Frontal lobe trauma in the elderly. Personality changes aren't always dementia.
Changes in personality and behavior are fairly specific when they are caused by damage to the frontal lobe of the cerebral cortex. They are characterized by changes in affect and in emotional response and may be pseudopsychopathic, pseudodepressive, or a combination of both. Cognitive ability (eg, verbal fluency, maintaining attention, achieving goals) may also be diminished. Neurologic signs may include abnormal reflexes, increased or decreased motor behavior, and loss of ability to complete purposeful movement. If the damage is caused by trauma, treatment begins with care of the acute injury. Any resulting seizures should be treated with an anticonvulsant and the patient observed carefully for side effects. Another agent (eg, a stimulant, antipsychotic, tricyclic antidepressant) may be needed as well, depending on the individual patient, to restore as much psychological function as possible. Counseling of both the patient and the family is important to help them avoid some difficulties and frustrations that may accompany the change in personality.
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