Prefrontal Cortex Damage: Understanding the Adverse Effects & Methods for Recovery

TBI patients with prefrontal cortex damage can experience personality changes and other higher cognitive deficits. Patients with a damaged prefrontal cortex do not usually experience physical impairments, therefore may initially appear to not have any glaring symptoms from their TBI. This can make it more difficult to recognize the cognitive effects, which are often more subtle.

To help you maximize recovery chances, this article will explain the signs and symptoms of prefrontal cortex damage. We’ll also discuss how to promote better cognitive function after a frontal lobe injury.

What is the Prefrontal Cortex?

The prefrontal cortex is located at the anterior part of the brain, directly behind the eyes and forehead. Researchers typically divide the prefrontal cortex into different sub-regions. These include the:

• Dorsolateral cortex
• Ventromedial cortex
• Orbitofrontal cortex

These areas control many diverse functions such as abstract reasoning, decision-making, and goal-oriented behavior. They also play a role in personality expression and creativity.

These skills are known collectively as executive functions. Executive functions are higher cognitive processes that help us control our impulses and act with long-term consequences in mind. They allow us to interact with others in appropriate ways and adjust our behavior to fit the circumstances.

Some more specific examples of executive functions include anticipation, initiation, self-monitoring, and self-correction. Unfortunately, a frontal lobe injury can cause a decrease in most of these functions.

Effects of Prefrontal Cortex Damage

Patients with prefrontal cortex damage do not typically display the classic signs of a brain injury. For example, they can have normal movement and intelligence, and all their senses are usually intact. Therefore, at first glance, they can appear to have made a full recovery from their injury.

However, family members and those close to the patient might notice more concerning changes. A person with damage to the prefrontal cortex might have blunted emotional responses, for instance. They might even become more aggressive and irritable, and struggle to initiate activities. Finally, they might perform poorly on tasks that require long-term planning and impulse inhibition.

Other common effects of frontal cortex damage include:

• decreased empathy
• short-term memory loss or amnesia
• inflexibility and stubbornness
• perseveration

Since these issues are all cognitive in nature, treatment can be a little more complex. However, with the right approach, it is still possible to improve a person’s cognitive function.

Treating Prefrontal Cortex Damage

Treating damage to the prefrontal cortex is difficult and will require help from a cognitive-behavioral therapist. A therapist can teach patients how to deal with their injury in a healthy way. They can also show you specific techniques to manage executive dysfunction.

People with prefrontal cortex damage thrive in a highly structured and organized environment. But actions that require creativity or initiative are harder for them to perform. Therefore, most therapists will try to help the person relearn how to adapt to new situations and create their own structure.

The following are a few ways to accomplish this:

1. Create a routine

Patients with prefrontal cortex damage often struggle to plan or initiate activities on their own. This can unfortunately cause inactivity, which will eventually lead to cognitive and physical decline.

Therefore, to help overcome this inertia, it’s important to create a structured routine. A routine helps patients know “what’s next” without having to come up with something on their own. This minimizes the amount of mental energy they must spend.

If possible, family members should work with the person to create a routine. An occupational therapist can also help create a daily or weekly schedule that includes productive activities.

2. Minimize distractions

Prefrontal cortex damage can also cause problems with attention. Therefore, when trying to finish a task, the best approach is to minimize distractions as much as possible.

This might look different for each person. For example, if loud noises distract the person, they might need to work in their own quiet room. If that is not possible, noise-canceling headphones might be a good alternative.

3. Try Behavioral Therapy

Cognitive-behavioral therapy (CBT) can help patients deal with the emotional and behavioral effects of damage to the prefrontal cortex. Specifically, CBT helps patients learn how to address the negative beliefs that might affect behavior.

Once you discover these beliefs, the therapist will teach you helpful ways to replace negative thoughts with positive ones.  

CBT therapists can also help persons relearn empathy and appropriate social interactions.

4. Practice Task-Sequencing

Another excellent exercise to improve cognitive function after prefrontal cortex damage is called task-sequencing.

To practice task-sequencing, have someone else write down the steps needed to complete a certain activity, such as going to the park. But make sure that these steps are not in the correct order. Your job is to rearrange the steps until they are in the correct order.

As you improve your skills, you can work on more complicated tasks, such as preparing a meal. Finally, you can try writing the steps down on your own.

This exercise can teach how to organize your thoughts and think through a problem clearly.

5. Medication

Finally, some medications used to manage the symptoms of ADHD can help reduce the adverse effects of prefrontal cortex damage. One commonly prescribed drug for TBI patients is Ritalin.

Ritalin, also known as methylphenidate, increases the level of dopamine in the brain. This helps increase motivation and concentration, two skills that many brain injury survivors struggle with.

While medication should not replace other treatments, it can act as a helpful supplement. In fact, many TBI patients have found that drugs such as Ritalin help them regain the motivation they need to continue with their other therapies.

Therefore, if the person’s symptoms do not improve with therapy, ask their doctor if Ritalin or other drugs might be an option.

Understanding Prefrontal Cortex Damage

An injury to the prefrontal cortex can cause problems with complex cognitive skills such as planning and behavior. It can also change the way the person expresses their emotions.

While these issues are difficult to treat, with the right tactics it is still possible to recover many higher cognitive functions and live independently again after brain injury. Make sure to talk to a neuropsychologist for more ideas on how to overcome prefrontal cortex damage.