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PubMed1999

Executive function in schizophrenia.

Many domains of executive function are impaired in patients with schizophrenia including forward planning, concept formation, initiation, self-monitoring, and the ability to direct attention and memory. These impairments are noticeable against a background of generalized cognitive deficits, and many affect 40% to 95% of individuals with this disorder. Specific executive deficits appear to be related to specific symptom clusters and are linked to structural and functional brain abnormalities. Executive impairment predicts multiple domains of functional outcome in schizophrenia patients. Atypical antipsychotic agents and cognitive rehabilitation may be promising new approaches for the treatment of cognitive and functional impairment in schizophrenia.

Antipsychotic Agents↗

PubMed2004

Executive function impairment in early-treated PKU subjects with normal mental development.

Executive functions were studied in 14 early and continuously treated PKU subjects (age 10.8 years, range 8-13) in comparison with controls matched for IQ, sex, age and socioeconomic status. Brain MRI examination was normal in all PKU patients. Neuropsychological evaluation included Wisconsin Card Sorting Test, Rey-Osterreith Complex Figure Test, Elithorn's Perceptual Maze Test, Weigl's Sorting Test, Tower of London, Visual Search and Motor Motor Learning Test. Whatever the IQ, PKU subjects performed worse than controls in tests exploring executive functions. Subgrouping the PKU subjects according to the quality of dietary control for the entire follow-up period (using 400 micromol/L as cut-off value for blood phenylalanine (Phe) concentration) showed that patients with worse dietary control performed more poorly than both the PKU group with the best dietary control and the control group. However, a mild impairment of executive functions was still found in PKU patients with a good dietary control (Phe <400 micromol/L) compared to controls. Concerning the PKU group as a whole, no linear correlation was found between neuropsychological performance and historical and concurrent biochemical parameters. We conclude that (a) PKU patients, even when treated early, rigorously and continuously, show an impairment of frontal lobe functions; (b) a protracted exposure to moderately high levels of Phe can affect frontal lobe functions independently of the possible effect of the same exposure on IQ; (c) in order to reduce the risk of frontal lobe dysfunction, the target of dietary therapy should be to maintain blood Phe concentration below 400 micromol/L.

Adolescent↗

PubMed2002

Validity of the behavior rating inventory of executive function in children with ADHD and/or Tourette syndrome.

The dynamic, multidimensional nature of executive function (EF), thought to be characteristically impaired in those with attention deficit hyperactivity disorder (ADHD), has been challenging to operationalize and assess in a clinical setting [Barkley, R. A. (1997). ADHD and the nature of self-control. New York: Guilford Press.]. Gioia, Isquith, Guy, and Kenworthy [Gioia, G. A., Isquith, P. K., Guy, S. C., & Kenworthy, L. (2000) Behavior Rating Inventory of Executive Function. Odessa, FL: Psychological Assessment Resources.] developed the Behavior Rating Inventory of Executive Function (BRIEF) to address these concerns. In order to provide concurrent validity information on the BRIEF, parents of 76 children (ADHD=18; Tourette syndrome (TS)=21; TS+ADHD=17; controls=20) completed the BRIEF, additional behavior rating scales and interviews, measures of psychoeducational (PE) competence, and performance-based measures of EF. Both ADHD and TS+ADHD groups were rated as more impaired (P<.0001) than the other groups on the five primary BRIEF indices. BRIEF index scores showed no significant correlation with performance-based EF or PE measures, with the exception of math achievement; however, the BRIEF showed a strong relationship with interviews and other parent rating measures of behaviors seen in ADHD. Future attempts to validate the BRIEF should focus on differences within subtypes of ADHD (e.g., inattentive, combined subtypes), and separating ADHD from other clinical groups in which EF is reported to be a problem.

Journal Article↗

PubMed1999

Differential patterns of executive function in children with attention-deficit hyperactivity disorder according to gender and subtype.

The present investigation examined differential patterns in executive functions of children with attention-deficit hyperactivity disorder (ADHD; no diagnosed comorbid disorders) according to subtype and gender, and identified instrumentation sensitive to executive function in children aged 6 to 12 years with ADHD. Data were obtained from 94 children diagnosed with ADHD (predominantly inattentive, n = 32, ADHD combined, n = 62), and from 28 controls. Participants with ADHD, who were unmedicated at the time of testing, were administered five tests of executive function (the Wisconsin Card Sorting Test, the Stroop Color-Word Test, the Matching Familiar Figures Test, the Trail Making Test, and the Tower of London). A two-way multivariate analysis of covariance with age as the covariate and subtype and gender as the independent variables was conducted on all of the tests administered. While children with ADHD predominantly inattentive and those with ADHD combined differed from controls, it was only the latter subtype that differed significantly in perseveration and response inhibition. The absence of diagnosed comorbidity in the children with ADHD at the time of test administration demonstrates that the impairments in executive function are clearly located in ADHD, particularly in the ADHD combined subtype, thus providing support for Barkley's proposed unifying theory of ADHD.

Attention Deficit Disorder with Hyperactivity↗

PubMed2002

Contribution of specific cognitive processes to executive functioning in an aging population.

The current study investigated executive function measures emphasizing Alpha Span (ASp) to understand relationships among executive and nonexecutive tasks. Nondemented older participants (N = 417) received a comprehensive cognitive battery. Age and vocabulary adjusted correlations revealed associations among ASp, Wechsler Adult Intelligence Scale--Revised (D. Wechsler, 1981) Digit Span subtests, and fluency tasks. Principal-components analysis with varimax rotation revealed a 4 component solution (86.4% of the variance) with executive variables contributing to all loadings. Calculated component indices were submitted to a regression analysis predicting ASp performance. After accounting for age (6.3% of the variance), Component 3 reflecting brief attention-mental manipulation accounted for 13.4% of ASp variance; Component 1, verbal language ability, 11.5%; Component 2, sustained attention-mental tracking, 1.9%; and Component 4, visuoperceptual spatial organization-planning, 0.9%. Results stress the importance of considering executive and nonexecutive aspects of cognition when conceptualizing executive functioning.

Aged↗

PubMed2006

Differential impact of executive function on visual memory tasks.

Despite their common use in neuropsychological evaluation, little is known about the differential contribution of executive functioning to visual memory tests. In this study, hierarchical regression was used to determine the role of executive functioning on the Visual Reproduction subtest of the Wechsler Memory Scale--Third Edition, and the Rey-Osterrieth Complex Figure (ROCF) in a mixed neurological sample of 193 patients. Executive functioning was predictive of Visual Reproduction but not ROCF recall variables after accounting for demographic variables and global cognitive functioning. Only executive tests with a visuospatial component, the Trail-Making Test Part B and Wisconsin Card Sorting Test perseverative responses, were predictive of recall of Visual Reproduction stimuli. Organization of the ROCF was predictive of both Visual Reproduction and ROCF recall. These findings increase our understanding of the executive contribution to two common visual memory tests and may aid in the clinical interpretation of seemingly discrepant visual memory performance.

Adult↗

PubMed2000

Metaphors and models of executive functioning: comment on Giancola (2000).

Clinical researchers have become increasingly interested in considering the role of normal and impaired executive functioning in psychopathology. The concept of executive functions is, however, often used as a metaphor for a wide range of operations that may, on the one hand, be distinct from one another, but also may be integrated in various ways under different information-processing conditions. A clinician's perspective of executive functioning should take full advantage of the rich body of data and theory that has developed in contemporary cognitive neuroscience around functions such as forms of inhibition and controlled (in contrast to automatic) functions, in a variety of cognitive domains such as making decisions and tracking performance.

Aggression↗

PubMed2006

Executive functions in attention-deficit/hyperactivity disorder.

OBJECTIVE: To examine the association between weaknesses in executive functions and attention-deficit/hyperactivity disorder (ADHD). METHOD: Empirical studies examining executive functions in ADHD samples were reviewed, with particular attention to results of recent meta-analyses. RESULTS: ADHD is associated with impaired performance on measures of response inhibition, working memory, and other aspects of executive functions, yet data also suggest significant neuropsychological variability within and across ADHD samples. CONCLUSION: ADHD may be best conceptualized as a neuropsychologically heterogeneous condition. More work is needed to characterize this heterogeneity and its clinical and pathophysiologic implications.

Attention↗

PubMed2006

Sustained attention and executive functions in euthymic young people with bipolar disorder.

BACKGROUND: Persistent neuropsychological impairments have been reported in the euthymic phase of bipolar affective disorder. However, the findings have been confounded by multiple episodes, chronic illness and residual mood symptoms. AIMS: To assess sustained attention and executive functioning in euthymic young people with bipolar I disorder who had had no more than two affective episodes. METHOD: Thirty euthymic patients (with illness duration of less than 5 years and no more than two affective episodes) and 30 matched healthy individuals were assessed for sustained attention and executive functioning. RESULTS: The bipolar group (mean age 22.4 years, s.d.=2.52; duration of illness 20.87 months, s.d.=14.72), showed impairment on tasks of attention and executive functioning. Multivariate logistic regression analysis demonstrated that deficits in executive functioning differentiated cases from controls. There was no correlation between residual depressive symptoms and neuropsychological performance. CONCLUSIONS: Deficits in attention and executive functioning were present in young people who had experienced only a few episodes of bipolar disorder, suggesting that the deficits are possibly trait abnormalities. Whether these deficits worsen with progression of illness needs to be examined in longitudinal studies.

Adult↗

PubMed2001

Executive function in fluency and recall measures among children with Tourette syndrome or ADHD.

This study assessed two relevant aspects of executive dysfunction in children with either Tourette syndrome (TS) or ADHD. Process variables derived from existing neuropsychological measures were used to clarify the executive function construct. Clustering of responses on measures of verbal fluency, figural fluency, and verbal learning was examined to assess strategic response organization. Rule breaks, intrusions, and repetition errors were recorded to assess inhibition errors. No significant differences were found among the three groups (TS, ADHD, and controls) on tasks of response organization (clustering). In our sample, both the ADHD and the TS groups were largely free from executive function impairment, and their performance on the fluency and list learning tasks was in the average range. There was a significant group difference on one of the disinhibition variables, with both TS and ADHD groups showing significantly more intrusions on verbal list learning trials than controls. When more traditional total score variables were analyzed among the three groups, there were no significant differences; however, analysis of effect size revealed medium-to-large effect sizes for Letter Word Fluency total score differences (ADHD vs. controls), and for Semantic Word Fluency total score differences (ADHD vs. TS), with the ADHD group having weaker performance in both comparisons. Results provide some support for the use and analysis of process variables-particularly those related to inhibition and intrusion errors, in addition to the total score variables when assessing executive function deficits in children with ADHD and TS. While group differences may be found, children with uncomplicated TS should not routinely be considered to have significant executive function impairments, and when deficits are found, they may be attributable to other comorbid disorders.

Attention Deficit Disorder with Hyperactivity↗

PubMed2004

Executive functions in children aged 6 to 13: a dimensional and developmental study.

A cross-sectional study using 92 children aged 6 to 13 years investigated the dimensionality and the development of executive functioning. The measures were drawn from developmentally relevant conceptualizations of executive functioning and included a go/no-go task, a verbal fluency task, a continuous performance task, a Stroop-like task, a hand movements task, and a digit span task. Analyses revealed 3 dimensions interpreted as Disinhibition, Speed/arousal, and Working memory/Fluency. Age and sex differences were analyzed for the delineated functions, which means that the results may be taken to represent age effects at the level of specific processes within the executive domain rather than on single tests. Age-dependent changes in children's performance on all 3 dimensions were demonstrated, with 3 particularly active stages of maturation: early childhood (6-8 years of age), middle childhood (9-12 years of age), and during early adolescence. Sex differences were only found for the speed/arousal dimension. The results are discussed in terms of 2 developmental executive function frameworks (Barkley, 1997b; Roberts & Pennington, 1996), where inhibition and the interaction between inhibition and working memory, respectively, are seen as key in the development of executive functioning.

Adolescent↗

PubMed2004

Executive function and ADHD: a comparison of children's performance during neuropsychological testing and real-world activities.

OBJECTIVE: Current understanding of executive function deficits in Attention-Deficit/Hyperactivity Disorder (ADHD) is derived almost exclusively from neuropsychological testing conducted in laboratory settings. This study compared children's performance on both neuropsychological and real-life measures of executive function and processing speed. METHOD: The Stroop and Wisconsin Card Sorting Task (WCST) were selected as neuropsychological measures, whereas route tasks in a videogame and at the zoo were used to index real-life measures. Participants comprised a community sample of 22 unmedicated boys with ADHD individually matched on age and IQ with 22 normally developing control boys. RESULTS: There were no group differences in executive function on the Stroop or zoo tasks, but the ADHD group exhibited deficits in set-shifting as assessed by the WCST (perseverative errors and responses) and videogame play (fewer challenges completed). Also, the ADHD group showed slowed processing speed on the Stroop (slower color naming) and zoo activity (longer time to complete task), as well as a slower rate of acquisition of the sorting rule on the WCST (more trials to complete first category). Efficient and flexible videogame play (number of challenges completed) was related positively to efficacy on the Stroop (number of items named correctly in the interference and two control conditions) and inversely related to set-shifting problems on the WCST (perseverative responses and errors). Also, problems in goal-directed behavior at the zoo (number of deviations from designated route) were related to problems in set-shifting on the WCST (perseverative responding). CONCLUSIONS: Children with ADHD exhibit impairments in executive function and processing speed in real-world activities as well as in neuropsychological testing. Cognitive deficits detected by standardized neuropsychological testing are related to performance difficulties in real-world activities.

Attention Deficit Disorder with Hyperactivity↗

PubMed2001

Adult age differences in self-ordered pointing task performance: contributions from working memory, executive function and speed of information processing.

This study investigated adult age differences in, and predictors of, the performance of a test of executive function, the Self-Ordered Pointing Task (SOPT; Petrides & Milner, 1982). Performance on the SOPT is thought to rely on high level working memory processes, therefore, measures reflecting the common operationalization of working memory, along with measures of executive function and speed of information processing, were investigated as predictors of SOPT performance. Younger (aged 17-48 years) and older (aged 65-88 years) adults completed a 16-item, 3-trial, modified version of Shimamura and Jurica's (1994) version of the SOPT, and tests assessing working memory, executive function and speed. Results showed that younger adults made fewer errors on the SOPT. There was no age difference in the frequency of use of a clustering strategy. Contrary to expectations, working memory was not a good predictor of individual or age differences in SOPT performance. Instead, speed of processing, and to a lesser extent, measures of perseverations, made larger unique and overlapping contributions to the variance. The SOPT and its association, or dissociation, with other measures of working memory may be useful for research into the nature of working memory and executive function and the theoretical links between them.

Adolescent↗

PubMed2006

Mesocortical dopamine modulation of executive functions: beyond working memory.

RATIONALE: Dopamine (DA) neurotransmission in the prefrontal cortex (PFC) is known to play an essential role in mediating executive functions such as the working memory. DA exerts these effects by acting on D1 receptors because blockade or stimulation of these receptors in the PFC can impair performance on delayed response tasks. However, comparatively less is known about dopaminergic mechanisms that mediate other executive functions regulated by the PFC. Furthermore, the functional importance of other DA receptor subtypes that reside on PFC neurons (D2 and D4) is unclear. OBJECTIVES: This review will summarize previous findings and previously unpublished data addressing the contribution of PFC DA to higher-order cognition. We will compare the DA receptor mechanisms, which regulate executive functions such as working memory, behavioral flexibility, and decision-making. RESULTS AND CONCLUSIONS: Whereas PFC D1 receptor activity is of primary importance in working memory, D1 and D2 receptors act in a cooperative manner to facilitate behavioral flexibility. We note that the principle of the "inverted U-shaped" function of D1 receptor activity mediating working memory does not necessarily apply to other PFC functions. DA in different subregions of the PFC also mediates decision-making assessed with delay discounting or effort-based procedures, and we report that D1, D2, and D4 receptors in the medial PFC contribute to decision-making when animals must bias the direction of behavior to avoid aversive stimuli, assessed with a conditioned punishment procedure. Thus, mesocortical DA modulation of distinct executive functions is subserved by dissociable profiles of DA receptor activity in the PFC.

Animals↗

PubMedDate not supplied

Executive functioning and preschoolers' understanding of false beliefs, false photographs, and false signs.

Two studies were conducted to investigate the specificity of the relationship between preschoolers' emerging executive functioning skills and false belief understanding. Study 1 (N=44) showed that 3- to 5-year-olds' performance on an executive functioning task that required selective suppression of actions predicted performance on false belief tasks, but not on false photograph tasks. Study 2 (N=54) replicated the finding from Study 1 and showed that performance on the executive functioning task also predicted 3- to 5-year-olds' performance on false sign tasks. These findings show that executive functioning is required to reason only about representations that are intended to reflect a true state of affairs. Results are discussed with respect to theories of preschoolers' theory-of-mind development.

Child, Preschool↗

PubMed2004

Relational integration and executive function in Alzheimer's disease.

Executive functions depend on the ability to represent relations between objects and events, and the prefrontal cortex provides the neural substrate for this capacity. Patients with probable Alzheimer's disease (AD) and control participants were administered measures of working memory and reasoning that varied systematically in their relational complexity. AD patients showed impairment on reasoning measures that required the online integration of relations but performed as well as control participants on nonrelational items and items requiring the processing of only single relations. When AD patients were divided into subgroups based on their performance on relational reasoning measures, the subgroup that showed significant impairment on relational integration measures exhibited a neuropsychological profile consistent with prefrontal cortical dysfunction.

Aged↗

PubMed2005

General psychopathology is more important for executive functioning than diagnosis.

OBJECTIVE: Impaired executive functioning (EF) has often been reported in patients with major depression or schizophrenia. We hypothesize that the variance in EF is more affected by level of general psychopathology than by diagnosis. METHOD: Forty-three patients with major depression and 47 with schizophrenia were included. EF was measured with Wisconsin Card Sorting Test, Stroop Colour Word Test, Paced Auditory Serial Addition Test, Digits Backwards and Controlled Oral Word Association Test. The level of general psychopathology was measured with Brief Psychiatric Rating Scale - Expanded and Positive and Negative Syndrome Scale, the General psychopathology subscale. RESULTS: The level of general psychopathology predicted more of the variance in EF than diagnosis. In multivariate analyses, the effect of general psychopathology on EF was more robust for adjustment for diagnosis than vice versa. CONCLUSION: Future research on cognitive functioning in psychiatric patients should include level of general psychopathology to avoid overemphasising effects of diagnoses.

Adult↗

PubMed2001

The executive functions and self-regulation: an evolutionary neuropsychological perspective.

Neuropsychology has customarily taken a molecular and myopic view of executive functioning, concentrating largely on those proximal processes of which it may be comprised. Although commendable as a starting point, such an approach can never answer the question, "Why executive functioning?" The present paper encourages neuropsychologists to contemplate the longer-term, functional nature of the executive functions (EFs), using an evolutionary perspective. For purely illustrative purposes, a previously developed model of the EFs is briefly presented and is then examined from an evolutionary perspective. That model views the EFs as forms of behavior-to-the-self that evolved from overt (public) to covert (private) responses as a means of self-regulation. That was necessary given the interpersonal competition that arises within this group-living species. The EFs serve to shift the control of behavior from the immediate context, social others, and the temporal now to self-regulation by internal representations regarding the hypothetical social future. The EFs seem to meet the requirements of a biological adaptation, being an improbable complex design for a purpose that exists universally in humans. Discovering the adaptive problems that the EFs evolved to solve offers an invaluable research agenda for neuropsychology lest that agenda be resolved first by other scientific disciplines. Some adaptive problems that the EFs may have evolved to solve are then considered, among them being social exchange (reciprocal altruism or selfish cooperation), imitation and vicarious learning as types of experiential theft, mimetic skill (private behavioral rehearsal) and gestural communication, and social self-defense against such theft and interpersonal manipulation. Although clearly speculative at the moment, these proposals demonstrate the merit of considering the larger adaptive problems that the EFs evolved to solve. Taking the evolutionary stance toward the EFs would achieve not only greater insight into their nature, but also into their assessment and into those larger adaptive capacities that may be diminished through injury or developmental impairment toward that system.

Adaptation, Psychological↗