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Executive function in treated phenylketonuria as measured by the one-back and two-back versions of the continuous performance test.

The executive dysfunction hypothesis in treated phenylketonuria was investigated by means of the one-back and two-back versions of the continuous performance test. Eleven non-retarded, primary school-age children with classical phenylketonuria who had been treated early and continuously were indistinguishable from healthy, matched controls on the measures and test performance was not predicted by historical or concurrent plasma phenylalanine concentrations. Mean lifetime phenylalanine concentrations for the phenylketonuric subjects were within ranges currently recommended as dietary optima in the United Kingdom. The negative neuropsychological test findings add weight to the rationale for this policy.

Child, Preschool↗

A study of performance on tests from the CANTAB battery sensitive to frontal lobe dysfunction in a large sample of normal volunteers: implications for theories of executive functioning and cognitive aging. Cambridge Neuropsychological Test Automated Battery.

Several tests from the CANTAB neuropsychological test battery previously shown to be sensitive to frontal lobe dysfunction were administered to a large group of normal volunteers (N = 341) ranging in age from 21 to 79 years. The main tests included a computerized form of the Tower of London test of planning, a self-ordered spatial working memory task, and a test of attentional set formation and shifting. A computerized form of the Corsi spatial span task was also given. Age-related graded declines in performance were seen, sometimes in a discontinuous manner, especially for the attentional set shifting task (at the extradimensional shift stage). Patterns of deficits reminiscent of frontal lobe or basal ganglia damage were observed in the oldest age group (74-79). However, overall the data were only partially consistent with the hypothesis that frontal lobe functions are the most sensitive to effects of aging. Factor analyses showed that performance in the executive tests was not simply related to a measure of fluid intelligence, and their performance had a factor loading structure distinct from that for the CANTAB tests of visual memory and learning previously administered to the same sample. Finally, only limited support was found for the hypothesis that cognitive aging depends on slowed information processing.

Adult↗

Executive functions after traumatic brain injury: supported cognition and self-advocacy.

Following traumatic brain injury, the most troubling issues are often those associated with executive system impairment caused by prefrontal injury. In this article, the cognitive, behavioral and communication challenges typically associated with executive system impairment are briefly reviewed, followed by discussion and illustration of an approach to intervention that highlights provision of customized supports in everyday contexts. Seven themes are identified that appear to be critical in effectively serving individuals with executive system impairment after TBI.

Adult↗

Executive functioning and speed of processing in phenylketonuria.

Treated phenylketonuria (PKU) has been linked to dopaminergic depletion in the dorsolateral prefrontal cortex, potentially leading to selective executive impairment. White matter abnormalities may lead to generalized slowing of information processing. These 2 hypotheses were evaluated in adults with PKU on a lifelong diet. Those with PKU were significantly slower than the control group regardless of working memory load on an n-back task and marginally slower regardless of trial type (inhibitory or noninhibitory) on a flanker task. There were no significant differences in speed on object alternation learning or perceptual judgment tasks. There were no group differences in accuracy on any task. These findings do not appear consistent with the selective executive hypothesis. A cognitive slowing account may prove more informative in adults with PKU, but more evidence is needed. The findings suggest that continuous dietary management is a fairly successful strategy in terms of cognitive outcome for adults.

Adolescent↗

Executive functioning and compliance in HIV patients.

25 adult HIV patients were evaluated in a study of appointments, medication, and compliance with restrictions on sexual activity. The Executive Interview (EXIT) was useful in assessing these patients for cognitive difficulties; compliance with medication and countertransference issues were negatively correlated with EXIT scores.

Adult↗

Neuropsychological executive functions of adolescent sex offenders and nonsex offenders.

A growing body of research now suggests that a substantial number of criminal offenders display neuropsychological deficits, especially frontal-executive dysfunctions. The present study investigated the possibility of similar deficits by comparing the performance of 60 adolescent sex offenders court-ordered to a residential treatment facility with the performance of 60 nonsexual delinquent offenders matched on several pertinent sociodemographic characteristics and scores on four neuropsychological tests: (1) the Trail Making Test, (2) the Controlled Oral Word Association test of the Multilingual Aphasia Examination, (3) the Tower of London, and (4) the Wisconsin Card-sorting Test. Analysis indicated a pattern of frontal-executive dysfunction in a subset of both groups of offenders; this pattern has both theoretical and treatment implications.

Adolescent↗

Executive functioning in obsessive-compulsive disorder, unipolar depression, and schizophrenia.

The present study investigated whether schizophrenic, unipolar depressive, and obsessive-compulsive psychiatric patients show a distinguishable profile in tasks considered sensitive to frontal lobe functioning. Three psychiatric samples, each comprising 25 patients with little symptomatic overlap, were compared to 70 healthy controls. Participants completed several executive tasks (Wisconsin Card Sorting Test (WCST), verbal fluency, digit span, Stroop, and Trail-Making). Except for age, which was entered as a covariate, subjects did not differ in any sociodemographic background variable. Healthy controls showed superior performance relative to depressive and schizophrenic patients who exhibited comparable deficits in all tasks. Obsessive-compulsive disorder (OCD) patients revealed dysfunctions in the Trail-Making Tests A and B and in the fluency task. Dysfunctions in the domains of working memory, verbal fluency, distractibility, and concept formation were not confined to a specific psychiatric population.

Journal Article↗

Executive function is independently associated with performances of balance and mobility in community-dwelling older adults after mild stroke: implications for falls prevention.

BACKGROUND: Stroke survivors have a high incidence of falls. Impaired executive-controlled processes are frequent in stroke survivors and are associated with falls in this population. Better understanding of the independent association between executive-controlled processes and physiological fall risk (i.e. performances of balance and mobility) could enhance future interventions that aim to prevent falls and to promote an independent lifestyle among stroke survivors. METHODS: Cross-sectional analysis of 63 adults who suffered a mild stroke >1 year prior to the study, aged > or =50 years. RESULTS: Cognitive flexibility was independently associated with performances of balance and mobility in community-dwelling older adults after mild stroke, after accounting for age, quadriceps strength of the paretic side and current physical activity level. CONCLUSIONS: Clinicians may need to consider cognitive function when assessing and treating impaired balance and mobility in community-dwelling older adults after mild stroke.

Accidental Falls↗

Development of executive functions through late childhood and adolescence in an Australian sample.

Although there have been significant theoretical advances in the field of child neuropsychology, developmental features of adolescence have received less attention. Progress in clinical practice is restricted due to a lack of well-standardized, developmentally appropriate assessment techniques. This article addresses these issues in relation to executive skills. These abilities are targeted for 2 reasons: first, because they are often considered to be mature during late childhood and adolescence, despite limited investigation in this age range; and second, because of their central importance to efficient day-to-day functioning. Using a normative sample of 138 children, aged 11.0 to 17.11 years, this article plots the development of executive skills through late childhood and early adolescence and interprets progress in these skills with reference to current neurological and cognitive theory.

Adolescent↗

Assessing the executive function deficits of patients with Parkinson's disease: utility of the Tower of London-Drexel.

The aim of the study was to investigate the utility of the Tower of London-Drexel (TOLDX) in assessing the executive deficits associated with Parkinson's disease (PD). We sought to determine whether the TOLDX would differentiate between (a) patients with PD and healthy control participants (HCP), (b) demented and nondemented patients, and (c) depressed and nondepressed patients. A new TOLDX score, stimulus bound, was introduced to assess utilization behaviors. Furthermore, the convergent and divergent validity of the TOLDX was examined. The TOLDX total move, rule and time violation, and stimulus-bound scores of patients with PD significantly differed from the HCP. Demented and nondemented patients also differed significantly in their TOLDX performance, with the stimulus-bound score being the most significantly differentiating score. However, the depressed and nondepressed patients did not differ in their TOLDX performance. Support was found for the convergent and divergent validity of the TOLDX. The clinical and theoretical implications of the findings are discussed.

Aged↗

D1 receptor modulation of hippocampal-prefrontal cortical circuits integrating spatial memory with executive functions in the rat.

Dopamine (DA) within the prefrontal cortex (PFC) plays an important role in modulating the short-term retention of information during working memory tasks. In contrast, little is known about the role of DA in modulating other executive aspects of working memory such as the use of short-term memory to guide action. The present study examined the effects of D1 and D2 receptor blockade in the PFC on foraging by rats on a radial arm maze under two task conditions: (1) a delayed task in which spatial information acquired during a training phase was used 30 min later to guide prospective responses, and (2) a nondelayed task that was identical to the test phase of the delayed task but lacked a training phase, thereby depriving rats of previous information about the location of food on the maze. In experiment 1, microinjections of the D1 antagonist SCH-23390 (0.05, 0.5, or 5 microg/&microl), but not the D2 antagonist sulpiride (0.05, 0.5, or 5 microg/microl), into the prelimbic region of the PFC before the test phase disrupted performance of the delayed task without affecting response latencies. In contrast, neither drug affected performance of the nondelayed task. In the present study, we also investigated the role of D1 receptors in modulating activity in hippocampal-PFC circuits during delayed responding. Unilateral injections of SCH-23390 into the PFC in the hemisphere contralateral to a microinjection of lidocaine into the hippocampus severely disrupted performance of the delayed task. Thus, the ability to use previously acquired spatial information to guide responding 30 min later on a radial arm maze requires D1 receptor activation in the PFC and D1 receptor modulation of hippocampal inputs to the PFC. These data suggest that D1 receptors in the PFC are involved in working memory processes other than just the short-term active retention of information and also provide direct evidence for DA modulation of limbic-PFC circuits during behavior.

Animals↗

The category test perseveration, loss of set, and memory scales: three new scales and their relationship to executive functioning measures.

The Category Test (CT) is a neuropsychological measure that taps into multiple domains of complex reasoning but yields a single error score, limiting the use of the test. In this study, three new CT scales were developed to assess specific aspects of executive dysfunction: Perseveration, Failure to Maintain Cognitive Set, and Inability to Recall and Re-Initiate Past Behavior. The relationship of these scales to well-established neuropsychological measures was examined in head-injured individuals and schizophrenia patients. The CT Perseveration score was correlated with the Wisconsin Card Sorting Test (WCST) Perseverative Responses score, but also with measures from the Wechsler Memory Scale-Revised and the California Verbal Learning Test. The CT Memory score correlated with other memory measures, but also with the WCST Perseveration measure. Although future studies designed to test discriminant and convergent validity are warranted, these scales may be useful in determining specific aspects of impaired CT performance.

Adult↗

Dissociation between performance on abstract tests of executive function and problem solving in real-life-type situations in normal aging.

This study examined the effects of normal aging on real-life-type problem-solving performance, using problems that had previously been found to be sensitive to lesions involving the frontal lobes. Executive skills assessed on abstract neuropsychological tests tend to decrease with normal aging. The effects of aging on tasks reliant on everyday knowledge and experience are less well understood. In the present study, groups of healthy older and younger people were compared on ability to solve real-life-type problems covering a range of everyday interpersonal situations. Performance was also examined on a range of standardized neuropsychological tests involving executive skills. Older people were similar to younger people in most aspects of everyday problem-solving performance, although the older group appeared to use a different strategy to the younger group in generating potential problem solutions. Both groups performed normally for their age on the executive tests. Comparisons based on raw scores rather than age-adjusted scores showed the younger group to perform better on the executive tests, but not on the problem-solving task. The possible contribution of knowledge and experience to problem solving on the current task is discussed. The greater life experience of the older group is likely to be the biggest contributory factor in maintaining problem-solving performance.

Adult↗

[Memory and executive functions in multiple sclerosis: preliminary findings with a cognitive battery].

Twenty one MS patients suffering from a relapsing-remitting (four patients), a secondary progressive (12 patients) or a primary progressive form of the disease (five patients) were assessed using a cognitive battery specifically devoted to executive and memory processes. Results showed that, patients without significant depressive state evaluated by the MADR scale, exhibited significant impairments in executive processes, working, episodic and procedural memories whereas short term memory, language and global intellectual efficiency were normal. The preliminary data suggest an impairment of encoding, a process previously underestimated in this disease. In addition, the battery was easily administered to the patients and relevant for the cognitive assessment of MS.

Adult↗

Dissociable executive functions in the dynamic control of behavior: inhibition, error detection, and correction.

The present study employed event-related fMRI and EEG to investigate the biological basis of the cognitive control of behavior. Using a GO/NOGO task optimized to produce response inhibitions, frequent commission errors, and the opportunity for subsequent behavioral correction, we identified distinct cortical areas associated with each of these specific executive processes. Two cortical systems, one involving right prefrontal and parietal areas and the second regions of the cingulate, underlay inhibitory control. The involvement of these two systems was predicated upon the difficulty or urgency of the inhibition and each was employed to different extents by high- and low-absent-minded subjects. Errors were associated with medial activation incorporating the anterior cingulate and pre-SMA while behavioral alteration subsequent to errors was associated with both the anterior cingulate and the left prefrontal cortex. Furthermore, the EEG data demonstrated that successful response inhibition depended upon the timely activation of cortical areas as predicted by race models of response selection. The results highlight how higher cognitive functions responsible for behavioral control can result from the dynamic interplay of distinct cortical systems.

Adult↗

The neurophysiological basis of learning, Part 2: Concept formation/abstraction, reasoning and executive functions--implications for SCI nurses.

Understanding the neurophysiological basis of learning enables nurses working with spinal cord injured persons to astutely assess potential for learning. This is particularly relevant when head injury or drug effects are influencing neurological systems relevant to learning. The neuroanatomical and neurophysiological bases of learning are related to attention, memory, concept formation/abstraction, reasoning, and executive systems. Concept formation/abstraction, reasoning and executive systems are discussed as they relate to learning in this article. This information is incorporated into expanded assessment. More in-depth nursing assessment related to cognitive systems necessary for learning enables nurses to identify intact and deficit cognitive systems and quantify deficits. Astute assessment is fundamental to planning effective teaching and learning strategies for spinal cord injured persons especially when learning deficits exist, e.g., in head injured persons who have sustained a spinal cord injury. Implications for client and family education derive from an understanding of the normal neurophysiological basis of learning and normal and abnormal assessment findings.

Humans↗

[Attention and executive functions in patients with severe obesity. A controlled study using the Attention Network Test].

In this paper, attention and temperament are compared between 41 severely obese patients with psychiatric comorbidity and 45 control persons. Networks of attention were assessed by the Attention Network Test: alerting (ability to achieve and maintain an alert state), orienting (ability to orient to a stimulus), and executive attention (ability to resolve conflict). According to hypotheses, obese patients show reduced executive attention, more effortful control, and higher negative affectivity than controls. The concept of attention networks is related to cognitive mechanisms of self-regulation, opening new perspectives for understanding psychiatric disorders.

Adolescent↗