THE SIGNIFICANCE OF FRONTAL SYSTEM DISORDERS FOR MEDICAL-PRACTICE ANDHEALTH-POLICY

In major chronic diseases, apathy or impaired executive cognitive func tion (ECF) can reduce the patient's ability to cope with the disease a nd its treatment and to maintain personal safety, dignity, and goal-di rected activity. Psychometric and imaging studies support a causal rol e for frontal system dysfunction. The view that frontal system dysfunc tion mediates or aggravates disability in a wide range of psychiatric and nonpsychiatric disorders 1) motivates further research on how ECF deficits interact with specific physical impairments to produce disabi lity; 2) supports policies that base entitlements to care on ECF impai rments; and 3) suggests the need for a vigorous search for drugs that prevent or palliate prefrontal dysfunction, especially the syndromes o f apathy and impaired ECF.