements and visual acuity were recorded and compared.Results:A mean orbital regression of 3.70 mm was noted following endoscopic decompression. The visual acuity improved significantly in one of two eyes decompressed for failing visual acuity secondary to optic nerve compression. Transient diplopia was invariable following surgery but resolved over the next 8 weeks. One case manifested unilateral frontal sinus obstruction symptoms 4 months postoperatively and responded to medical therapy.Conclusion:Endonasal endoscopic orbital decompression provides for an effective, safe, and minimally invasive treatment for proptosis and visual loss of Graves Orbitopathy. Long-term problems with diplopia were not noted in the endonasal endoscopic approach for orbital decompression.

Cognitive disconnective syndrome by single strategic strokes in vascular dementia

Strategic regions correspond to associative, limbic and paralimbic structures and related circuits, that underpin cognitive/behavioral functions. Strokes in these eloquent sites produce pictures of vascular dementia with syndromic features due to specific site lesion and/or interruption of their interconnections. This study aims at analysing subcortical strategic strokes that express similar cognitive/behavioral elements, by sharing common pathways. Patients (n=6) who attended in specialized ambulatory, were submitted to neuropsychological and neuroimaging assessments through MRI (GE Signa Horizon 1.5T) and brain SPECT (Millennium MG, ECD [TC-99m]). Stroke locations and respective main symptoms were: 1. anteromedian thalamus [L]: anterograde and retrograde amnesia (ARA), expression aphasia (EA), executive dysfunction (ED), apathy, and depression; 2. anterior thalamus [R]: ARA, inattention, apathy, and aggressiveness; 3. dorsomedian thalamus [L]: inattention, ED, anosognosia, and aggressiveness; 4. central paramedian thalamus [R]: EA, visual perception deficits (VPD), ED, infantility, and personality disorder; 5. caudate nucleus (ventral-head) [L]: VPD, ED, delirium, visual hallucinations, and personality disorder; and 6. anterior capsule [L]: VPD, ED, apathy, and depression. Vascular strategic syndromes connote the predominantly impaired cognitive/behavioral symptom of each site. Temporal and frontal disconnection symptoms were produced by disrupted MTT/hippocampal and IML/amygdala circuits expressing amnesic syndrome associated with heterogeneous dysexecutive syndrome, in all the cases, by disrupting frontal–basal ganglia–thalamus–cortical net, in three different levels of their pathway.

Severe Anxiety and Frontal Cognitive Dysfunction Heralding a Progressive Supranuclear Palsy-Corticobasal Overlap Syndrome (P07.190)

Objective: To describe the evolution of behavioral, cognitive, and motor symptoms and ancillary testing in a case of progressive supranuclear palsy-corticobasal overlap syndrome. Background Progressive supranuclear palsy (PSP) and corticobasal degeneration have genetic and pathologic similarities, but different phenotypes. Occasionally, the clinical diagnosis between PSP and corticobasal syndrome (CBS) is blurred, and patients are felt to have an overlap syndrome. In such cases, less is known about the spectrum of behavioral and cognitive features that can be seen, especially those preceeding the movement symptoms. Design/Methods: We review the clinical evolution, brain MRI and brain PET scans and videotaped examination findings in this case. Results: This patient is a 76-year-old woman who developed severe and constant anxiety and obsessive-compulsive features including strict rule-bound activities for herself and family, self-harm threats if separated from her spouse, mental rigidity, and bizarre and time-consuming rituals. This was followed by impaired problem solving and perspective-taking, childlike behavior, and pathological laughing and crying. One and a half years later, she developed repeated falls, slow and soft speech, largely symmetric bradykinesia, and axial symptoms of neck rigidity and worsened postural instability, but only slightly slowed downward saccades. Subsequently, right-sided predominant rigidity, myoclonus, and mild apraxia developed. Brain MRI at 3 months and brain PET at 1 year after motor onset, revealed left-sided predominant parietal, medial prefrontal, and anterior temporal mild atrophy and hypometabolism, respectively. Anxiety and obsessive-compulsive features were somewhat responsive to sertraline and behavioral strategies were also employed. Conclusions: Severe anxiety with frontal cognitive symptoms may preceed a PSP-CBS overlap disorder but often go unrecognized, yet may respond to pharmacotherapy and family education. This symptom cluster requires additional study to determine its abillty early on to predict PSP-CBS syndromes. Disclosure: Dr. Smyth has nothing to disclose. Dr. Riley has received personal compensation for activities with Allergan, Ipsen, Lundbeck, Merz and Teva as a consultant.Dr. Riley has received research support from Cleveland Medical Devices. Dr. Lerner has nothing to disclose.

Alzheimer's disease and related disorders: specificity of young onset patients, including ethical aspects

The number of patients with young onset dementia (YOD) (that is before age 65) is estimated at 32,000 in France, and 5000 with onset dementia before 60 years. These patients differ from older ones by the greater number of rares causes (29%), heterogeneity of the presentation among the usual diseases, such as non-amnestic phenotypes of Alzheimer's disease, high frequency of frontal symptoms, and possible genetic origin. These aspects must be taken into account for the diagnosis, often more difficult than in older ones because patients have a little knowledge of the YOD, excepted in the genetics forms. YOD patients can still work or drive a car, and we should choose between the respect for autonomy and the security for the patient and their carers. YOD patients can be more often included in pharmacological trials because they have lower associated disorders. Individual non-pharmacological treatment should be priviledged because they don't easily accept collective activities with other patients over 60 years of age. Excepted for the very young patients (onset before 45), the survival is longer than in late onset dementia, with sometimes severe behavioral problems related to frontal syndrome. In France, the caregiving at home has been improved since the possibility for the YOD patients to receive a financial assistance reserved for the disabled patients, but admission to a nursing home before 60 is very difficult and increases the caregiver burden and perception of unfairness. There is a discrimination between young or older demented patients related to the great difficulty to meet the needs of younger patients, due to the rigidity of the medical and social systems. The presentation of a limited offer for the YOD patients must initiate reflections on our capacities to respect the autonomy and the dignity of the Alzheimer's patients regardless of age.

Neuropsychiatric Profiles in Dementia

We compared patterns of neuropsychiatric symptoms across 4 dementia types [Alzheimer disease (AD), vascular dementia (VAD), dementia with Lewy bodies (DLB), and Parkinson disease dementia], and 2 mixed groups (AD/VAD and AD/DLB) in sample of 2,963 individuals from the National Alzheimer's Coordinating Center Uniform Data Set between September 2005 and June 2008. We used confirmatory factor analysis to compare neuropsychiatric symptom severity ratings made by collateral sources on the Neuropsychiatric Inventory Questionnaire for people with Clinical Dementia Rating scores of 1 or higher. A 3-factor model of psychiatric symptoms (mood, psychotic, and frontal) was shared across all dementia types. Between-group comparisons revealed unique neuropsychiatric profiles by dementia type. The AD group had moderate levels of mood, psychotic, and frontal symptoms whereas VAD exhibited the highest levels and Parkinson disease dementia had the lowest levels. DLB and the mixed dementias had more complex symptom profiles. Depressed mood was the dominant symptom in people with mild diagnoses. Differing psychiatric symptom profiles provide useful information regarding the noncognitive symptoms of dementia.

Misdiagnosis of depression in patients with selective cognitive deficits: A case study

Detection of cognitive markers of dementia is focused on episodic memory and spatio-temporal orientation. However, semantic memory and executive functions may also be impaired in various types of progressive dementias. In this report we describe the distinct clinical features of a case of frontotemporal dementia (FTD), which was falsely been diagnosed and treated for depression. We report a 70-year-old male patient who was admitted to our hospital due to drug resistant depression. The patient was receiving antidepressants for 2 years up to his admission. He showed no clinical improvement of his psychiatric condition and additionally exhibited confusion and marked agitation with incremental drug doses. His neurological examination revealed small-stepped gait, urinary incontinence, pyramidal signs and prominent grasp and suck reflexes. Immediate recall and episodic memory were intact, whereas, he presented with phonemic paraphasias and anosmia. His speech was characterized as syntactically fluent, but empty. Furthermore, he exhibited marked disturbance in all the executive function tasks. Psychiatric manifestations included apathy (emotional indifference) and lack of volution, rather than depression. The brain CT scan pronounced atrophy of the frontal and temporal lobes. Although it is doubtful whether the diagnosis of FTD can be made on pure clinical grounds, the clinical presentation and the course of symptoms in this patient, in conjunction with the brain CT scanning results, directed us towards the diagnosis of a generative type of dementia with frontal symptoms mainly and the exclusion of senile depression. Executive functions and semantic memory tasks should be included in the battery test used in common clinical practice for the evaluation of cognitively impaired patients. These, in conjunction with careful clinical judgment, are of prime importance in order to minimize misdiagnosis of dementia syndromes.

Assessment of physical activity and body composition of free-living elderly men with and without Alzheimer’s disease

the patients had moderate dementia (mean MMSE 18). CB ranged from little to moderate in 78,6% of the cases (mean ZBI 28, maximum possible 88). Most frequent BNS (at least in 50% of the patients) were apathy, depression, anxiety, appetite and eating changes, agitation and delusions. (I) increased CB is related to higher level of depression (0,52; p 0,0002) and anxiety (0,62; p 0) among caregivers; (II) according to ESQ2 caregivers anxiety is the main factor influencing ZBI (0,72; p 0); (III) connection between CB and severity of dementia is not correlated to the degree expected (-0,023; p -0,04) (IV) higher level of CB is elicited by hallucinations (0,76; p 0,03) and disinhibition (0,71; p 0,02), (V) patients with severe sleep and nighttime changes have less disinhibition at daytime (0,997, p 0,048); (VI) patients with appetite and eating changes have higher level of agitation (0,71; p 0,03). Conclusions: It has been ascertained, that BNS are the most determinative of predicting CB, but it was not important finding in our study. Only few NPI studies analyzed BNS separately. While analyzing single symptoms, correlations appeared between BNS. Daytime disinhibition is negatively correlated with disturbed night-time behavior; collocation was found of frontal symptoms (correlation between appetite-eating changes and agitation). The strongest positive correlation was found between ZBI and ESQ2 (increased CB related to higher level of depression and anxiety among caregivers). CV is not influenced by the severity of PBS but rather by the caregivers emotional status.

La malattia di Alzheimer e la sindrome di Down: un infelice connubio

Introduction People with Down's syndrome (DS) have an increased risk of developing Alzheimer's disease (AD) during middle age. Both disorders can present with a decline in cognitive skills and behavioral symptoms. Therefore, dementia, particularly in its early stages, can be difficult to diagnose in this population. Materials and methods We conducted a search of electronic databases for literature on the relationship between AD and DS. The key words used were: “Down syndrome”, “Alzheimer's disease”, “dementia”, and “mental retardation”. Results AD onset has been reported as early as age 30 in individuals with DS, and there is a dramatic increase in prevalence rates in older age groups. This trend reflects increased survival of persons with DS probably as a result of advances in medical treatment and improved living conditions. Even with careful clinical assessment, it can be very difficult to identify early symptoms of dementia when it is superimposed on a background of intellectual disability. The reasons include the wide intra-individual variability in cognitive functioning and difficulties involved in establishing baseline levels of the premorbid condition. Many frontal lobe-related symptoms usually associated with later stages of dementia in the general population are commonly seen in the early stage of the dementia that develops in adults with DS. Discussion After onset, the clinical symptoms of dementia progress rapidly in all subjects with DS. Research suggests that the presentation of dementia in people with DS may differ from that typical of AD in the general population. Early changes tend to involve personality and behaviour rather than memory. DS can be best understood as a complex syndrome of genetic origin that has protean neurobiological consequences and numerous clinical characteristics.

Selective frontal neurodegeneration of the inferior fronto-occipital fasciculus in progressive supranuclear palsy (PSP) demonstrated by diffusion tensor tractography

BackgroundThe clinical presentation in progressive supranuclear palsy (PSP), an atypical parkinsonian disorder, includes varying degrees of frontal dysexecutive symptoms. Using diffusion tensor imaging (DTI) and tractography (DTT), we investigated whether diffusion changes and atrophy of the inferior fronto-occipital fasciculus (IFO) occurs in PSP and if these changes correlate with disease stage and clinical phenotype. The corticospinal tract (CST), which is often involved in PSP, was investigated for comparison.MethodsDTI of the whole brain was performed with a 3 T MR scanner using a single shot-EPI sequence with diffusion encoding in 48 directions. Scans were obtained in patients with PSP (n = 13) and healthy age-matched controls (n = 12). DTT of the IFO and CST was performed with the PRIDE fibre tracking tool (Philips Medical System). Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) were calculated and correlated with disease stage and clinical phenotype.ResultsIn patients with PSP, significantly decreased FA and increased ADC was found in the frontal part of IFO compared with the medial and occipital parts of IFO, as well as compared to controls. Four of the thirteen patients with PSP showed a marked decrease in the number of tracked voxels in the frontal part of IFO. These findings were most pronounced in patients with severe frontal cognitive symptoms, such as dysexecutive problems, apathy and personality change. There was a strong correlation (r2 = -0.84; p < 0,001) between disease stage and FA and ADC values in the CST.ConclusionsDTT for identification of neuronal tracts with subsequent measurement of FA and ADC is a useful diagnostic tool for demonstrating patterns of neuronal tract involvement in neurodegenerative disease. In selected tracts, FA and ADC values might act as surrogate markers for disease stage.

Diagnosis and treatment of conduct disorder related to frontal lobe syndrome in a 16-year-old girl

Conduct disorders are the most frequent psychiatric diagnosis in the pediatric and adolescent population, with different etiology and difficult to treat. Delinquent, aggressive, and impulsive behavior, lack of empathy and inability to predict possible consequences of the behavior lead to significant desadaptation and danger for these patients. In clinical practice, focus is usually given on social and psychological causes of conduct disorders ignoring possible biological factors in etiology and pathophysiology. A clinical case described in this article shows the linkage between frontal brain dysfunction and behavioral symptoms. The first clues of organic brain disorder were multiple and severe symptoms of disinhibition resistant to treatment with dopaminergic drugs and the results of neuropsychological testing. Computed tomography, magnetic resonance imagining, and single-photon emission computed tomography findings were minor and not supported by associated neurological symptoms. However, the location of alterations of brain structure and perfusion significantly correlated with psychopathology. Clarification of the organic cause of the conduct disorder allowed choosing an effective strategy of psychopharmacologic treatment. A positive clinical effect was achieved after switching the treatment from dopaminergic antipsychotic drugs to carbamazepine, which modulates the GABAergic system. Presenting this clinical case, we intended to emphasize the importance of careful attention to the findings of neurovisual and neuropsychological testing diagnosing conduct disorders and individually choosing the most effective psychopharmacologic treatment.

Personalidad y sintomatología frontal en adictos y población no clínica: hacia una neuropsicología de la personalidad

For many years now, Neuropsychology and the Psychology of Personality have developed in parallel, without any attempt to integrate the knowledge provided by the two disciplines. This paper sets out to analyze the relationship between the presence of symptoms in daily life related to the functioning of the brain's frontal lobes and individuals' personality patterns. The Dysexecutive Questionnaire (DEX-Sp), the Frontal System Behavior Scale (FrSBe- Sp) and the Inventory of Temperament and Character Revised (TCI-R) were administered to 421 non-clinical participants and 246 individuals in treatment for substance abuse or dependence. Significant correlations were found between symptoms for all frontal syndromes (mesial, dorsolateral and orbital) and some personality traits (novelty seeking, harm avoidance and self-directedness), even more than 50% of the variance being predicted. Results suggest that frontal performance should be seen as a continuous dimensional variable, ranging from optimal to non-adaptive performance, without a neat cut-off point. Addiction would be related to an increase in frontal symptoms, both mesial (apathy) and orbital (disinhibition), as well as dorsolateral (dysexecutive syndrome), and this would result in changes in the previous personality pattern. These data seriously question the supposed genetic basis of temperamental traits, and suggest hypotheses of great relevance for clinicians.

Neuropsychiatric symptom profiles in Mild Cognitive Impairment and Alzheimer's disease

Mild cognitive impairment (MCI) is a risk state for Alzheimer's disease (AD). It has been well established that behavioral symptoms are commonly observed in AD. Our objective was to determine if the profile of neuropsychiatric symptoms in MCI was qualitatively unique to the profile found in AD. The data were obtained from the Alzheimer's Disease Neuroimaging Initiative (ADNI), a longitudinal study on healthy aging, MCI, and AD. These analyses included 393 individuals with MCI and 191 individuals with AD who all completed the Neuropsychiatric Inventory Questionnaire (NPI-Q), an informant-based rating scale for assessing the presence and severity of 12 behavioral symptoms. For the MCI and AD groups, factor analyses were conducted on the NPI-Q data. Factors were selected based on the number of eigenvalues > 1, and factor loadings > .40 were considered significant. For the MCI group, ‘mood’ (depression and anxiety) and ‘frontal’ (agitation, disinhibition, and irritability) factors emerged. The analysis for the AD group yielded ‘frontal-behavioral’ (elation and disinhibition), ‘frontal-emotional’ (agitation, apathy, irritability), and ‘psychosis’ (delusions and hallucinations) factors. Our findings indicate that although the two groups share some similar frontal symptoms, mood problems are more common in MCI, while psychotic symptoms are more common in AD. Furthermore, a wider range of frontal symptoms is found in AD. Overall, the behavioral patterns in these groups are qualitatively dissimilar.

Estudio neuropsicológico de adultos jóvenes con quejas subjetivas de memoria: implicación de las funciones ejecutivas y otra sintomatología frontal asociada

Subjective memory complaints are one of the reasons why young adults visit neurology services. Generally speaking, memory complaints are considered to increase with age and, in the elderly, they become associated to a number of factors (depression, other emotional problems, personality or self-perceived quality of life). Their appearance has also been related with disorders affecting meta-memory and the frontal lobes. Thus, certain attentional and executive deficits could account for the appearance of mistakes and lapses in day-to-day life that are perceived as memory disorders by the general population. A neuropsychological examination battery and the dysexecutive questionnaire (DEX-Sp) were administered to two groups of young adults, one with subjective memory complaints that were severe enough to require a visit to a neurology service (n = 50) and the other without such complaints (n = 67). RESULTS; Data showed how the individuals with subjective complaints had a lower mnemonic, attentional and executive performance than subjects who did not present any complaints. Both groups, however, are within what can be considered statistically normal values. There were also significant differences in the number of frontal symptoms self-informed by means of the questionnaire that was applied. The differences that were found in mnemonic performance can be explained by non-pathognomonic attentional and executive dysfunctions, given the absence of a neuropathological process to justify them. Furthermore, use of the DEX-Sp in collaboration with classic neuropsychological assessment is proposed. Some new hypotheses and recommendations for the management of these patients in daily clinical practice are also discussed.

Mucoceles of the Frontal Sinus: Munich Experience with Drill-Out Procedures

Background and Aim: The purpose of this study is to analyze the symptoms, pain, and quality of life following drill-out procedures in patients with frontal sinus mucoceles. Material and Methods: In the years 2007 and 2008, patients with frontal sinus mucoceles requiring drill-out procedures at the Department of Otorhinolaryngology at the LMU Munich (Germany) were asked to complete questionnaires to assess the patient-based measure of health status and the quality of life before and after surgery (using SNOT-20 and VAS to rate their symptoms and pain). Postsurgery, the patients were followed up with regular examinations, the questionnaires, and nasal endoscopies (at 10 days, 3 months, 6 months, and 1 year). Results: A total of 20 patients (16 male and 4 female) underwent navigation-controlled, endoscopic drill-out procedures in the observed period, of whom 11 required drainage type III and 9 type IIB, according to Draf. The indications for surgery were based on chronic frontal sinus symptoms refractory to medical treatment, post-trauma status, and frontal sinus mucoceles. All patients received revision surgeries (with an average of three previous endo- and/or external surgical procedures). The mean headache score evaluated from the VAS improved significantly from 6.3 preoperatively to 1.2 at 3 months postoperatively and 0.6 at 6 months postoperatively. The SNOT-20 scores improved from 36.4 +/− 4.3 points before surgery to 15.5 +/− 3.8 points 6 months after surgical treatment. Conclusions: Navigation-controlled drill-out procedures are safe and efficient in the endonasal treatment of frontal sinus mucoceles and significantly improve symptoms with less postoperative pain and better quality of life.

The Riddle of Frontal Lobe Function in Man

This paper records a recurrent perplexity and a recent attempt at its resolution. Let me begin with the perplexity. Man_s frontal lobes have always presented problems that seemed to exceed those encountered in studying other regions of his brain. In striving to give a functional interpretation of anatomic pattern, we have therefore tended, in our laboratory, to begin by considering the occipital lobes and their processing of visual information (Teuber and Bender 1949; Teuber et al. 1960), and to progress from there to analysis of parietal and temporal lobe syndromes involving touch and hearing and higher processes (Teuber et al. 1951; Semmes et al. 1960). In this way, one can spend one’s life as an investigator without ever crossing the central fissure. And well one might—because it appears that by starting at the posterior end of the brain, it may become impossible in principle to reach the frontal lobes. I now believe that analysis of frontal lobe functions requires that we begin from that end, considering how these anterior parts act upon posterior, and predominantly sensory structures. What is needed is a 180° turn (Teuber 1961b). It is hardly an accident that the frontal lobes have continued to pose such insuperable difficulties to interpretations in traditional stimulus-response terms. Such conventional attacks on the problem go from sensory to motor functions; if the opposite approach is required—going from motor to sensory, as we shall suggest—then it may become understandable why frontal symptoms have been so perplexing.

Sintomatología frontal en adictos a sustancias en tratamiento mediante la versión española de la escala de comportamiento frontal

There are different studies that suggest a relationship between frontal symptoms and substance addiction. The Frontal System Behavior Scale is a questionnaire used to consider the manifestations of three frontal syndromes: executive dysfunction, apathy and lack of inhibition. The Spanish version of the Frontal System Behavior Scale (FrSBe-Sp) is administered to 215 addicted individuals starting treatment and to 267 nonclinical participants. The FrSBe-Sp is a self-administered questionnaire of 46 items that evaluate the three syndromes afore- mentioned, in an estimation of baseline (before substance use) and in a present estimation (after substance consumption). The questionnaire shows suitable psychometric properties and convergent validity with another similar questionnaire (DEX-Sp). Statistically significant differences appear between the scores of the addicted individuals compared with the group control at the baseline, as well as, specially, the present time. The results point out the fact that possibly the alterations of frontal character were previous. Maybe they acted as some kind of risk factors at the beginning of substance use. Also, they have significantly increased during the phase of active substance use. The FrSBe-Sp seems to be a good instrument to explore, both synchronically and diachronically, symptoms of frontal type related to addictive behaviors. New hypotheses of special relevance for treatment of addictive behaviors are suggested.