Q. My husband is 75 years old. The neurologist has stated that my husband has frontal lobe disorder. Can you tell me what causes this and the prognosis?

A. I'm sorry to hear that your husband has this problem, but I'm not at all sure what the neurologist meant by the term, "frontal lobe disorder". The term is too non-specific to tell us much, and without knowing the underlying cause of your husband's problem, it's impossible to state the prognosis.

The frontal regions of the brain are involved in higher level cognitive functions, such as complex planning, abstract thinking, control of emotions, and executive decision-making. When the frontal lobes are damaged from any cause, the affected individual may show deficits in one or more of these areas. Some individuals with frontal lobe damage may show either aggressive, disinhibited behavior; or extreme apathy and lack of spontaneous speech (mutism).

Damage to the frontal lobes can occur as a result of many causes, including head trauma; insufficient blood supply to the brain; viral infections; or so-called degenerative brain diseases, such as Alzheimer's or Pick's Disease (the latter affects the frontal lobes more specifically than does Alzheimer's Disease).

Recently, there has been a great deal of interest in so-called Frontotemporal dementia (FTD) syndromes, which affect both the frontal and temporal lobes of the brain. (The temporal lobes are closely linked to long-term memory). There is some evidence suggesting that mutations in one or more genes may account for some cases of FTD, but this is still speculative. There is also evidence that some patients with FTD may be deficient in a brain chemical called serotonin.

While there is no specific or curative treatment for FTD, there is evidence that--depending on the specific symptoms--several types of medication may be helpful. For example, Prozac-type medications (called SSRIs) may reduce disinhibition, depressive symptoms, and compulsions in some FTD patients (Swartz et al, J Clin Psychiatry 1997 Jun;58(6):275). Other medications that may be helpful include guanfacine, pramipexole, and so-called mood stabilizing medications--again, depending on the patient's specific symptoms.

I would suggest that you have a detailed discussion with your husband's neurologist as to the underlying cause of this "frontal lobe disorder", and its possible treatments. If you don't get satisfactory answers, you may want to consider obtaining a second opinion from an expert in dementia.

You could try contacting a department of neurology at a medical school in your area, and asking for a referral. The Alzheimer Foundation (www.alz.org) may also be a good source of information and support, depending on your husband's final diagnosis. I hope things work out for you both.

October 2003

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