Objective: To evaluate the ability of the Frontal Lobe Score (FLS) to differentiate patients with frontal lobe lesions from those with nonfrontal lesions and normal controls.
Design: In a prospective, blind setup, the sensitivity and specificity of the Frontal Lobe Score was compared with the Wisconsin Card Sorting Test (WCST) and the Stroop Test.
Patients: A sample of 108 subjects (26 patients with cerebral lesions confined to the frontal lobes, 28 patients with cerebral lesions without involvement of the frontal lobes, 31 patients with mixed frontal/nonfrontal lesions, 23 controls without cerebral lesions) was examined.
Results: The Frontal Lobe Score detected pure frontal lesions with a sensitivity of 92.3%. It discriminated patients with frontal lesions from normal controls with a specificity of 100%; differentiation from patients with nonfrontal lesions was obtained with a specificity of 75.0%. For the WCST, sensitivity for detection of pure frontal lesions was 65.4%, while specificity was 60.9% compared with normal controls and 53.6% compared with nonfrontal lesions. The Stroop Test showed a sensitivity of 30.8%, a specificity compared with normal controls of 95.7% and compared with nonfrontal lesions of 92.9%.
Conclusion: The Frontal Lobe Score has clinical usefulness for screening of effects of frontal lobe damage superior to that of the WCST and the Stroop Test.
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References
1.
Ettlin Th, Kischka U, Beckson M, Gaggiotti M, Rauchfleisch U, Benson DF. The Frontal Lobe Score: part I: Construction of a mental status of frontal systems. Clin Rehabil2000; 14: 260–271.
2.
Luria AR. Human brain and psychological processes. New York: Harper & Row, 1966.
3.
Luria AR. The working brain. An introduction to neuropsychology. New York: Basic Books, 1973.
4.
Fuster JM. The prefrontal cortex: anatomy, physiology and neuropsychology of the frontal lobe, second edition. New York: Raven Press, 1989.
5.
Stuss DT, Benson DF. The frontal lobes. New York: Raven Press, 1986.
6.
Walsh K. Neuropsychology: a clinical approach. New York: Churchill Livingstone, 1987.
7.
Grant AD, Berg EA. A behavioral analysis of degree of reinforcement and ease of shifting to new responses in a Weigl-type card sorting. J Exp Psychol1948; 38: 404–411.
8.
Stroop JR. Studies of interferences in serial verbal reactions. J Exp Psychol1935; 18: 643–662.
9.
Smith A. The serial sevens subtraction test. Arch Neurol1967; 17: 78–80.
10.
Weinberg J, Diller L, Gerstman L, Schulman P. Digit span in right and left hemiplegics. J Clin Psychol1972; 28: 361-361.
11.
Bender MB. Defects in reversal of serial order of symbols. Neuropsychologia1979; 17: 125–138.
12.
Reitan RM. Validity of the Trail Making Test as an indication of organic brain damage. Percept Mot Skills1958; 8: 271-271.
13.
Fulton JF. Forced grasping and groping in relation to the syndrome of the premotor area. Arch Neurol Psychiatry1934; 31: 221–225.
14.
Denny-Brown D. The nature of apraxia. J Nerv Ment Dis1958; 126: 9–32.
Regard M, Strauss E, Knapp P. Children's production on verbal and nonverbal fluency tasks. Percept Mot Skills1982; 55: 839–844.
17.
Rey A. L'èxamen clinique en psychologie. Paris: Presses Universitaires de France, 1964.
18.
McCarthy M, Ferris SH, Clark E, Crook T. Acquisition and retention of categorized material in normal aging and senile dementia. Exp Aging Res1981; 7: 127–135.
19.
Levin HS, High W, Goethe R et al. The neurobehavioral rating scale: assessment of the behaviorial sequelae of head injury by the clinician. J Neurol Neurosurg Psychiatry1987; 50: 183–193.
Bäumler G. Farbe-Wort-Interferenztest. Göttingen: Hogrefe, 1985.
22.
De Renzi E, Vignolo LA. The Token Test: a sensitive test to detect disturbances in aphasics. Brain1962; 85: 665–678.
23.
Huber W, Poeck K, Weniger D, Willmes K. Der Aachener Aphasie Test. Göttingen: Hogrefe, 1983.
24.
Poeck K. Apraxie. In: Poeck K ed. Klinische Neuropsychologie. Stuttgart: Thieme, 1982.
25.
Alexander GE, DeLong MR, Strick PL. Parallel organization of functionally segregated circuits linking basal ganglia and cortex. Annu Rev Neurosci1986; 9: 357–381.
26.
Alexander GE,Crutcher MD, DeLong MR. Basal ganglia-thalamocortical circuits: parallel substrates for motor, oculomotor, ‘prefrontal’ and ‘limbic’ functions. Prog Brain Res1990; 85: 119–146.
27.
Cummings JL Frontal-subcortical circuits and human behavior. Arch Neurol1993; 50: 873–880.
28.
Anderson SW, Damasio H, Jones RD, Tranel D. Wisconsin Card Sorting Test as a measure of frontal lobe damage. J Clin Exp Neuropsychol1991; 13: 909–922.
29.
Pardo JV, Pardo PJ, Janer KW, Raichle ME. The anterior cingulate cortex mediates processing selection in the Stroop attentional conflict paradigm. Proc Natl Acad Sci USA1990; 87: 256–259.
30.
Frith CD, Friston KJ, Liddle PF, Frackowiack RS. A PET study of word finding. Neuropsychologia1991; 29: 1137–1148.
31.
Rezai K, Andreasen NC, Alliger R, Cohen G, Swayze V, O'Leary DS. The neuropsychology of the prefrontal cortex. Arch Neurol1993; 50: 636–642.
32.
Shallice T, Fletcher P, Frith CD, Grasby P, Frackowiack RS, Dolan RJ. Brain regions associated with acquisition and retrieval of verbal episodic memory. Nature1994; 368: 633–635.
33.
Bench CJ, Frith CD, Grasby PM et al. Investigations of the functional anatomy of attention using the Stroop test. Neuropsychologia1993; 31: 907–922.
34.
Vendrell P, Junqué C, Pujol J, Jurado MA, Molet J, Grafman J. The role of prefrontal regions in the Stroop task. Neuropsychologia1995; 33: 341–352.
