From the Guidelines
Perseveration is primarily caused by damage to the frontal lobes of the brain, particularly the prefrontal cortex, which controls executive functions like cognitive flexibility and inhibition, often associated with neurodegenerative diseases such as dementia, as noted in a recent literature overview 1. This condition manifests as the uncontrollable repetition of specific behaviors, words, or thoughts beyond their appropriate context.
Common Causes of Perseveration
- Neurodegenerative diseases like Alzheimer's, Parkinson's, and frontotemporal dementia, which can lead to problems with reasoning, communication, decision making, and memory, as discussed in the context of dementia symptomatology 1
- Traumatic brain injuries
- Strokes affecting frontal regions
- Psychiatric disorders such as schizophrenia, OCD, and autism spectrum disorders
- Certain medications, particularly stimulants and antipsychotics
Treatment and Management
Treatment depends on addressing the underlying cause, which may involve:
- Medications like cholinesterase inhibitors for dementia, such as donepezil, rivastigmine, galantamine, and memantine, intended to temporarily reduce or slow down progression of cognitive symptoms 1
- Antipsychotics for schizophrenia, although their use should be carefully monitored due to the risk of adverse effects, including falls, stroke, and death 1
- SSRIs for OCD
- Cognitive rehabilitation therapy to help patients develop strategies to recognize and interrupt perseverative patterns
Neurobiological Basis
The neurobiological basis involves disruption of neural circuits connecting the prefrontal cortex with other brain regions, particularly the basal ganglia, which normally help regulate the initiation and termination of behaviors and thoughts. Given the complexity and variability of perseveration, high-quality, person-centered care, including psychosocial interventions, is now recognized as the first line of prevention and treatment, with medication used as a carefully monitored, short-term, last resort in specific cases 1.
From the Research
Causes of Perseveration
- Perseveration is believed to arise from lesions involving the frontal, temporal, or parietal lobes or subcortical motor regions 2
- Attention and memory deficits are also thought to contribute to the presence of perseveration 2
- Working memory impairments have been identified as a potential cause of perseveration in individuals with traumatic brain injury (TBI) and Alzheimer's disease (AD) 3, 4
- In TBI, perseveration may be related to failures in working memory, inhibitory control, or word retrieval 3
- In AD, perseveration has been linked to the progressive deterioration of different brain regions, including those involved in working memory and executive function 4
Underlying Mechanisms
- Neuroinflammation and oxidative stress have been implicated in the development of perseveration and other neurodegenerative symptoms after TBI 5, 6
- Glutamatergic excitotoxicity has also been suggested as a potential mechanism contributing to perseveration and neurodegeneration 6
- The deposition of phosphorylated tau protein has been observed in individuals with chronic traumatic encephalopathy, a condition characterized by perseveration and other neurobehavioral changes 5
Associated Conditions
- Perseveration has been observed in individuals with TBI, AD, and other neurodegenerative diseases 2, 3, 4
- The presence of perseveration has been linked to poorer outcomes and slower rates of progress in individuals with TBI 2
- Perseveration has also been associated with increased risk of neurodegeneration and chronic neurological and neuropsychiatric sequelae after TBI 5, 6