Psychological Services

Dementia and Aging: Frontal Lobe Dementia

Frontal lobe dementia is a somewhat new form of dementia being diagnosed in individuals in their 50’s and 60’s; far younger than the other forms of dementia you may be familiar with. At issue here is that this is a more rapidly developing dementia and the medication typically used for dementia does not tend to be successful; making it critical to diagnose this as a separate disorder and the affected person be under the care of a neurologist specializing in dementia.

The frontal processes have three functional systems:

  1. The system that manages the emotional functioning of the person. This means attaching emotional relevance to events, allowing the person to experience the feelings of others, to engage in meaningful relationships, to use emotions to develop goals and values that makes up their sense of self, values used through time to make decisions, to have an internal value system that guides us to continually make good decisions, to behave appropriately for the environmental setting we are in at the time.
  2. The system that specializes in the reception, storing and efficient organization and compartmentalization of information received from the external environment. This system helps us to attend to information that is important and to not attend to information that is not relevant. Information is prioritized in an integrated manner into some type of hierarchy so that we can find it later, like the use of a filing cabinet.
  3. The output system that allows us to act upon our decisions, have good skills of planning and organization, efficient problem solving that uses feedback so we learn from our mistakes, mental flexibility (as opposed to becoming stuck or perseverating) to use an alternative solution when the first solution does not work, with the goal of action, allowing the person to make decisions and to act upon them.

Together these systems allow the individual to:

  • Interact with their environment in an appropriate manner
  • Filter information from the environment with what is important from what is not important
  • Form and carry out meaningful goal directed behavior
  • Anticipate the consequences of one’s actions
  • Continually adapt to changes in the external environment and life’s day-to-day challenges.
  • Attend to, use and integrate information from the external and internal environment
  • Form hypotheses, to execute plans, make decisions, to monitor and modify their behavior based upon feedback received regarding outcome.

Right frontal processes form the cornerstone of self regulation:

  • The foundation that supports the forming of goals and the use of some type of guidance system (composed of values) to guide behavior
  • Goal directed action that persists through time (creating an internal drive state as opposed to being driven by the moment).
  • Dominance in the areas of social behavior, self-awareness, development and maintaining a person’s sense of self, who they are in life, mediating the subtleties or nuances of social conduct and interaction with others in the environment.

Accomplishing these multi-faceted tasks requires the person to be able to both comprehend and express emotions. When the right frontal area of the brain has been compromised, typical symptoms emerge of irritability and impulsiveness, difficulty understanding or predicting the impact of one’s behavior; lacking an internal drive state, they are driven by minor irrelevancies, inappropriate habits and routines.

The left frontal processes provide:

  • The ability to utilize information received from one’s environment to:
    • Plan and organize
    • To make decisions and act upon them
    • To problem solve and utilize feedback for successful solution generation
    • To exercise sufficient mental flexibility to adapt to life’s continual changes.
  • Verbal learning and verbal working memory are mediated by the left frontal processes, use of verbal cues or subvocalization (talking to ones’ self) to direct, guide or organize ongoing behavior.

The frontal processes are the “seat of civilization,” what separates us from animals, govern the thinking and emotional processes, interpreting and using information received from other brain areas to allow the human experience of making decisions and executing goals over time.

Signs to look for of deteriorating executive reasoning, frontal processes:

  • Difficulty making any kind of decision, from ordering in a restaurant to setting priorities for the day
  • Knowing what you want to do but being unable to accomplish the task due to being continually distracted by something else
  • Difficulty starting anything, a general lack of initiative, decreased spontaneity and productivity, loss of ambition and overall general apathy
  • Problems prioritizing attention, determining the importance or relevance of any given event
  • Difficulty determining what is important in life and what is not important, focusing on inconsequential items or issues
  • Chronically confused, distracted by irrelevant information on a continual basis, the busier the environment, the worse this becomes
  • Easily overwhelmed by too much information, feeling constantly bombarded by information from internal thoughts and the external environment (with the tendency to confuse these two sources of information)
  • Difficulty differentiating reality from internal thoughts, internal thoughts leading to increased emotional lability (reactivity)
  • Moody, emotionally up and down, unpredictable emotions
  • Unpredictable reactions to day to day events
  • Cannot understand the feelings of someone else in a specific situation
  • Black white thinking, rigid in thoughts
  • Old personality comes back
  • Suspicious, paranoid thoughts regarding the actions of others
  • Tendency to bounce from one uncompleted topic or sentence making everyday conversation confusing and frustrating
  • Tendency for misconstrued or misperceived conversations
  • Diminished ability to regulate emotions, to modulate or control
  • Increased emotional sensitivity and fragility despite a hard shell on the outside
  • Difficulty adjusting behavior to the environmental setting
  • Sundowner’s syndrome, things become worse at night
  • Difficulty benefiting from feedback to fix mistakes or errors
  • Difficulty generating alternative solutions to problems
  • Problems seeing or understanding sequential order
  • Difficulty anticipating consequences of one’s behavior
  • Difficulty planning ahead for events
  • Difficulty predicting the future, if this… then that
  • Deficient self-awareness and difficulty appreciating the impact upon others
  • Difficulty taking the emotional perspective of another person to understand their feelings
  • Rigid thinking, difficulty thinking in a flexible manner leads to becoming stuck or perseverated.
  • Tendency to maintain assumptions once they are made without considering other perspectives
  • Difficulty with the integration of concepts to generalize and apply newly learned concepts
  • Tendency to be more concrete, difficulty with the abstract
  • Daily fatigue due to energy needed to get through the day