Frontal Lobe Damage: When the Leader Can’t Lead

Today, a look at what can happen when the work of the frontal lobe is interrupted or damaged.

This builds on my attempt last week to simply explain what the frontal lobe does.

How Does Frontal Lobe Damage Happen?

Last week I mentioned a book I had found useful THE EXECUTIVE BRAIN: Frontal Lobes And The Civilized Mind by Dr Elkhonon Goldberg.

In a Chapter entitled “When the Leader is Wounded” (yes your frontal lobe is the boss of the brain), he uses a military picture to describe how frontal lobe damage can happen.

I will try and summarise what Dr Goldberg describes:

If the leader is damaged, the soldiers (read ‘soldiers’ as ‘other lobes of the brain’) are without an organiser. The soldiers can’t sort out what needs to be done because they don’t know what each other is doing, no-one is taking charge, and they can’t do their job properly.

If the links between the leader and the field are damaged (inside, or outside the frontal lobe) the soldiers will be cut off from their leader, and soldiers in the field lack information to act as a team.

The frontal lobe appears to be very sensitive to damage. It can be damaged from a wide range of causes including dementia, stroke, disease, and trauma.

Dr Goldberg explains that the frontal lobes can be affected even if damage is not directly to the frontal lobe. For example studies of tumours elsewhere in the brain, showed that blood flow was disrupted around the tumour, and also in the frontal lobe.

Why would that be?

The conclusion is that the frontal lobe is very susceptible to what is going on in the rest of the brain. More sensitive than most other parts of the brain. This is most likely, because it has far more connections to other parts of the brain.

What does all this mean?

In short:

  • Interruption to the work of the frontal lobe is common in brain injury of any type.
  • Damage can occur whether the damage is to the front lobe directly, or to another lobe in the brain.
  • Frontal lobe damage can cause a wide range of difficulties because it controls much of what the brain does.

 What Can Happen With Frontal Lobe Damage?

Before listing what can happen with frontal lobe damage it is worth remembering 4 things:

  1. Every person with brain injury will be different, UNIQUE.
  2. Not all of these difficulties will occur in every person.
  3. The degree of difficulty will vary from person to person.
  4. It is not always negative. People do find new strengths, skills and talents. Imagine a politician who as a result of disinhibition, who could not help but tell the truth!

Cognitive Outcomes after Frontal Lobe Damage

In the list below I have underlined the terms you might hear, or read about, along with an explanation of what might happen if a person had this outcome. The list is not exhaustive, it is a range of the difficulties you might see.

Please ask questions in the comments below or contact me if anything does not make sense, or if you have additional information and resources to offer.

  • Lack of initiation and motivation – Lack of drive, not able to start up – you might sit, or lie in bed, gazing blankly and not do anything without significant prompting and assistance. In more mild damage you may be less enthusiastic, less interested in what is going on around you.
  • Memory Loss – Changes in working memory. Memory loss following frontal lobe damage is thought to be more because of its job organising memory for other parts of the brain. Damage to other functions of the frontal lobe might also affect your ability to remember such as difficulty concentrating and paying attention.
  • Sequencing difficulties – Not able to follow the proper order of steps, tasks, or movements to do a task. This might happen  even if it’s a very familiar task such as making a cup of coffee or performing a work task previously done many many times.
  •  Distractibility – Not being able to filter out what is unnecessary for the task being carried out. Difficulty staying on track. Following everything going on whether important or not.
  • Difficulty with planning organizing and problem solving – Inability to plan and to work out what the consequences of your actions might be.
  • Behaviour changes – there are likely to be MANY future discussions about the challenges around behaviour. Listed here because it is a common outcome of frontal lobe damage. Many changes can occur from mild impulsive acts to physical aggression.
  • Broca’s Aphasia – also called Expressive Aphasia. Not being able to express language. This can include word and gesture. You might be able to understand what is said, but not respond.
  • Perseveration – Lack of ability to stop a word, thought or action – repeating over and over again. There may also be difficulty stopping a behavior or action once started (this can be related to the lack of initiation and motivation in the point above).
  • Echolalia or Echopraxia – The term “echo” gives a clue. It is when words or actions are copied rather than giving an answer, or independent response. When asked “What do you want for dinner?” the person replies “What do you want for dinner?” or the person might mimic what another person is doing. Repetition may also be doing something automatically because there is a familiar prompt – picking up and sipping from a glass even if it is empty. This is commonly seen in dementia.
  • Rigidity and Concrete thinking  – not able to be flexible in thinking. Difficulty changing from one thought or task to another. Not able to follow morethan one  path of thinking or action. Maybe you are not able to change course even if it looks like the wrong path.  You might stay on track no matter what. Loss of the ability to think about, and imagine something.
  • Anogognosia – you might not often see this term but you are likely to see the difficulty. What it means is you appear to not be aware of your difficulties, and what things are really like. There might also be a lack of insight that can sometimes be overcome with time. This may be more related to the overwhelming changes. Way too much to be able to face everything at once.
  • Reduced attention and concentration – Inability to remain focussed. See HERE for more information.
  • Disinhibition – the filter on words and action is reduced or missing. You are no longer able to stop, or modify the behaviour, actions, or comments that are not OK.  You find yourself doing and saying what first comes into our mind, without thinking.
  • Lability – Unpredicatable, sudden mood changes. Laughing one minute, crying the next, or not being able to control emotions as well.
  • Changes in personality – All these potential changes that can happen with frontal lobe damage can appear to change your personality. It might become a more extreme version, or it might change completely e.g someone quiet and thoughtful, becomes very talkative and appears brash. This can often be linked back to the various changes that have been listed above.

Many of these difficulties along with strategies, will be discussed in individual posts in the future. For now this was a summary of just some aspects of frontal lobe damage. At the risk of repeating myself too often I want to add (again) that the outcomes will be different for each person.

What Can You Do?

One small step

Think about the idea the frontal lobe is the boss. If the frontal lobe is the leader, the boss, the CEO, think about what leaders, bosses, CEO’s need? They usually have a good assistant (Chief of Staff, Personal Assistants (PA), Secretary).

Whatever the title, they need a person who helps with planning and organizing schedules and projects. A person who works alongside to achieve the goals, monitors what the boss is asked to do and say, does the tasks the boss is not able to do, modifies the task or schedule when necessary, and steps in whenever needed.

And if you ask any PA… a whole lot more!

The important part of the role is to make the boss look good, and efficient, while quietly working away in the background. As a supporter we can learn from this role.

What I Found this Week

As always, an exciting week of prowling around the internet and finding lovely surprises. Here are two you might like, both using a more creative approach to all things brain:

The first is a delightful and informative blog I discovered while looking for an image to compliment this post. Click on the image below to visit Die Hard Brain. A blog by Jill Andrews who describes herself as an artist and a writer:

The second is a perspective of frontal lobe damage by Anne Ricketts, presented in a creative and personal way


28 Responses to Frontal Lobe Damage: When the Leader Can’t Lead

  1. Amanda August 26, 2015 at 4:06 pm #

    Great post! It’s frustrating for someone like myself who, after being hit by a car, flying through the air and landing on her head, to not get the right feedback from medical professionals when I can actually FEEL something not quite right. A few years ago, they did an MRI and found that I have HFI. I could have told them that without a scan. In the same way someone might tap along a wall to find the studs, is the same way I could tell the thickening of the skull in my frontal-right side. It feels and sounds different when tapped upon. I get a burning and fuzzy numbing feeling in that region whenever I am focused intently on a task. Amongst somewhat alarming memory, verbal clumsiness with occasional stammering as I attempt to retrieve the correct response, physical clumsiness and some of the above examples with initiation, motivation, variations in mood, patience, etc. Also localized headaches – from someone who never ever used to get headaches… I KNOW without a doubt that the degree of HFI is affecting my frontal lobe. BUT, because previous information of physicians, based on limited patient studies and there aren’t a lot of great detailed studies, I consistently get the response that HFI does not cause ANY symptoms. I have searched for some relatable information but always fall short. It’s frustrating and disheartening to say the least.

    • Melanie Atkins August 30, 2015 at 12:04 pm #

      Amanda, Thankyou for sharing your experience for others. For those who may not know of HFI – it stands for Hyperostosis frontalis interna – in simple terms a thickening of bone over the frontal lobes. For more medical/ technical infomation here are a couple of articles – This again highlights the complexity of our brains and the difficulty fully understanding when things aren’t working right. Thanks again. Melanie

    • Allen Mack April 19, 2016 at 2:17 pm #

      My injury came from a stroke at 38. Non smoking 170 pound 6’3″ male, no history in family. Who knew? My most compelling deficit is the front lobe brain damage. Memory loss occurs…the list goes on. My biggest struggle is my inability to use a filter or go too far when ppl are joking around. It is a very serious problem. It keeps me and my wife out of public invite. Any guidance with this one

  2. Amanda August 26, 2015 at 4:07 pm #

    On a side note, I really do like the explanation here about how the different lobes work together. It’s an easy portrayal for those not sure how one area being injured or damaged can affect another, but this does well to explain that! Great post!

    • Melanie Atkins August 30, 2015 at 12:06 pm #

      Thanks Amanda feedback is always welcome and nice to hear when a post is helpful. Regards

  3. Arlene Beavers August 27, 2015 at 3:33 am #

    What can I do to get help, from my injury, that I need and my dr. won’t give me a referral?

    • Melanie Atkins August 30, 2015 at 12:08 pm #

      Arlene I am not sure where you are living but sometimes contact with a local brain injury organisation can be helpful. This should not need a Doctors referral, you may even find an online support network. Regards

  4. Jolene hale September 1, 2015 at 3:48 am #

    I’ve just read this having a 4 year old who was diganoised with a brain tumour at 14 months old and over the years things have changed so much she can now tick every sign and symptoms listed.

    • Melanie Atkins September 3, 2015 at 6:26 pm #

      Thank you for this Jolene I hope it is of some help in what must be such a difficult path for you all. It is also a reminder for readers that unfortunately brain injury can happen at any age, and also that Brain tumour is not always thought of as a brain injury yet it is, and therefore can have many of the many outcomes associated with brain injury. Regards Melanie

  5. john broody December 11, 2015 at 6:18 pm #

    (Hit by drunk driver 1991) I cannot explain to anyone except Dr.’s that I can’t help what this has done to me. People get angry because I can’t think right. They believe I am doing it on purpose. Or I am made fun of. Every morning is a clean slate. I have to try to remember everything. Notes do not work, I forget to look at them. Out of sight…out of mind. I am a burden to my family. My wife thinks there is some cure. &I am tired of just existing, I used to have my own business now I just pretty much stare into space and listen to the radio and draw. Existing though, is extremely beautiful. I will never tire of how beautiful everything really is. So I keep hanging in, for that reason alone. At least I survived the bleeding after the impact or I couldn’t even enjoy life at all. Bummer! But what can you do? Nothing. ( I once had a 190 IQ.) Best of luck & support to anyone who this happens to! J.B.

    • Melanie Atkins December 14, 2015 at 12:21 pm #

      Thankyou for writing J.B. That is a powerful statement “Existing though is extremely beautiful, I will never tire of how beautiful everything really is”. I hope your story will resonate with others. Memory loss is such a common outcome of brain injury yet so poorly understood by many. Thanks again. Regards Melanie

    • Billie February 1, 2016 at 6:53 am #

      God bless you John! Thank you for sharing your story, and remember that you are not alone! My 11 year old son and myself struggle everyday with executive functioning! I’m a 38 year old single mother of two children and I feel like I am just existing as well! It’s one of the worst feelings someone could have! My memory is pretty much non existent! And it hard to find words to explain to people how I’m feeling because I can’t even figure out the words to use! I feel nobody really understands! But I just wanted to say thanks again for sharing and you gave me a glimmer of hope! I don’t feel alone anymore!

      • Melanie Atkins February 2, 2016 at 11:31 am #

        Thankyou Billie for replying to John. And for sharing briefly the challenges when others do not seem to understand brain injury. I am so pleased the article has been useful to others. Regards Melanie

  6. Stacey June 11, 2016 at 4:47 am #

    My daughter was in a car accident almost a year ago. I notice a change in her behavior 3 weeks after, since then she has gone through almost all of the symptoms listed above. A MRI shows that her left frontal lobe is smaller than her right. She has spent 4 weeks in a mental hospital had a neuropsychological assessment and has been diagnosed with depression, anxiety and bipolar 1. She is also seeing a neurologist who is recommending she sees a neurosurgeon. My question is the psychiatrist wants to treat her with anti-psychotic medication for the bipolar and I’m not sure if that is the right treatment if it is a brain injury? When she was on it before (while in the mental hospital) it didn’t help her!

    • Melanie Atkins June 11, 2016 at 2:15 pm #

      Hi Stacey, Thankyou for your letter. This is a tricky, but not uncommon situation family finds themselves in. Sometimes a range of professionals can be involved but not be aware of the involvement of others. Having them talk to each other might be useful. Or you might discuss this suggested treatment with each of them yourself, tell them what you have observed and gather more information to help you make your decision. Maybe it is possible to get another opinion or to discuss this with the Neuro-psychologist. Regards Melanie

  7. Jerleeza Ferguson June 11, 2016 at 4:22 pm #

    I was hit by a car when I was 11 years old I flew in the air and landed on my head but i didn’t break anything. I just damaged my frontal lobe I was supposes to get MRI’s and go see the neurologist but I never did. I was out of school for 3 months and then I went back to school. I felt like I had changed I went from being timid and shy to not caring and bold. I had a lot of behavioral problems after that getting into fights and being very impulsive. I went through a lot growing up. After my mother passed away I was diagnosed with bipolar disorder. I have been in and out of the hospital (psychiatric) and been on a lot of different meds and none seem to work. Well anyway I am now 23 with 2 kids and I live with their grandparents because of my actions. I have a chance to get them back and be on my own with them. But I am having a hard time with problem solving decision making remembering and just focusing on what i have to do. I want to be a better mom and person for my kids and myself.

    • Melanie Atkins June 14, 2016 at 7:42 pm #

      Thankyou for sharing your experience Jerleeza I think many people with read this and think about their own similar kinds of experiences after brain injury. I am not sure if it is of any help but a year or two ago I wrote an article on decision-making and problem solving The article was written for carers but I hope it is useful to people living with brain injury. I will try and update it again soon. Regards and thankyou again for writing. Melanie

  8. Kevin August 8, 2016 at 11:49 am #

    Great article. Apparently I have congenital posterior fossa arachnoid cyst (large one) and hydrocephalus. My wife noticed my having nocturnal seizures about 5 years ago now. But, the neurologist said I’ve probably been having those my whole life but, there was no one to notice when I did. I probably had “staring spell” that were seizures and dismissed. Anyhoo, my seizures are in my frontotemporal lobe, neurologist believes pressure in the arachnoid cyst is causing a “push” in the opposite frontotemporal lobe.
    After talking to the doctor, my wife noticed my having a lot (almost all) of these symptoms before I have a seizure and days after. The one that especially noticed is the lack of a “filter”. I’m more agressive, I swear (I never swear), mood changes, irritability. A lot of the other symptoms I’ve had most of my life. Probably caused by pressure on the frontal lobe.
    Anyhoo, now I have a shunt taking pressure off my brain. Still have occasional issues, especially when it’s getting ready to storm. I think it has something to do with the barometric pressure but, my neurologist says it shouldn’t be affected.

    • Melanie Atkins August 11, 2016 at 4:54 pm #

      Thanks Kevin I am pleased you felt the article was useful and thankyou also for sharing some of your story. I do think it helps everyone to understand the brain and brain injury a little better through sharing experiences.

  9. Joao Gaspar October 20, 2016 at 6:50 am #

    My case is disturbing and probably unique in medicine, as I haven’t found a single doctor or testimonial online after googling for 3 years the entire web in 8 different languages.

    my main complaint to doctors and keywords used in my search were:

    “burning sensation on the left frontal cortex”
    “burning sensation on the left frontal lobe”
    “numbing sensation on the left frontal lobe”
    “acid and tingling like sensation on the left frontal lobe”
    “permanent burning sensation in the brain”
    “burning brain”
    “burning frontal cortex”
    “burning frontal lobe”
    “stabbing sensation on the left frontal lobe”
    “saran wrap sensation on the left frontal lobe”
    “lobotomy sensation on the left frontal lobe”

    etc etc

    Basically my story started in 2002 when I got symptoms of major depression and was very successfully treated with Zoloft. I became a person extremely engaged with life, probably more than before. I used to say to myself that the Zoloft pill I was taking was my “China-deal kryptonite”. I was clueless about any harm I could be causing to my nervous system, as Zoloft completely allowed me to live my life at 120% at all levels. So I took Zoloft for 11 years.

    By the 11 year mark, several years of emotional and professional stress contributed probably to something I can’t understand:

    Suddenly, without nothing that could have predicted it: I felt one day a huge headache like I never had before, and the next day, I woke up feeling a stabbing sensation on the left frontal lobe. I immediately wend down-hill to the darkest depression I had ever seen, and stood there since then, bedridden and suicidal 80% of the time. CAT scans and MRIs showed no abnormalities.

    All my symptoms match perfectly what is to have a CEO that can’t lead, in the points your article mentions. I lost my ability to be on top of my game, make plans and foresee the consequences of the actions at a higher level. Lost the ability to initiate action, and to persevere. My executive function and working memory are severely hindered and all is accompanied by this agonizing permanent burning sensation on my left frontal lobe.

    I fell through the cracks of psychiatry, neurology, and available clinical research literature as nobody can explain why do I feel this in this region of the brain.

    My executive functions seem to be inline with frontal lobe damage. All articles I have found in the internet, just like yours, tend to focus on the frontal lobe damage as a result of physical insult, not a chemical insult. And user comments always refer they had physical trauma to the brain.

    My question is. Can chemical frontal lobe damage occur for instance from taking an SSRI for 10 years? I feel lobotomized and it’s only only at the Left-DLPFC. The right side feels fine just as the rest of the brain. This is like a curse, a plague that has haunted me like voodoo and I can’t get the CEO to lead again, no matter what I do or try.

    The most I wanted was obviously to improve, but for trying to help myself I needed to understand at least what happened. And couldn’t find that answer anywhere.

    I literally exhausted all research literature around the globe on my subject. From western medicine, to TCM research articles on active components, no non-systemic approaches to severe depression treatment.

    I can’t prove it, I can’t help myself. Does anyone have a clue on what I could try to do?

    I was always a fighter but always had hope. Now my hope is fading as I’ve exhausted everything the world could have to offer, and I’m giving up.

    If I only knew what I had and which was the best path to follow…Kindly comment if you feel you have some insights to share. I would be so grateful.

    Kind Regards,

    • Melanie Atkins November 22, 2016 at 11:50 am #

      Hi Joao, I am sorry this has taken so long to reply. Two messages I repeat often about brain injury are 1) Every person with brain injury has different outcomes. No two people are the same. And 2) We do not know all there is to know about our brain.
      Unfortunately both these seem to be affecting you with your symptoms and I am not sure what more I can offer here. You are right in that your outcomes are most unusual – this is not uncommon but makes it difficult to find strategies and treatments. I am not sure what I can suggest other than new methods of diagnosis and treatement are being developed so seeking highly skilled brain injury specialists may provide some answers. Sorry this can not be more helpful. Regards Melanie


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