Abstract
The frontal lobes play a major role in the regulation of our emotions and behavior, planning, decision making, social conduct, actions, and executive functions. They are quite vulnerable to damage when an individual sustains a moderate or severe traumatic brain injury. Patients who sustain damage to their frontal lobes may not complain of any cognitive or neurobehavioral symptoms. They often do not show any abnormalities on standardized neuropsychological tests, particularly when the anterior and ventral areas of their frontal lobes are damaged. When these patients are observed in unstructured, novel, or complex real-world settings, they frequently exhibit cognitive difficulties, neurobehavioral symptoms, and problems with their executive functions. Since standardized neuropsychological tests are generally poor at assessing these problems and symptoms, neuropsychologists may not be aware of these problems if they have never observed these patients function in real-world settings or have never interviewed the significant others of these patients. As a consequence, neuropsychologists should not rely solely on the quantitative test data of these patients since it may provide inaccurate and misleading information.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Albert, M. L., Feldman, R. G., & Willis, A. L. (1974). The “subcortical dementia” of progressive supranuclear palsy. Journal of Neurology, Neurosurgery and Psychiatry, 37, 121–130.
Alexander, M. P., Benson, D. F., & Stuss, D. T. (1989). Frontal lobes and language. Brain and Language, 37, 656–691.
Anderson, S. W. & Tranel, D. (1989). Awareness of disease states following cerebral infarction, dementia, and head trauma: Standarized assessment. The Clinical Neuropsychologist, 3, 327–339.
Askin-Edgar, S., White, K. E., & Cummings, J. L. (2004). Neuropsychiatric aspects of Alzheimer’s disease and other dementing illnesses. In S. C. Yudofsky & R. E. Hales (Eds.), Essentials of neuropsychiatry and clinical neurosciences (pp. 421–456). Washington: American Psychiatric.
Barch, D. M., & Buckner, R. L. (2003). Memory. In R. B. Schiffer, S. M. Rao, & B. S. Fogel (Eds.), Neuropsychiatry (2nd ed., pp. 426–443). New York: Lippincott, Williams, and Wilkins.
Bechara, A., Damasio, A. R., & Damasio, H. (1994). Insensitivity to future consequences following damage to human prefrontal cortex. Cognition, 50, 7–15.
Bennett, P. C., Ong, B., & Ponsford, J. (2005). Measuring executive dysfunction in an acute rehabilitation setting: Using the dysexecutive questionnaire (DEX). Journal of the International Neuropsychological Society, 11, 376–385.
Benson, D. F. (1994). The neurology of thinking. New York: Oxford.
Bigler, E. D. (1988). Frontal lobe damage and neuropsychological assessment. Archives of Clinical Neuropsychology, 3, 279–297.
Boyd, T. M., & Sautter, S. W. (1993). Route-finding: A measure of everyday executive functioning in the head-injured adult. Applied Cognitive Psychology, 7, 171–181.
Butler, R. E., Anderson, I., Furst, C. J., & Namerow, N. S. (1989). Behavioral assessment in neuropsychological rehabilitation: A method for measuring vocational-related skills. The Clinical Neuropsychologist, 3, 235–243.
Butler, R. E., Rorsman, I., Hill, J. M., & Tuma, R. (1993). The effects of frontal brain impairment on fluency: Simple and complex paradigms. Neuropsychology, 7, 519–529.
Chaytor, N., & Schmitter-Edgecombe. (2003). The ecological validity of neuropsychological tests: A review of the literature on everyday cognitive skills. Neuropsychological Review, 13(4), 181–197.
Chaytor, N., Schmitter-Edgecombe, M., & Burr, R. (2006). Improving the ecological validity of executive functioning assessment. Archives of Clinical Neuropsychology, 21, 217–227.
Cicerone, K. D., & DeLuca, J. (1990). Neuropsychological predictors of head injury rehabilitation outcome (abstract). Journal of Clinical and Experimental Neuropsychology, 12, 92.
Cripe, L. I. (1996). The ecological validity of executive function testing. In R. J. Sbordone & C. Long (Eds.), Ecological validity of neuropsychological testing (pp. 129–146). Delray Beach: St. Lucie.
Cummings, J. L. (1993). Frontal–subcortical circuits and human behavior. Archives of Neurology, 50(8), 873–880.
Cummings, J. L. (1995). Anatomic and behavioral aspects of frontal–subcortical circuits. In: J. Grafman, K. J. Holyoak, & F. Boller (Eds.), Structure and function of the human pre-frontal cortex. Annals of the New York Academy of Sciences, 769, 1–13.
Damasio, A. R. (1985). The frontal lobes. In K. M. Heilman & E. Valenstein (Eds.), Clinical neuropsychology (2nd ed., pp. 409–460). New York: Oxford.
Daubert vs. Merrell Dow Pharmaceuticals, Inc., U.S. 113 S. Ct. 2786 (1993).
Delis, D. C., Kaplan, E., & Kramer, J. H. (2001). Delis–Kaplan executive function system. San Antonio: The Psychological Corporation.
Flowers, K. A., & Robertson, C. (1985). The effect of Parkinson’s disease on the ability to maintain a mental set. Journal of Neurology, Neurosurgery and Psychiatry, 48, 517–529.
Gioia, G. A., Isquith, P. K., Guy, S. C., & Kenworthy, L. (2000). Brief rating inventory of executive function: Professional manual. Lutz: Psychological Assessment Resources.
Grace, J., & Malloy, P. F. (2001). Frontal system behavior scale: Professional manual. Lutz: Psychological Assessment Resources.
Grace, J., Stout, J. C., & Malloy, P. F. (1999). Assessing frontal lobe behavioral syndromes with the Frontal Lobe Personality Scale. Assessment, 6(3), 269–284.
Grafman, J., Litivan, I., Gomez, C., & Chase, T. N. (1990). Frontal lobe functioning in progressive supranuclear palsy. Archives of Neurology, 47, 553–558.
Isquith, P. K., Roth, R. M., & Gioia, G. A. (2005). Behavior rating inventory of executive function—adult version. Lutz: Psychological Assessment Resources.
Jankovic, J., & De Leon, M. L. (2003). Basal ganglia and behavioral disorders. In R. B. Schiffer, S. M. Rao, & B. S. Foge (Eds.), Neuropsychiatry (2nd ed., pp. 934–946). New York: Lippincott, Williams, and Wilkins.
Joseph, R. (1997). Neuropsychiatry, neuropsychology, and clinical neuroscience (2nd ed.). Baltimore: Williams and Wilkins.
Kaufer, D. I., & Cummings, J. L. (1997). Dementia and delirium: An overview. In T. E. Feinberg & M. J. Farah (Eds.), Behavioral neurology and neuropsychology (pp. 499–520). New York: McGraw-Hill.
Lees, A. J., & Smith, E. (1983). Cognitive deficits in the early stages of Parkinson’s disease. Brain, 106, 257–270.
Levine, B., Katz, D. I., Dade, L., & Black, S. E. (2002). Novel approaches to the assessment of frontal damage and executive deficits in traumatic brain injury. In D. T. Stuss & R. T. Knight (Eds.), Principles of frontal lobe function (pp. 448–465). New York: Oxford.
Lezak, M. D. (1982). Problems assessing the executive functions. International Journal of Psychology, 17, 281–297.
Lezak, M. D. (1995). Neuropsychological assessment (3rd ed.). New York: Oxford.
Lezak, M. D. (1997). Principles of neuropsychological assessment. In T. E. Feinberg & M. J. Farah (Eds.), Behavioral neurology and neuropsychology (pp. 43–54). New York: McGraw-Hill.
Lezak, M. D., Howieson, D. B., & Loring, D. W. (2004). Neuropsychological assessment. New York: Oxford.
Maher, E. R., Smith, E. M., & Lees, A. J. (1985). Cognitive deficits in the Steele–Richardson–Olzwewski syndrome (progressive supranuclear palsy). Journal of Neurology, Neurosurgery and Psychiatry, 48, 1234–1239.
Mega, M. S., & Cummings, J. L. (1994). Frontal subcortical circuits and neuropsychiatric disorders. Journal of Neuropsychiatry and Clinical Neurosciences, 6(4), 358–370.
Mesulam, M. M. (1986). Frontal cortex and behavior: Editorial. Annals of Neurology, 19, 320–325.
Meyer, J. S., Finn, S. E., & Eyde, L. D. (2001). Psychological testing and psychological assessment: A review of the evidence and issues. American Psychologist, 56, 128–165.
O’Shanick, G. J., & O’Shanick, A. M. (1994). Personality and intellectual changes. In J. M. Silver, S. C. Yudofsky, & R. E. Hales (Eds.), Neuropsychiatry of traumatic brain injury (pp. 163–188). Washington: American Psychiatric.
Reitan, R. M. (1955). The distribution according to age of a psychologic measure dependent upon organic brain functions. Journal of Gerontology, 10, 338.
Sbordone, R. J. (1996). Ecological validity: Some critical issues for the neuropsychologist. In R. J. Sbordone & C. J. Long (Eds.), Ecological validity of neuropsychological testing (pp. 15–41). Orlando: St. Lucie.
Sbordone, R. J. (1997). The ecological validity of neuropsychological testing. In A. M. Horton, D. Wedding, & J. Webster (Eds.), The neuropsychology handbook, vol. 1: Foundations and assessment (2nd ed., pp. 365–392). New York: Springer.
Sbordone, R. J. (2000). The executive functions of the brain. In G. Groth-Marnat (Ed.), Neuropsychological assessment in clinical practice: A guide to test interpretation and integration (pp. 437–456). New York: Wiley.
Sbordone, R. J., & Guilmette, T. J. (1999). Ecological validity: Prediction of everyday and vocational functioning from neuropsychological test data. In J. J. Sweet (Ed.), Forensic neuropsychology (pp. 227–254). Lisse: Swets and Zeitlinger.
Sbordone, R. J., Seyranian, G. D., & Ruff, R. M. (1998). Are the subjective complaints of brain-injured patients reliable? Brain Injury, 12(6), 505–515.
Sbordone, R. J., Seyranian, G. D., & Ruff, R. M. (2000). The use of significant others to enhance the detection of malingers from traumatic brain-injured patients. Archives of Clinical Neuropsychology, 15, 465–477.
Sbordone, R. J., Saul, R. E., Purisch, A. D. (2007). Neuropsychology for Psychologists, Health Care Professionals, and Attorneys. 3rd edition. Boca Raton: Florida
Silver, J. M., Hales, R. E., & Yudofsky, S. C. (2002). Neuropsychiatric aspects of traumatic brain injury. In S. C. Yudofsky & R. E. Hales (Eds.), American psychiatric press textbook of neuropsychiatry and clinical neurosciences (3rd ed.). Washington: American Psychiatric.
Silver, J. M., Hales, R. E., & Yudofsky, M. D. (2004). Neuropsychiatric aspects of traumatic brain injury. In S. C. Yudofsky & R. E. Hales (Eds.), Essentials of neuropsychiatry and clinical neurosciences (pp. 241–292). Washington: American Psychiatric.
Sohlberg, M. M., & Mateer, C. A. (2001). Cognitive rehabilitation. An integrated neuropsychological approach. New York: Guilford.
Spreen, O., & Strauss, E. (1998). A compendium of neuropsychological tests (2nd ed.). New York: Oxford.
Strauss, E., Sherman, E., & Spreen, O. (2006). A compendium of neuropsychological tests (3rd ed.). New York: Oxford.
Stuss, D. T., & Benson, D. F. (1986). The frontal lobes. New York: Raven.
Wilson, B. A. (1993). Ecological validity of neuropsychological assessment: Do neuropsychological indexes predict performance in everyday activities? Applied and Preventive Psychology, 2, 209–215.
Wilson, B. A., Alderman, N., & Burgess, P. W. (1996). Behavioural assessment of the dysexecutive syndrome. Bury St. Edmunds: Thames Valley Test.
Wood, R. L., & Liossi, C. (2006). The ecological validity of executive tests in a severely brain injured sample. Archives of Clinical Neuropsychology, 21, 429–437.
Zangwill, O. L. (1966). Psychological deficits associated with frontal lobe lesions. International Journal of Neurology, 5, 395–402.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Sbordone, R.J. Neuropsychological Tests are Poor at Assessing the Frontal Lobes, Executive Functions, and Neurobehavioral Symptoms of Traumatically Brain-Injured Patients. Psychol. Inj. and Law 3, 25–35 (2010). https://doi.org/10.1007/s12207-010-9068-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12207-010-9068-x