Chow T W
UCLA Frontotemporal Dementia Clinic, UCLA Alzheimer's Disease Research Center, University of California at Los Angeles, 710 Westwood Plaza, Los Angeles, CA 90095-1769, USA.
Curr Psychiatry Rep. 2000 Oct;2(5):446-51. doi: 10.1007/s11920-000-0031-5.
Personality changes in frontal lobe disorders are easy to recognize, but their evolution can be hard to predict. Both focal lesions and diffuse neurodegenerative processes may produce personality change based on interruption of prefrontal cortex or subcortical structures that comprise the frontal-subcortical circuits. Observed changes in personality have been classified by behavioral neurologists into three frontal-subcortical circuit syndromes, yet a given patient may defy this classification system by manifesting only selective features of one or more syndromes simultaneously, based on the neuroanatomic distribution of pathology. The orbitofrontal syndrome is the most well known and consists of major antisocial behaviors such as disinhibition, emotional lability, and impulsivity. In some cases, changes are severe enough to lead to new onset of criminality. Apathy and amotivational state lie at the other end of the personality change spectrum. Many psychologic instruments can measure the degree of change in personality, but none of them can be used to extrapolate a patient's ability to function at home or at large in society. The psychopathy checklist by Hare may predict risk of violence but has been validated only for use in criminal populations.
额叶疾病中的人格改变易于识别，但其演变却难以预测。局灶性病变和弥漫性神经退行性过程均可基于前额叶皮质或构成额-皮质下环路的皮质下结构的中断而导致人格改变。行为神经学家已将观察到的人格改变分为三种额-皮质下环路综合征，但由于病理的神经解剖分布，特定患者可能会同时仅表现出一种或多种综合征的选择性特征，从而不符合该分类系统。眶额综合征最为人所知，其包括诸如脱抑制、情绪不稳定和冲动等主要反社会行为。在某些情况下，这些改变严重到足以导致新的犯罪行为。冷漠和无动机状态则位于人格改变谱的另一端。许多心理测量工具可测量人格改变的程度，但没有一种可用于推断患者在家中或在社会中的功能能力。哈雷编制的精神病态检查表可能预测暴力风险，但仅在犯罪人群中得到验证。
