Review article

Personality Changes in Traumatic Brain Injury Patients

Jelena Jakšić orcid.org/0000-0002-3520-296X ; School of Medicine, University of Zagreb, Zagreb, Croatia *

* Corresponding author.

Abstract

Traumatic brain injury (TBI) is a major contemporary healthcare problem, and many TBI survivors suffer lifelong disability due to somatic, cognitive, or neurobehavioral sequelae. In this narrative review, we aimed to present a synopsis of the current understanding of TBI and its accompanying personality changes. This topic has been a scientific challenge ever since Phineas Gage fascinated the world with his bizarre frontal lobe injury. Evidence of correlation with neurobehavioral sequelae was found in the damage of prefrontal anatomical circuitry. Functional relationships have been defined: the dorsolateral prefrontal circuit mediates executive functions, the anterior cingulate circuit is involved with motivational mechanisms, and the orbitofrontal circuit is dedicated to emotional and behavioral regulation. The frontopolar area has been isolated as responsible for integrative/meta-cognitive functions. Damage to distinct parts of the prefrontal cortex and said circuitry elicits personality changes encompassed by three syndromes: abulic, dysexecutive, and behavioral. There is still no consensus on the treatment of personality changes following TBI. The approach of grouping some behavioral symptoms into metaphorical syndromes and treating them as such (e.g., depression-like syndrome, irritable mania-like syndrome) has proven useful. Another method is targeted pharmacological treatment of defined prefrontal areas with malfunction after TBI. Deep brain stimulation proved to be a promising new method that allows precise stimulation of deep brain nuclei and the reactivation of prefrontal circuitry. The environmental impact on the rehabilitation process in TBI patients should never be underestimated. The case of Phineas Gage also intrigued the medical world due to the potential recovery of his profound personality changes. The brain's frontal lobe is one of its most naturally plastic and integrated regions. Further focus on understanding its malleability could show great hope for the rehabilitation of TBI survivors and allow them to find their way back to who they used to be.

Keywords

frontal lobe; neuronal plasticity; personality disorders; traumatic brain injuries

Hrčak ID:

353427

URI

https://hrcak.srce.hr/353427

Publication date:

20.12.2024.

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