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American Journal of Alzheimer's Disease and Other Dementias®
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Confused and disturbed behaviour in the elderly following silent frontal lobe infarction

Nages Nagaratnam, MD, FRACP

Pascal Bou-Haidar, MBBS

Harry Leung, MBBS

Department of Geriatric Medicine, Blacktown-Mount Druitt Health, Blacktown Hospital, Blacktown, Australia.

It is unclear whether silent frontal lobe infarction is truly asymptomatic; frontal behavioral syndromes following strokes have rarely been reported. We studied 12 elderly patients with silent frontal lobe infarction who were exhibiting confused and disturbed behavior. Ten were male and two female; their ages ranged from 68 to 79 (mean 78). Three groups of symptom clusters emerged: changes in mood and emotional behavior, cognitive deterioration with minor psychiatric symptoms, and a confusional state. When related to the CT scan location, three regions were identified: predominantly orbitofrontal, deep white matter and caudate, and border-zones, respectively. These findings were related to what is known about the neuroanatomic location of the lesions and the role of the frontal subcortical circuitry in relation to behavior. The different manifestations could be explained by damage to the frontal lobe or interruption of the complex frontal subcortical circuits.

Key Words: disturbed behavior • confusional state • silent cerebral infarction • frontal lobe • frontal/subcortical circuitry

American Journal of Alzheimer's Disease and Other Dementias®, Vol. 18, No. 6, 333-339 (2003)
DOI: 10.1177/153331750301800608
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