BAOJ Neurology Traumatic Prefrontal Encephalopathy and Amotivational Apathetic Syndrome: Revisiting the Historical Limitations of Standardized Neuropsychological Assessments

The field of neuropsychology has made significant gains regarding the development and implementation of diagnostic measures and assessment techniques for frontal lobe pathology. Nevertheless, it is becoming increasingly evident that the existing battery of tests remains relatively insensitive to the ever-growing range of functions known to be mediated by the prefrontal regions. In the present study, a 62 year-old gentleman was involved in a pedestrian motor vehicle accident and suffered bilateral prefrontal, left parietal, and left occipital trauma (as evidenced by magnetic resonance imaging [MRI] scans). Secondary to this accident, he complained of significant depression, thought disturbances, and paranoia, while family members reported additional personality changes. A consistent diagnosis of frontal lobe syndrome was established across three independent neuropsychological evaluations, in which his postrehabilitative scores on a range of standardized assessments were consistently above average, regardless of his significant social, affective, and motivational changes following the accident. This case demonstrates the limitations and insensitivity that current standardized measures still obtain for assessing prefrontal lobe injury. The results are interpreted within the context of test development relevant to neuroscience rather than strictly psychometric concerns. The importance of these constraints on the evaluation of frontal lobe syndrome is discussed within the context of traumatic brain injury from contact sports and military combat.