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PubMed1998

The construct validity of the Tower of LondonDX as a measure of the executive functioning of ADHD children.

Currently, there are a limited number of measures that have been developed to assess childhood executive planning and problem-solving abilities. The present study represents ongoing efforts to determine the psychometric properties of the newly developed Tower of London Drexel (TOLDX), a measure of executive functions. Specifically, the construct-related validity of the TOLDX was investigated with a sample of attention-deficit hyperactivity disorder (ADHD) children (N = 129), 7 to 15 years of age. The performance of the children on a neuropsychological battery of measures sensitive to executive abilities, psychometric intelligence, and memory was subjected to maximum-likelihood factor analysis. A four-factor solution was extracted that best fit the selected variables. The TOLDX was found to produce the highest loading on an Executive Planning/Inhibition factor comprised of other executive measures. The Executive Planning/Inhibition measure was separate from factors of Executive Concept Formation/Flexibility, Psychometric Intelligence, and Memory. Moreover, the two executive factors were found to be correlated (r = .42) suggesting that each assesses, to varying degrees, related executive dimensions. The neuropsychological construct structure of the TOLDX is discussed in relationship with the temporal organization of behavior and frontal lobe functioning.

Adolescent↗

PubMed2004

A prospective study of the association among impaired executive functioning, childhood attentional problems, and the development of bipolar disorder.

Studies of adults who have been diagnosed with, and treated for, bipolar disorder have shown that these patients exhibit impairment on measures of executive functioning. However, it is unclear whether executive dysfunction precedes the diagnosis of bipolar illness, or develops subsequent to its onset. Moreover, investigators have failed to control for the effects of premorbid attentional problems on cognitive performance in these patients. The present authors explored these questions using data from a longitudinal prospective study of individuals at risk for major mood disorder. Results revealed that 67% of participants who met criteria for bipolar disorder in young adulthood showed impairment on the Wisconsin Card Sorting Test (WCST) when they were assessed during adolescence, as compared with 17% of individuals with no major mood diagnosis, and 19% with unipolar depression. This association between performance on the WCST and bipolar illness was not accounted for by high rates of premorbid attentional disturbance. In fact, among participants with early attentional problems, only those who ultimately developed bipolar disorder exhibited impairment on the WCST. Early attentional problems that preceded unipolar depression or no mood disorder were not associated with executive dysfunction.

Adolescent↗

PubMed2005

The influence of executive functions, sensation seeking, and HIV serostatus on the risky sexual practices of substance-dependent individuals.

From a public health standpoint, identifying factors that contribute to risky sexual practices among substance-dependent individuals is critical, particularly in the context of HIV infection. This study examines the respective contributions of executive neurocognitive functions, sensation seeking, and HIV serostatus in predicting risky sexual practices among poly-substance users (with a history of dependence primarily for cocaine or cocaine/heroin). HIV+ (n=109) and HIV- (n=154) substance-dependent individuals were assessed using three neurocognitive tasks of executive functions: Stroop reaction time, delayed non-matching to sample, and the Iowa Gambling Task. Sensation seeking was assessed using the Sensation Seeking Scale-V. Greater sensation seeking was associated with more risky sexual practices among HIV+ participants, particularly among those who performed best on the Iowa Gambling Task. Our findings indicate that continued risk behavior among HIV+ drug users may be driven by sensation seeking (a personality trait common among drug users); however, the impact of executive functions is less clear.

Adult↗

PubMed2002

Chronic alcoholism and the frontal lobe: which executive functions are imparied?

OBJECTIVE: Over the last decade, various hypotheses have been advanced concerning the cognitive functions affected by chronic alcoholism. The aim of this study was to identify the pattern of executive function impairment in chronic alcoholism, shedding light on possible differences between specific functions related to the frontal lobe. METHODS: Twenty-two male alcoholics and 22 controls, matched for age, educational level and IQ, were enrolled in the study. MMPI and a battery of neuropsychological tests [i.e. digit symbol, trail making test, Stroop test, digit cancellation test, Wisconsin card sorting test (WCST), simple and choice reaction times] for assessing frontal lobe functioning were administered. RESULTS: The alcoholics were found to be impaired in a wide range of executive domains, with the exception of the Stroop test, which nevertheless showed a trend towards statistically significant differences between patients and controls. CONCLUSION: With the exception of aggression - our subjects did not have high aggression scale scores - the 'frontal lobe hypothesis', according to which alcoholic patients are impaired on function tests related to the frontal lobe, was therefore confirmed in our sample.

Adult↗

PubMed2006

Age-related change in executive function: developmental trends and a latent variable analysis.

This study examined the developmental trajectories of three frequently postulated executive function (EF) components, Working Memory, Shifting, and Inhibition of responses, and their relation to performance on standard, but complex, neuropsychological EF tasks, the Wisconsin Card Sorting Task (WCST), and the Tower of London (ToL). Participants in four age groups (7-, 11-, 15-, and 21-year olds) carried out nine basic experimental tasks (three tasks for each EF), the WCST, and the ToL. Analyses were done in two steps: (1) analyses of (co)variance to examine developmental trends in individual EF tasks while correcting for basic processing speed, (2) confirmatory factor analysis to extract latent variables from the nine basic EF tasks, and to explain variance in the performance on WCST and ToL, using these latent variables. Analyses of (co)variance revealed a continuation of EF development into adolescence. Confirmatory factor analysis yielded two common factors: Working Memory and Shifting. However, the variables assumed to tap Inhibition proved unrelated. At a latent level, again correcting for basic processing speed, the development of Shifting was seen to continue into adolescence, while Working Memory continued to develop into young-adulthood. Regression analyses revealed that Working Memory contributed most strongly to WCST performance in all age groups. These results suggest that EF component processes develop at different rates, and that it is important to recognize both the unity and diversity of EF component processes in studying the development of EF.

Adolescent↗

PubMed2002

Localization of executive functions in dual-task performance with fMRI.

We report a study that investigated the neuroanatomical correlates of executive functions in dual-task performance with functional magnetic resonance imaging. Participants performed an auditory and a visual three-choice reaction task either separately as single tasks or concurrently as dual tasks. In the dual-task condition, two stimuli were presented in rapid succession to ensure interference between the component tasks (psychological refractory period). The behavioral data showed considerable performance decrements in the dual-task compared to the single-task condition. Dual-task-related activation was detected with two different neuroimaging methods. First, we determined dual-task-related activation according to the method of cognitive subtraction. For that purpose, activation in the dual-task was compared directly with activation in the single-task conditions. This analysis revealed that cortical areas along the inferior frontal sulcus (IFS), the middle frontal gyrus (MFG), and the intraparietal sulcus (IPS) are involved in dual-task performance. The results of the subtraction method were validated with the method of parametric manipulation. For this purpose, a second dual-task condition was introduced, where the difficulty of the dual-task coordination was increased compared with the first dual-task condition. As expected, behavioral dual-task performance decreased with increased dual-task difficulty. Furthermore, the increased dual-task difficulty led to an increase of activation in those cortical regions that proved to be dual-task related with the subtraction method, that is, the IFS, the MFG, and the IPS. These results support the conclusion that dorsolateral prefrontal and superior parietal cortices are involved in the coordination of concurrent and interfering task processing.

Acoustic Stimulation↗

PubMed2005

Executive functioning in normal aging: a study of action planning using the Zoo Map Test.

A particularly important aspect of executive functioning involves the ability to form and carry out complex plans, that is to say planning. This study aimed to investigate planning in 18 older and 16 younger normal participants using an ecological planning subtask derived from the Behavioural Assessment of the Dysexecutive Syndrome test battery, the "Zoo Map Test." There are two trials. The first trial consists of a "high demand" version of the subtask in which the participants must plan in advance the order in which they will visit designated locations in a zoo (formulation level). In the second, or "low demand" version, the participant is simply required to follow a concrete externally imposed strategy to reach the locations to visit (execution level). The two-way ANOVAs mainly showed more difficulties in elderly adults than in younger adults, more difficulties in formulation level than in execution level, and lastly a greater difference between formulation and execution in older participants than in younger adults. These results suggest that elderly participants have some problems developing logical strategies whereas they are able to execute complex predetermined plans.

Adult↗

PubMed2002

An attempt to discriminate different types of executive functions in the Wisconsin Card Sorting Test.

This study examined the roles of the phonological working memory and the central executive in the Wisconsin Card Sorting Test by altering the materials and the procedure of the task and using a dual-task design, in which cognitive abilities of normal participants were manipulated by performance of the secondary tasks selectively taxing the phonological loop or the central executive. The present study used three novel versions of the Wisconsin Card Sorting Test, namely the WCST-4 stimuli, the WCST-12-stimuli, and the WCST-12-stimuli-box, in all of which the participants were given the exact sorting criterion. So the tasks did not involve processes such as maintenance of inferences about the sorting criterion which would require phonological memory load. However, the tasks were assumed to require the executive process of response inhibition. In the WCST-4-stimuli condition no change was made to the WCST materials. In the other two conditions, relying on the assumption that the three-dimensional nature of the cards triggers inappropriate responses, unidimensional stimulus cards were used instead of the four normal three-dimensional WCST stimulus cards. The difference between these two conditions was that, in the WCST-12-stimuli-box condition, boxes were used to conceal the response cards previously sorted. The results supported Dunbar and Sussman's (1995) argument that some executive processes in the Wisconsin Card Sorting Test require the use of phonological store, and the present design was able to differentiate the type of executive functions that do not involve the use of a phonological loop from the ones that do. In addition, the results concerning manipulations of the visual aspects of the Wisconsin Card Sorting Test suggest that the three-dimensional nature of the WCST stimulus cards leads to an increase in the number of inappropriate responses produced with the executive secondary task interference.

Adolescent↗

PubMed2006

Reliability and stability of executive functioning in older adults.

A number of methodological questions have been raised about the reliability and validity of measuring executive functioning (EF) across multiple time points. In this study, correlational and latent-variable analyses were used to examine test-retest reliability of 5 common measures of EF and the stability of a latent EF construct. One hundred eighteen nondemented older adults were tested twice over a 4- to 8-week period. Findings demonstrated modest reliability of individual EF measures but very high stability of a latent EF construct. Relative contributions of each measure to the latent EF factor did not change across measurement trials. In addition, age-related effects on EF were similar at the 2 time points and were within the expected range. Implications for future studies of EF are discussed.

Aged↗

PubMed2005

Executive functioning in hyperactive children as young adults: attention, inhibition, response perseveration, and the impact of comorbidity.

Tests of several executive functions (EFs) as well as direct observations of symptoms of attention deficit hyperactivity disorder (ADHD) during testing were collected at the young adult follow-up (M = 20 years) on a large sample of hyperactive (H; N = 147) and community control (CC; N = 71) children. The EF tasks included tests of attention, inhibition, and response perseveration. The H group was subdivided into those with and without ADHD (+ or w/o) at follow-up. The H+ADHD group made significantly more inhibition errors than the CC group on a Continuous Performance Test (CPT) and showed more ADHD symptoms while performing the CPT. The H+ADHD group also displayed more ADHD symptoms during a letter cancellation task than did both the hyperactive w/o ADHD and CC groups. Both H groups showed slower reaction times during a Card Playing Task. That subset of hyperactive probands with Conduct Disorder (CD) displayed significantly more perseverative responding on that task than did those without CD, but otherwise it did not differ on any other measures. Current level of anxiety contributed adversely to both CPT commission errors and ADHD behavior during the CPT. Comorbid depression did not contribute to any group differences on these tests. Although developmental improvements were found in both the H and the CC groups in their CPT inattention and inhibition scores since adolescence, the H groups remained distinguishable from the CC groups over this period. We conclude that formerly hyperactive children manifest greater EF deficits at follow-up in the areas of inattention, disinhibition, and slowed reaction time and greater ADHD behavior during testing, but these problems are mostly confined to those with current ADHD. Response perseveration, however, was limited to those hyperactive children with CD by follow-up, consistent with Quay's theory of these two disorders.

Adult↗

PubMed2005

Cognitive consequences of cannabis use: comparison with abuse of stimulants and heroin with regard to attention, memory and executive functions.

This review aims to compare cognitive consequence between cannabis, and stimulants and heroin with regards to attention, memory and executive functions. The available studies using brain imaging techniques and neuropsychological tests show that acutely, all drugs create a disharmony in the neuropsychological network, causing a decrease of activity in areas responsible for short-term memory and attention, with the possible exception of heroin. Cannabis induces loss of internal control and cognitive impairment, especially of attention and memory, for the duration of intoxication. Heavy cannabis use is associated with reduced function of the attentional/executive system, as exhibited by decreased mental flexibility, increased perserveration, and reduced learning, to shift and/or sustain attention. Recent investigations on amphetamine/methamphetamine have documented deficits in learning, delayed recall, processing speed, and working memory. MDMA users exhibit difficulties in coding information into long-term memory, display impaired verbal learning, are more easily distracted, and are less efficient at focusing attention on complex tasks. The degree of executive impairment increases with the severity of use, and the impairments are relatively lasting over time. Chronic cocaine users display impaired attention, learning, memory, reaction time and cognitive flexibility. Heroin addiction may have a negative effect on impulse control, and selective processing.

Amphetamine-Related Disorders↗

PubMed2006

Trail making test errors and executive function in schizophrenia and depression.

The Trail Making Test (TMT) frequently is used as a measure of executive cognitive function. However, traditional use of test completion time as the primary outcome score does not give the more detailed information on cognitive processes that analysis of test-taking errors may provide. The present study compared TMT performance of three groups: patients with schizophrenia, patients with major depression, and healthy control participants (n = 30 for each group). Three operationally defined error types were examined: (a) tracking, (b) perseverative, and (c) proximity. Although both patient groups were slower than the healthy control group, only the schizophrenia group made significantly more errors, particularly tracking errors, suggesting a greater degree of cognitive disorganization. Within-group analysis of a larger group of schizophrenia patients (n = 84) revealed that TMT time was most strongly associated with the Withdrawal-Retardation factor of the Brief Psychiatric Rating scale. In contrast, TMT errors were most strongly associated with the Conceptual Disorganization factor. Comparisons of TMT scores and other cognitive tests showed moderate to high associations with tests of working memory, psychomotor speed, and executive function. Stepwise regression analysis revealed an independent association between Digit Cancellation and Part B Time, indicating a unique contribution of visuomotor scanning to performance. In contrast, Part B errors were uniquely associated with the Verbal Series Attention Test and the Token Test, tests of mental tracking and executive-mediated working memory, respectively. These findings demonstrate the utility of TMT error analysis in revealing cognitive deficits not traditionally captured using completion time as the sole outcome variable.

Adult↗

PubMed2006

Executive function deficits in autism spectrum disorders and attention-deficit/hyperactivity disorder: examining profiles across domains and ages.

Deficits in 'executive function' (EF) are characteristic of several clinical disorders, most notably Autism Spectrum Disorders (ASD) and Attention-Deficit/Hyperactivity Disorder (ADHD). In this study, age- and IQ-matched groups with ASD, ADHD, or typical development (TD) were compared on a battery of EF tasks tapping three core domains: response selection/inhibition, flexibility, and planning/working memory. Relations between EF, age and everyday difficulties (rated by parents and teachers) were also examined. Both clinical groups showed significant EF impairments compared with TD peers. The ADHD group showed greater inhibitory problems on a Go-no-Go task, while the ASD group was significantly worse on response selection/monitoring in a cognitive estimates task. Age-related improvements were clearer in ASD and TD than in ADHD. At older (but not younger) ages, the ASD group outperformed the ADHD group, performing as well as the TD group on many EF measures. EF scores were related to specific aspects of communicative and social adaptation, and negatively correlated with hyperactivity in ASD and TD. Within the present groups, the overall findings suggested less severe and persistent EF deficits in ASD (including Asperger Syndrome) than in ADHD.

Adolescent↗

PubMed2005

Executive functioning in children with autism and Tourette syndrome.

The main aims of this study were to investigate if children with high-functioning autism (HFA) and children with Tourette syndrome (TS) can be differentiated in their executive functioning (EF) profile compared to normal controls (NCs) and compared to each other and to investigate whether children with HFA or children with TS and a comorbid group of children with both disorders are distinct conditions in terms of EF, Four groups of children participated in this study: HFA, TS, comorbid HFA + TS, and a NC group. All children were in the age range of 6 to 13 years. The groups were compared on five major domains of EF: inhibition, visual working memory, planning, cognitive flexibility, and verbal fluency. Children with HFA scored lower than NC children on all the EFs measured. Children with TS and NC children showed the same EF profile. The HFA group scored lower than the TS group for inhibition of a prepotent response and cognitive flexibility. Children with HFA performed poorer than children with comorbid HFA + TS on all functions, with the exception of inhibiting an ongoing response, interference control, and verbal fluency. Children with TS and children with comorbid HFA + TS could not be differentiated from one another in terms of EF. This study indicates that EF deficits are highly characteristic of children with HFA in comparison to children with TS and NC. The results suggest that for the comparison between HFA and TS groups, it is important to take into account comorbidity. A reevaluation of the EF hypothesis in children with TS is suggested.

Adolescent↗

PubMed2004

Executive function and theory of mind: stability and prediction from ages 2 to 3.

Several studies have demonstrated a relation between executive functioning (EF) and theory of mind (ToM) in preschoolers, yet the developmental course of this relation remains unknown. Longitudinal stability and EF-ToM relations were examined in 81 children at 24 and 39 months. At Time 1, EF was unrelated to behavioral measures of ToM but was significantly related to parent report of children's internal-state language, independent of vocabulary size. At Time 2, behavioral batteries of EF and ToM were significantly related (r=.50, p<.01). Furthermore, EF (Time 1) significantly predicted ToM (Time 2), independent of several controls. A reciprocal relation (internal-state language --> EF at Time 2) was nonsignificant with the controls included. Individual differences in EF were relatively stable.

Child Development↗

PubMed2005

Executive functioning and working memory in fetal alcohol spectrum disorder.

The goal of this report is to critically review research on executive functioning (EF) and working memory in individuals with fetal alcohol spectrum disorder (FASD). Individuals with FASD exhibit EF deficits in the areas of cognitive flexibility, planning and strategy use, verbal reasoning, some aspects of inhibition, set shifting, fluency, working memory, and, recently, on tests of emotion-related or hot EF. Some researchers have linked prenatal alcohol exposure to abnormalities in the development of the frontal cortex of affected individuals or animals. One common finding is that these EF deficits persist regardless of whether the individual has facial dysmorphology. Furthermore, EF deficits are not simply due to a low IQ in these individuals. More research with larger sample sizes, smaller age ranges, and consistent measurement tools is needed in this area to ameliorate some inconsistencies in the literature. Furthermore, researchers should now focus on studying the pattern of weakness in EF in individuals with FASD as well as relations among working memory and EF, which will help to identify specific areas of weakness, to enhance diagnosis, and to improve treatment. There is limited research on the development of EF in individuals with FASD, which can have important implications for understanding of how these deficits unfold from childhood through adulthood.

Adolescent↗

PubMed2006

Memory, attention, and executive functions before and after sine and pulse wave electroconvulsive therapies for treatment-resistant major depression.

OBJECTIVE: Studies of the cognitive effects of electroconvulsive therapy (ECT) have resulted in controversial findings up to now, partly because researchers and reviewers have not always made a clear distinction among various aspects of cognition and because there are many parameters involved in the administration of ECT that have a potential impact on cognition. The present study focused on the impact of sine and pulse waveforms on anterograde memory and nonmemory cognitive functions. METHODS: We assigned 18 patients with unipolar major depression or bipolar I or II disorder, most recent episode depressed, to receive sine wave or pulse wave ECT and assessed their cognitive function before and after ECT, using a neuropsychologic test battery that measured anterograde memory, attention, and executive functions. Outcomes were measured, on average, 8.2 days after the last ECT session. RESULTS: Both waveforms were equally effective in alleviating depression. Those who received sine wave ECT showed statistically significant deterioration in attention and executive tasks, such as the Stroop test, which measures selective attention (P = 0.02), and the dual task, which taps divided attention (P = 0.01). On the other hand, those who received pulse wave ECT improved to a significant degree in certain memory tasks, such as visual memory (P = 0.01) and general memory (P = 0.01) of the Wechsler Memory Scale-Revised (WMS-R), as well as in the dual task (P = 0.01). The between-group comparison revealed robust superiority of the pulse wave over the sine wave in terms of the dual task (P = 0.004). CONCLUSIONS: Anterograde memory improved to a statistically significant or nonsignificant degree at 1 week post-ECT in comparison with pre-ECT regardless of waveforms. Attention/executive functions tended to deteriorate with sine wave ECT but improved with pulse wave ECT.

Attention↗

PubMed1998

The role of executive function in imagery mnemonics: evidence from multiple sclerosis.

The use of imagery in learning and memory involves metacognitive skills that seem to depend upon executive function as well as motivational mechanisms. This implies that the efficacy of imagery mnemonics should be impaired in neurological patients who show either executive dysfunction or affective disorders. This hypothesis was tested in patients with multiple sclerosis. Imagery instructions led to improved recall in three different tasks, although experimenter-generated imagery proved to be more effective than subject-generated imagery and there was little evidence that patients maintained the use of imagery mnemonics on follow-up testing. Three other tasks defined a unitary trait of executive processing efficiency, and this was significantly correlated with the benefit obtained from the use of the Method of Loci in a free-recall tasks, but not with the benefit gained from other imagery mnemonics. The patients' scores, on a widely used depression inventory, were not significantly correlated with the benefit obtained from the use of imagery mnemonics. Nonetheless, it is concluded that executive processing capacity determines the benefit that is derived from the use of more complex forms of imagery mnemonic in verbal-learning tasks.

Adult↗