7.1 Frontal Lobe Dysfunction

Describe frontal lobe dysfunction in a patient with ABI.

The following may be seen in the frontal lobe syndrome:

  1. Impaired concentration
  2. Reduced fluency of speech
  3. Apathy
  4. Inattentiveness
  5. Delayed responses to questions
  6. A striking lack of inhibition, including socially inappropriate behavior (anger, agitation, aggression) 1
  7. Depression 2

7.1.1  Mini-Mental State Examination

What is the Mini Mental State Examination (MMSE)?

  1. The MMES provides a quantitative assessment of cognitive impairment and provides a record of cognitive changes over time 3.
  2. Although the tool was originally developed to assist in the detection of dementia within a psychiatric setting, it use is now more widespread.
  3. To view the MMSE go to: endnotes.tripod.com/MMSE.pdf

What are the advantages of using the MMSE?


1.    It can be completed in a very short period of time (10 minutes);

2.    It’s brief, inexpensive and simple to administer;

3.    It is widely used; and

4.    Its widespread use and accepted cut-off scores increase its interpretability.

What are the disadvantages of the MMSE?

  1. Low levels of sensitivity have been reported, particularly among individuals with mild cognitive impairment and patients with right sided strokes 4-6.
  2. The low level of sensitivity may be derived from the emphasis placed on language items and a paucity of visual-spatial items 5;7;8.
  3. The MMSE has been shown to be affected by age level of education and sociocultural background which may lead to miscalculation.
  • The test included 6 domains of cognition: orientation, registration of new information, attention and calculation, recall, language and visuospatial construction 11, and yields a total score of 30. 
  • Once completed a picture of the subject’s present cognitive performance based on direct observation of test items/tasks. 
  • A score of 23/24 is the generally accepted cutoff point indicating the presence of cognitive impairment 6.
  • Levels of impairment have also been classified as none (24-30); mild (18-24) and severe (0-17) 4.
  • An acceptable cut-off for the identification of the presence of an impairment may be possible only when the test is used as a measure of “cognitive impairment” 12.


For a more detailed discussion on the MMSE post ABI, please see ERABI/Assessment of Outcomes Following Acquired /Traumatic Brain Injury.

7.1.2 Montreal Cognitive Assessment (MoCA)

What is the Montreal Cognitive Assessment (MoCA)?

1.    The MoCA is an assessment tool designed to detect mild cognitive impairment.


For permission to use the MoCA click here: http://www.mocatest.org/permission.html

To view the MoCA click here.

What are the advantages and disadvantages of using the MoCA?


  1. The MOCA is able to detect mild forms of impairment in patients that score in the normal range on other assessment measures (e.g. the MMSE).


  1. The validity of the MoCA has not been thoroughly tested.
  • The MoCA uses tasks such as picture naming, clock drawing, and recall to assess the following domains: attention and concentration, executive functions, memory, language, visuoconstructional skills, conceptual thinking, calculations, and orientation.
  • The MoCA yields a total score out of 30 with scores of 26 or lower indicating the presence of cognitive impairment.


For more details in using the MoCA post ABI please see ERABI/Assessment of Outcomes Following Acquired/Traumatic Brain Injury.