Amen Clinic Brain System Handout
Daniel G. Amen, MD, Amen Clinics, Inc.
The following handout is a compilation of the work done at the Amen Clinics. Please use this as a reference to
understand the different brain systems as they relate to function, problems and treatments. We revise this handout
as new information is available.
Prefrontal Cortex (PFC)
top down surface view left side surface view underside surface view
PFC Functions PFC Problems PFC Behavioral Treatments
Coaching/goal setting Organizational help
PFC Dorsal lateral Intense aerobic exercise Relationship counseling
Attention Inattention Stimulating activities Higher protein diet
Planning Lack of forethought Neurofeedback HBOT, rTMS
Follow through Procrastination
PFC Supplements
PFC Inferior orbital
Focus and Energy
Impulse control Impulsive
Zinc (for hyperactivity)
Inhibition Disinhibited
Attention Support for Kids/Teens
Judgment Poor judgment
Mood support – SAMe (SAMe Mood and Movement)
Empathy Lack of empathy
Fish oil – Omega 3 Power
Ethics Lack of ethics
Morality
PFC Meds
Some Conditions Affecting the PFC For ADD – stimulants, such as Adderall or Ritalin, or
ADHD Depression Stratterra
Brain Trauma Dementia For Depression – Wellbutrin
Schizophrenia Antisocial PD For Low Energy – Provigil
Conduct disorders Borderline PD For Psychosis -- Abilify
Positives w/low PFC activity: Spontaneous, risk taking, creative, “out of the box,” curious, wide interests
Decreases in the PFC during concentration is often associated with impulsivity, short attention span, distractibility
and difficulties with organization and planning. We have seen a strong correlation between this finding and ADHD
and ADD, especially when this occurs during the performance of a concentration task. When decreased activity in
the PFC is seen during a resting state, it is often associated with depressive disorders, and may be responsive to
antidepressant medication. When it is seen in both the resting and concentration states there may be a combination
of depression and ADD or ADHD present. Clinical correlation is always needed. This pattern has also been seen in
response to head injuries affecting this part of the brain, and later in life in some dementia processes.
Copyright 2021 Amen Clinics, Inc. All rights reserved 1
No portion of this document may be reproduced in any form without the written consent of Amen Clinics, Inc.
Amen Clinic Brain System Handout
Daniel G. Amen, MD, Amen Clinics, Inc.
Anterior Cingulate Gyrus (ACG)
top down active view left side active view underside active view
ACG Functions ACG Problems ACG Behavioral Treatments
Brain’s gear shifter Gets stuck, Trouble shifting Distraction, Paradox, Options
Cognitive flexibility Inflexible , worries Cognitive/behavioral strategies
Cooperation Holds grudges, oppositional Intense aerobic exercise
Go from idea to idea Obsesses Lower protein/complex carbs diet
See options Compulsions
Go with the flow Argumentative ACG Supplements
Error detection Excessive error detection Worry and Insomnia – Serotonin Mood Support
Area 25 – mood states, activates GI system
Mood – Serotonin Mood Support, Happy Saffron
Area 24v – emotional attention, communicates with limbic system Anxiety – DHA Omega-3s
Area 24g (genu) -- attention to cold cognition Fish oil – Omega 3 Power
Area 24d – activated in nearly all cognitive tasks, focus to detail
Area 24d more posterior – error detection ACG Meds
Middle Cingulate – response to pain, also insular cortex
Posterior Cingulate – visual memory, visual attention, response to For Worry, Anxiety and Depression – SSRIs, such as
pain, posterior part has access to hippocampus and memory circuit Lexapro, Paxil, Zoloft, Celexa, Prozac, and Luvox
Effexor or Cymbalta if also low PFC
Some Conditions Affecting the ACG Atypical antipsychotics in refractory cases
OCD Anxiety disorders
Addictions PMS
Eating Disorders Chronic pain
PTSD Oppositional Defiant
Positives w/high AC activity: Persistent, strong-willed, likes routine, consistent
Increased AC is often associated with problems shifting attention which may be clinically manifested by cognitive
inflexibility, obsessive thoughts, compulsive behaviors, excessive worrying, argumentativeness, oppositional
behavior or "getting stuck" on certain thoughts or actions. We have seen a strong association with this finding and
obsessive-compulsive disorders, oppositional defiant disorders, eating disorders, addictive disorders, anxiety
disorders, Tourette's syndrome and chronic pain (especially when combined with increased basal ganglia activity).
If clinically indicated, hyperactivity in this part of the brain may be helped by anti-obsessive antidepressants that
increase serotonin. Certain forms of behavior modification techniques have also been found to help lessen activity
in this part of the brain. When this area is low in activity it is often associated with low motivation and verbal
expression. Clinical correlation is always needed.
Copyright 2021 Amen Clinics, Inc. All rights reserved 2
No portion of this document may be reproduced in any form without the written consent of Amen Clinics, Inc.
Amen Clinic Brain System Handout
Daniel G. Amen, MD, Amen Clinics, Inc.
Basal Ganglia System (BGS)
top down active view left side active view underside active view
BG Functions BG Problems BG Behavioral Treatment
Body biofeedback ANT therapy
Caudate
Hypnosis, meditation Relaxing music
Sense of calm Tension, nervousness
Assertiveness training Limit caffeine/alcohol
Sets anxiety level Anxiety/panic
EMDR
Conflict avoidance Predicting the worst
Putamen BG Supplements
Motor related Tremors/tics Anxiety – GABA Calming, Everyday Stress Relief,
Magnesium Chewables
Nucleus Accumbens Fish oil (Omega 3 Power)
Mediates pleasure Addiction
** ventral striatum has to do with BG Meds
limbic/emotional/neuroendocrine regulation, For Anxiety – Buspar, anti-seizure meds, some
while dorsal caudate is more related to dorsal blood pressure meds, such as propranolol may help,
PFC/executive and 'cold' cog functions benzodiazepines (low dose, short time)
Some Conditions Affecting the BGS
Anxiety Disorders Tourette’s/tics
OCD PTSD
Movement disorders
Positives w/high BG activity: Prepared, cautious, risk-averse, motivated
Increased basal ganglia activity is often associated with anxiety (left sided problems are often associated with
irritability, right sided problems more often associated with inwardly directed anxiety). Often, we have seen
increased activity in this part of the brain in our normal population as well. We have seen increased activity
associated here with increased motivation. Clinical correlation is needed. We have seen relaxation therapies, such
as biofeedback and hypnosis, and cognitive therapies help calm this part of the brain. If clinically indicated, too
much activity here may be helped by anti-anxiety medications, such as buspirone. Sometimes, if the finding is
focal in nature (more one side than the other), anticonvulsant medications can also he helpful.
Copyright 2021 Amen Clinics, Inc. All rights reserved 3
No portion of this document may be reproduced in any form without the written consent of Amen Clinics, Inc.
Amen Clinic Brain System Handout
Daniel G. Amen, MD, Amen Clinics, Inc.
Deep Limbic System/Thalamus (DLS)
top down active view left side active view underside active view
DLS Functions DLS Problems DLS Supplements
Mood control Depression Mood – Happy Saffron, SAMe, DL-phenylalanine,
Motivation Poor motivation L-tyrosine
Attitude Poor attitude Fish oil (Omega 3 Power)
Appetite/sleep Sleep/appetite issues Cyclic Mood Changes – Fish oil, GABA Calming
Bonding Tends to isolate For Pain - SAMe
Sense of smell Lack of smell
Libido Negativity, guilt DLS Meds
Hopelessness For Depression – antidepressants, such as
Wellbutrin, Effexor or Cymbalta, SSRIs (if
Some Conditions Affecting the DLS
high ACG also present);
Depression Cyclic mood disorders
Cyclic Mood Changes -- anticonvulsants or
Pain syndromes
lithium
Behavioral Treatments For Pain -- Cymbalta
Cognitive-behavioral strategies
Biofeedback, increase left prefrontal activity
Intense aerobic exercise, Relationship counseling
Increased protein diet – The Zone
Positives w/high DLS activity: Sensitive, deeply feeling, empathic
Increased activity in the DLS can be associated with mood issues. Left-sided problems are often associated with
anger and irritability, right sided problems more often associated with inwardly directed sadness. In our experience
we have seen diffuse DLS overactivity tends to be more consistent depression and focal increased DLS activity
(more on one side than the other) to be associated with cyclic mood disorders. When focal increased uptake is
found in conjunction with patchy increased uptake across the cortical surface there is a higher likelihood of a
cyclothymic or bipolar disorder. If clinically indicated, diffuse increased DLS uptake is often helped by
antidepressant medications. If there is also increased anterior cingulate activity consider a serotonergic
antidepressant. If there is not increased anterior cingulate activity consider an antidepressant which increases either
dopamine (such as buprion) or norepinephrine (such as imipramine or desipramine). We use anticonvulsants or
lithium to help with focal DLS hyperactivity when a cyclic mood clinical pattern is present. We have also seen
increased activity in this part of the brain in our normal population. Clinical correlation is needed.
Copyright 2021 Amen Clinics, Inc. All rights reserved 4
No portion of this document may be reproduced in any form without the written consent of Amen Clinics, Inc.
Amen Clinic Brain System Handout
Daniel G. Amen, MD, Amen Clinics, Inc.
Temporal Lobes (TLs)
left side surface view underside surface view
TL Functions TL Problems TL Behavioral Treatments
Biofeedback to stabilize TL function
Amygdala Emotional valence
Relationship counseling, anger management
Emotional reactions Mood stability
Ketogenic diet
Moodiness, irritability Temper control
HBOT
Anger, anxiety, fears, Phobias, dark thoughts
Hippocampus TL Supplements
Memory Forgetfulness For Mood Stability, Irritability or Anxiety – GABA
Calming, valerian, fish oil (Omega 3 Power)
Lateral Language
Trouble finding words Listening For Memory – Brain and Memory Power Boost (gingko
Processing problems Reading and vinpocetine for blood flow, huperzine A for
Poor reading Read social cues acetylcholine, phosphatidylserine (PS), NAC, and alpha
Poor social skills Rhythm, music lipoic acid
Rhythm problems Spiritual experience
Unusual experiences Religiosity TL Meds
?? Sexual addiction For Mood Stability, Irritability and Anxiety – anti-
Inferior Recognize faces seizure medications: Lyrica, Neurontin for anxiety,
irritability and pain; Lamictal and Depakote for bipolar
Some Conditions Affecting the TLs symptoms
Head injury Dissociation
Anxiety Temporal epilepsy For Memory -- memory enhancing medications for
Amnesia Serious depression more serious memory problems, such as
Left side – aggression, dyslexia Namenda, Aricept, Exelon or Reminyl
Right side – autistic spectrum disorders
Abnormal TL (either increased or decreased) activity may be associated with mood instability, irritability,
memory struggles, abnormal perceptions (auditory or visual illusions, periods of deja vu), periods of
anxiety with little provocation, periods of spaciness or confusion, and unexplained headaches or
abdominal pain. Left sided problems are more associated with irritability and dark thoughts, right sided
more with anxiety and social struggles. Anticonvulsant medications often help with TL problems.
Decreased activity in the posterior aspects of the left temporal lobes, in our experience is often, although
not always, associated with language learning problems, especially reading and auditory processing
problems. Memory loss is often associated with decreased activity in the medial temporal lobes.
Copyright 2021 Amen Clinics, Inc. All rights reserved 5
No portion of this document may be reproduced in any form without the written consent of Amen Clinics, Inc.
Amen Clinic Brain System Handout
Daniel G. Amen, MD, Amen Clinics, Inc.
Cerebellum (CB)
left side surface view underside surface view
CB Functions Some Conditions Affecting CB
Motor control Trauma
Posture, gait Alcohol abuse
Executive function, connects to PFC Autism, Asperger’sADHD
Speed of cognitive integration (like clock
speed of computer) CB Treatments
Prevention of brain injury
CB Problems Stop alcohol use or other toxic exposure
Gait/coordination problems Occupational Therapy
Slowed thinking Maximize brain nutrition
Slowed speech Hyperbaric Oxygen Therapy
Impulsivity Interactive Metronome
Poor conditioned learning Coordination exercises such as dance or table tennis
The cerebellum is usually the most active part of the brain and is usually symmetrical in appearance.
When it is low in activity it has been associated with ADD, autism, brain trauma, toxic exposure, and
judgment or impulsivity issues.
Copyright 2021 Amen Clinics, Inc. All rights reserved 6
No portion of this document may be reproduced in any form without the written consent of Amen Clinics, Inc.
Amen Clinic Brain System Handout
Daniel G. Amen, MD, Amen Clinics, Inc.
Parietal Lobes (PLs)
left side surface view top down surface view
PL Functions PL Problems Some Conditions Affecting PLs
Direction sense Gets lost easily Trauma
Create and read maps Poor map reading Toxic exposure
Sense of touch Oversensitive Infection
Spatial processing Poor spatial processing Anoxia
Sees objects in space Poor tracking Substance abuse
Visual guidance Poor visual guidance Alzheimer’s Disease
Distinguish L from R RL Confusion
PL Treatments
R - Personal ownership Unilateral neglect, Prevention of brain injury/toxic exposure
Construction apraxia Occupational Therapy
Admitting a problem Denial Sensory Integration Therapy
L – Spatial cognition Calculation, writing, Maximize brain nutrition
reading Hyperbaric Oxygen Therapy.
Increased activity in the PLs often indicates hypersensitivity to noise, touch and taste. The parietal lobes
have also been implicated in attentional issues and distractibility (too much stimulation comes in). In
addition, when there is both sided parietal lobe and frontal lobe activity it is often associated with a
pattern we call the ring of fire. Decreased activity in the PLs may be associated with trauma, toxicity, or
memory loss.
Copyright 2021 Amen Clinics, Inc. All rights reserved 7
No portion of this document may be reproduced in any form without the written consent of Amen Clinics, Inc.
Amen Clinic Brain System Handout
Daniel G. Amen, MD, Amen Clinics, Inc.
Toxicity/Scalloping
top down surface view left side surface view underside surface view
Toxicity/Scalloping Toxicity/Scalloping Treatments
On scans toxicity shows up as scalloping, Eliminate offending agent(s)
bumpy or irregular appearance Maximize brain nutrition
Hyperbaric Oxygen Therapy
Toxicity/Scalloping Causes Brain healthy strategies to consider:
Drug or alcohol abuse/exposure • Both physical & mental exercise
Environmental toxic exposure (paint fumes, solvents, • Avoid behaviors risky for brain injury
metals, pesticides, pollution, mold, etc.) • Omega-3 fatty acids
Oxygen deprivation • Alpha lipoic Acid, 100-300mg 2XD
Brain infections • Multiple vitamin
Cancer chemotherapy • Vitamin E 100 IUs 2XD and Vitamin C
Anesthesia/surgery 1,000mg 2XD as antioxidants
Metabolic issues (thyroid, liver, kidney) • Brain and Memory Power Boost 3 2XD
• Coenzyme Q10 (CoQ10) help with energy/
Toxicity/Scalloping Symptoms (depends on memory, especially if Parkinson’s disease is
system affected) present or in family. 100 – 400 mg/day
Cognitive problems (attention and memory)
Fatigue
Irritability
Prefrontal, temporal, and/or parietal lobe symptoms
Toxicity or scalloping is often seen on scans and may be due to a number of causes, such as substance
abuse, environmental toxins, oxygen deprivation, infections, etc. Scans cannot date the time of exposure,
but say if there is increased likelihood that they occurred. When toxicity is present it is critical to
eliminate the offending agent and work to regain the best brain health possible.
Copyright 2021 Amen Clinics, Inc. All rights reserved 8
No portion of this document may be reproduced in any form without the written consent of Amen Clinics, Inc.
Amen Clinic Brain System Handout
Daniel G. Amen, MD, Amen Clinics, Inc.
Physical Brain Trauma Patterns
top down surface view underside surface view underside surface view
Physical Brain Trauma Patterns Physical Brain Trauma Treatments
Brain trauma can show in many different ways Eliminate risk for future injuries
on scans. Typically, there is: Maximize brain nutrition
• Focal areas of decreased activity in the Hyperbaric Oxygen Therapy
prefrontal cortex, temporal lobes, parietal Neurofeedback over damaged area
lobes, occipital lobes Brain healthy strategies to consider:
• Decreased prefrontal pole • Both physical & mental exercise
• Decreased anterior temporal poles • Avoid behaviors risky for brain injury
• Decreased temporal lobes • Omega-3 fatty acids
• Focal areas of increased activity • Brain and Memory Power Boost 3 2XD
• Off center anterior cingulate activity • Multiple vitamin
• Coenzyme Q10 (CoQ10) help with energy/
Trauma Causes memory, especially if Parkinson’s disease is
Blunt force present or in family. 100 – 400 mg/day
Whiplash injuries
Acceleration/deceleration injuries
Falls, sports, motor vehicle accidents
** loss of consciousness may not be present
Trauma Symptoms (depends on system
affected)
Cognitive problems (attention and memory)
Fatigue
Irritability
Prefrontal, temporal, parietal lobe symptoms
Physical brain trauma is more common than people realize. We often see damage on scans of what most
people would consider minor brain trauma. Scans cannot date the time of the trauma, but say if there is
increased likelihood that they occurred. When trauma is present it is critical to eliminate future risk and
work to regain the best brain health possible.
Copyright 2021 Amen Clinics, Inc. All rights reserved 9
No portion of this document may be reproduced in any form without the written consent of Amen Clinics, Inc.
