The Human Frontal Lobes and Frontal Network Systems: An Evolutionary, Clinical, and Treatment Perspective

Table 18

Proposed approach of neurological/neuropsychiatric disorders.

(1) Use the list of symptoms and signs to form an overall generic categorical diagnostic syndromes such as abulic/apathetic, disinhibited/dysexecutive, depression, and obsessive compulsive disorders. This is a clinical assessment that may be aided by inventories, scales, or diagnostic manuals such as DSM IV
(2) Component analysis in terms of the core frontal functions embedded in the 5 currently appreciated frontal subcortical behavioral circuits
(3) Establish the cerebrovascular component and its specific treatment
(4) Establish whether medical conditions (hypothyroidism, low B12, Vit D, folate) are contributing to the cognitive impairment
(5) Establish contribution of impaired sleep (sleep apnea, dyssomnia)
(6) Establish contribution of centrally acting drugs and discontinue, reduce dosage or change to another less conflicting drug if possible.
(7) Use known information about neurotransmitter deficiencies in these syndromes and/or FSC’s and target with specific pharmacological and behavioral treatment approaches.
(8) Counsel with respect to the 5 principal components of brain health