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PubMed2005

Qualitative evaluation of divergent thinking in patients with schizophrenia.

Patients with schizophrenia show deficits across a broad spectrum of neurocognitive domains. In particular, deficits in verbal fluency are common. Verbal fluency tests are neuropsychological tests that assess frontal lobe function or executive function but also assess divergent thinking. However, few studies have considered the impairment of verbal fluency from the viewpoint of divergent thinking. To consider the structure of divergent thinking, not only verbal assessments but also non-verbal assessments are indispensable. We administered several fluency tests, the idea fluency test, the design fluency test, and word (letter and category) fluency tests to 26 patients with schizophrenia and 26 healthy control subjects to evaluate divergent thinking in both groups and assessed their responses qualitatively. An acceptable minimal level of intelligence was maintained in the patient group. Although attention and executive functioning were relatively preserved in the subjects with schizophrenia, they demonstrated significant deficits in divergent thinking and had particular difficulty in producing ideas and designs requiring concept flexibility, a conversion of viewpoint, originality, or novelty. Research on deficits in divergent thinking in patients with schizophrenia may contribute to the development of cognitive and behavioral rehabilitation programs.

Adult↗

PubMed2003

Factors of significance for mobility in children with myelomeningocele.

AIM: To investigate neurological impairment, hand function and cognitive function in a group of children with myelomeningocele, in order to identify factors of significance for independent mobility and the physical assistance required for mobility in daily activities. METHODS: The study material comprised 32 children, aged 6-11 y and without mental retardation. Mobility was assessed with the Pediatric Evaluation of Disability Inventory, scored as caregiver assistance. Statistical differences and correlations between the caregiver assistance scores and the selected variables were analysed. RESULTS: Nine children scored independent mobility. The independent children had better hand coordination (p = 0.004) and walking ability (p = 0.01), lower cele levels (p = 0.011), higher performance IQ (p = 0.027), better visuospatial function (p = 0.029) and executive function (p = 0.037) than the others. The caregiver assistance scores were lower for both the children with early and severe symptoms of brainstem dysfunction and the children with scoliosis. Statistically significant correlations were found between the need for caregiver assistance and reduced walking ability, high cele level, poor hand strength and coordination, visuospatial function, executive function and performance IQ. In the subgroup of children who needed a wheelchair or walking aids, hand strength was the only variable significantly correlated with caregiver assistance (r(s) = 0.703, p = 0.000). CONCLUSION: Most of the children were dependent on others in daily activities. Impaired hand function and cognitive function were significant for mobility, and this has implications for the therapy programme in children with myelomeningocele.

Activities of Daily Living↗

PubMed2000

Metacognition following pediatric traumatic brain injury: a preliminary study.

Metacognition is one of the cognitive processes included under the general term executive functions. The executive functions are widely held to be under the control of the prefrontal cortex, an area often damaged after severe traumatic brain injury (TBI). We examined the metacognitive processing of a group of 9 children with TBI, and a group of 9 healthy, age-matched control children. Children with TBI showed significant impairments in their accuracy of prediction of the ease with which an item would be learned and their ability to predict recall of an item after a 2-hr delay. No significant differences in recall performance between the TBI and control groups were exhibited. The results are interpreted as suggesting an impairment in metacognitive processing resulting from frontal lobe damage after TBI in children. Additional research is necessary to confirm the relation of frontal lobe pathology and severity of injury to metacognitive impairments.

Adolescent↗

PubMed2006

Executive control function: a clinically practical assessment.

Intact executive control function is emerging as a determinant of functional status and independent living. Multiple causes of impaired executive control function including subclinical impairments exist. Integration of bedside executive control function assessment into routine nursing assessment and documentation provides a quantitative measure of an individual's ability to provide self-care.

Activities of Daily Living↗

PubMed2005

Neuropsychological functioning and alcohol dependence.

PURPOSE OF REVIEW: Alcohol dependence is a significant challenge to society and health-care services. The associated cognitive deficits are thought to affect behavioral control, therapy and liability to relapse. The present review demonstrates important new findings. RECENT FINDINGS: Recent interest focused on compensatory functional circuits, components of executive functioning, externally induced attentional biases and the relevance of the cognitive deficits for therapy and rehabilitation. SUMMARY: Recent studies found widespread compromised fronto-cortico-cerebellar circuits to underlie cognitive deficits. The inclusion of cerebellar structures to support functions traditionally associated with cortical and even prefrontal structures is important. However, most importantly, alcohol-dependent patients use additional and generally higher-order executive functions to compensate for deficient task performance. The compensatory mechanisms might help to explain close to normal functioning in basic cognitive domains enabled by support of executive components. But deficits in executive functions themselves might emerge more directly. New approaches concerning executive functioning, analyzing functional components of executive tasks, found response inhibition and decision-making to be impaired but normal performance in simple working memory tasks. Multiple withdrawals have been shown to lead to a higher degree of executive deficit. The causing mechanism underlying the attentional bias induced by alcohol-related words (stroop effect) is still under debate. Correlation of cognitive deficits with therapy outcome turned out to be weak. However, important interactions of cognitive deficits with personality, therapy-setting and successful coping, together with the finding that cognitive performance of alcohol-dependent patients could be enhanced by motivating instructions, might open new strategies in treatment planning and cognitive rehabilitation.

Journal Article↗

PubMed2001

Neuropsychological dysfunction in depressed suicide attempters.

OBJECTIVE: Neuropsychological deficits in the context of psychiatric disease may be associated with suicide risk. In this study, neuropsychological performance was compared among depressed patients with at least one prior suicide attempt of high lethality, depressed patients with low-lethality prior attempts, depressed patients with no prior suicide attempts, and nonpatients. METHOD: Fifty unmedicated patients in a major depressive episode (21 with no history of suicide attempts and 14 and 15 patients with previous attempts of low and high lethality, respectively) and 22 nonpatients were assessed. Groups were comparable in age, education, occupational level, and estimated premorbid intelligence. The neuropsychological battery produced scores within five composite domains: general intellectual functioning (current), motor functioning, attention, memory, and executive functioning. RESULTS: Patients whose prior suicide attempts were of high lethality performed significantly worse than all groups on tests of executive functioning and were the only group to perform significantly worse than nonpatients on tests of general intellectual functioning, attention, and memory. A discriminant function analysis revealed two prominent dimensions in the data: one that discriminated high-lethality suicide attempters from all other groups (primarily associated with performance on tests of executive functioning) and another that discriminated all depressed patient groups from nonpatients (associated with performance on measures of attention and memory). For the patients with high-lethality prior suicide attempts, deficits did not appear to reflect diffuse brain damage from past attempts, since the results of tests commonly affected by diffuse injury were not selectively impaired. CONCLUSIONS: Neuropsychological deficits in depressed patients with high-lethality prior suicide attempts suggest impairment of executive functioning beyond that typically found in major depression. This more extensive neuropsychological impairment in the context of depression may be a risk factor for severe suicide attempts.

Adult↗

PubMed2000

Clinical and ethical implications of impaired executive control functions for patient autonomy.

The authors identify the clinical and ethical implications of impaired executive control functions for patient autonomy. Executive control functions are processes that orchestrate relatively simple ideas, movements, or actions into complex goal-directed behavior, and impairments in these functions are becoming more common as the population ages. The authors examine difficulties that individuals with impaired executive control functions may have in making treatment decisions and describe a practical, ethically justified framework for making treatment decisions for patients with impairments in these functions. Three components of autonomy are identified-intentionality, understanding, and voluntariness. Intentionality and voluntariness are especially affected by impaired executive control functions. Impairments of these aspects of autonomy may often be overlooked when only traditional mental status examinations are employed, with adverse consequences for the health of patients wrongly thought to possess intact ability to make and carry out plans of care. Two case vignettes illustrate the complexities faced by clinicians intervening with patients who have deficits in decision-making capacity caused by impaired executive control functions.

Aged↗

PubMed2003

Dysexecutive syndrome and social adjustment in schizophrenia.

OBJECTIVE: This paper reports on a study designed to (i) assess levels of executive functions among patients suffering from schizophrenia; (ii) investigate associations between measures of executive functions and psychosocial adjustment; and (iii) examine the influence of psychopathology on the relationship between executive functions and psychosocial adjustment. Clear knowledge of executive functions and of their impact on social adjustment in patients with schizophrenia may play a decisive role in preparing and structuring appropriate outpatient care. METHOD: An extensive battery constituted of several tests developed for the assessment of executive functions was used in 38 inpatients with a DSM-IV diagnosis of schizophrenia. Psychosocial adjustment was assessed with a set of commonly used scales. RESULTS: Performance on measures of executive functions was heterogeneous among the patient population, with a subgroup performing within normal scores. A similar pattern was found on measures of psychosocial adjustment. Most of the executive measures were not dependent on demographic or clinical variables. A factorial analysis on measures of psychosocial adjustment yielded a one-factor model which showed inconsistent, and at most, weak to moderate correlations with executive functions. Regression analysis revealed that symptom levels accounted for two-thirds of the variance of psychosocial adjustment, and together with measures of executive functions for 91% of the variance. General and negative symptoms showed strong correlations with psychosocial adjustment. CONCLUSIONS: Our study supports the view that executive function is a heterogeneous construct with several subdimensions. Additionally, it suggests that symptom level has an important role as "rate limiting factor" on psychosocial adjustment and is partially mediated by executive dysfunction. Our results call for careful and detailed assessment in this patient population in order to establish appropriate treatment programmes such as cognitive remediation.

Adaptation, Psychological↗

PubMed1998

Executive cognitive functioning in alcohol use disorders.

Executive cognitive functioning (ECF) has been identified as an important determinant in the etiology of alcoholism. ECF represents a "higher-order" cognitive construct involved in the self-regulation of goal-directed behavior. The prefrontal cortex and its subcortical connections represent the primary neurological substrate that subserves ECF. Both alcoholics and individuals at high risk for alcoholism exhibit a mild dysfunction in ECF. However, this deficit appears to be significantly stronger in alcoholics with a comorbid diagnosis of an antisocial personality disorder. Individuals with other disorders that are also highly comorbid with alcoholism, such as attention deficit hyperactivity disorder and conduct disorder, also demonstrate deficits in ECF. As such, compromised ECF may not be specific to alcoholism, but instead, might be a potential underlying etiologic substrate for a number of disorders of behavioral excess-disinhibition. Subsequent to reviewing the literature implicating ECF deficits in alcoholism and comorbid disorders, the authors present a heuristic cognitive-neurobehavioral model of alcoholism implicating the frontostriatal system. Finally, recommendations for the prevention and treatment of alcoholism, based on this model, are discussed.

Alcoholism↗

PubMed1999

Executive control functions in task switching: evidence from brain injured patients.

Executive mechanisms involved in task switching were studied in 18 brain injured patients. The patients had to rapidly switch back and forth between two visual classification tasks and the analyses focused on switch costs, (i.e., performance differences between switch and no-switch trials), and on interference effects, (i.e., processing costs imposed by the presence of interfering stimulus attributes). The patients were grouped according to the side of the brain lesion. Patients with left brain damage (LBD) showed higher switch costs than patients with right brain damage (RBD). These group differences were attributable to disproportionally high switch costs in patients with LBD and language or speech disorders. This result suggests that the efficiency of suppressing internal interference from a recently activated task set depends on the availability of verbal representations of the upcoming task. Patients with RBD showed higher interference from external task sets. This effect was not affected by language or speech disorders. The overall results argue for a fractionation of executive functions to protect against interference from internal and external sources in task switching.

Adolescent↗

PubMed2003

Selective impairment of frontal-executive cognitive function in african americans with cardiovascular risk factors.

OBJECTIVES: To determine whether a summary cardiovascular risk score is associated with an increased risk of frontal-executive cognitive impairment. DESIGN: Cross-sectional study. SETTING: Subjects were recruited from senior centers, senior housing complexes, and communities in the Boston metropolitan area. PARTICIPANTS: Forty-three predominantly female elderly African Americans. MEASUREMENTS: Cardiovascular risk factors were assessed during an interview and clinical examination. For each subject, the total number of cardiovascular (CV) risk factors was summed to compute a CV risk score. A battery of neuropsychological tests was administered that examined memory, visuospatial abilities, and frontal-executive functions. Cognitive test scores were transformed into domain-specific (memory, visuospatial, frontal-executive) composite z scores. Cognitive impairment for each composite z score was defined as performance less than the median for the study group. Multivariate logistic regression was used to examine the relationship between the CV risk score and the risk for cognitive impairment in the three cognitive domains of interest. RESULTS: After controlling for age and education, the CV risk score was associated only with frontal-executive cognitive impairment (odds ratio (OR)=2.44, 95% confidence interval (CI)=1.06-5.65). The CV risk score was not associated with the risk of memory (OR=1.30, 95% CI=0.64-2.67) or visuospatial impairment (OR=1.49, 95% CI=0.66-3.36). Greater CV risk scores were associated with an increased likelihood of having frontal-executive cognitive impairment. CONCLUSION: CV risk factors may exert a specific deleterious effect on frontal-executive cognitive abilities as opposed to memory or visuospatial functions. Associated executive dysfunction may compromise the ability of patients with CV risk factors to comply with recommendations for risk reduction.

Aged↗

PubMed2006

Memory and frontal lobe functions; possible relations with dopamine D2 receptors in the hippocampus.

Cerebral cortical regions are thought to be important for cognitive functions such as memory and executive function. Although the functional associations between dopamine D2 receptors and motor and cognitive functions have been extensively examined in the striatum using positron emission tomography (PET), the role of dopamine D2 receptors in extrastriatal regions has been unexplored. We aimed to investigate the relationship between dopamine D2 receptors in extrastriatal regions and the performance of a broad spectrum of cognitive functions including memory, language, attention, and executive function in healthy subjects. Extrastriatal dopamine D2 receptors were measured in 25 male subjects using PET with [(11)C]FLB457. After the PET scans, a battery of neuropsychological tests was administered to all subjects. We found that the binding potential (BP) of [(11)C]FLB457 in the hippocampus was positively correlated with memory function. Furthermore, BP of [(11)C]FLB457 in the hippocampus, but not in the prefrontal cortex, was associated with frontal lobe functions such as executive function and verbal fluency. Our findings suggest that dopamine D2 receptors in the hippocampus might affect the local hippocampal function, but also brain functions outside the hippocampus such as the prefrontal cortex.

Adult↗

PubMed2000

Executive frontal functions.

This chapter presents a conceptual model of the representational and executive functions of the cortex of the frontal lobe derived from empirical evidence obtained principally in the monkey. According to this model, the neuronal networks of the frontal lobe that represent motor or executive memories are probably the same networks that cooperate with other cerebral structures in the temporal organization of behavior. The prefrontal cortex, at the top of the perception-action cycle, plays a critical role in the mediation of contingencies of action across time, an essential aspect of the temporal organization of behavior. That role of cross-temporal mediation is based on the interplay of two short-term cognitive functions: one retrospective, of short-term memory or sensory working memory, and the other prospective, of attentive set (or motor working memory). Both appear represented in the neuronal populations of dorsolateral prefrontal cortex. At least one of the mechanisms for the retention of working memory of either kind seems to be the reentry of excitability through recurrent cortical circuits. With those two complementary and temporally symmetrical cognitive functions of active memory for the sensory past and for the motor future, the prefrontal cortex secures the temporal closure at the top of the perception-action cycle.

Attention↗

PubMed2004

The frequency of executive cognitive impairment in elderly rehabilitation inpatients.

The aim of this study was to determine the frequency of executive cognitive dysfunction in a sample of elderly patients in 2 rehabilitation wards in Wellington, New Zealand. All patients in 2 wards over a 2-month period were approached and invited to complete a brief neuropsychological battery. Sixty-two patients volunteered, of whom 52 completed at least 3 of the 4 measures of executive functioning. The frequency of executive dysfunction in the resulting sample of 52 was determined. Impaired executive function was defined as impaired performance on at least 2 executive function tests. The authors administered the Hayling-Brixton tests, the verbal fluency test, the Trail-Making Test, the Mini-Mental State Examination (MMSE), and the Geriatric Depression Scale. Patients' behavior was rated for executive problems on the Dysexecutive Questionnaire by themselves and by a nurse. The frequency of executive impairment was high at 13 out of 52 patients (25%). Only 1 of these 13 patients with executive difficulties was impaired according to their MMSE score. Screening for executive impairment among older rehabilitation inpatients is a necessary part of their medical management and rehabilitation. This should involve more than just administering the MMSE at admission. Several brief methods for screening for executive impairment are now available.

Aged↗

PubMed2006

Neurocognition and suicidal behaviour in an Irish population with major psychotic disorders.

OBJECTIVES: Although neurocognitive deficits are seen as core to schizophrenia the association between suicidality and neurocognition has received little attention. Our aim was to examine the relationship between neurocognitive variables and suicidal behaviour in patients with schizophrenia and schizoaffective disorder. METHODS: Seventy-eight patients with DSM-IV diagnoses of schizophrenia or schizoaffective disorder were categorised as either having attempted suicide or not having attempted suicide based on clinical interview and chart review. Attempters and non-attempters were compared on an extensive neuropsychological battery examining pre-morbid and current general cognitive functioning, episodic memory, and executive functioning. RESULTS: Suicide attempters tended to out perform non-attempters across all areas of executive functioning, and showed significantly better performances on measures of attention and verbal fluency. After controlling for relevant clinical and demographic variables, the differences between attempters and non-attempters remained significant for measures of attention (F = 4.97, p = 0.03) and verbal fluency (F = 4.28, p = 0.04). CONCLUSION: This study adds to existing data that suicide attempters with schizophrenia or schizoaffective disorder may have higher cognitive functioning than non-attempters. In particular, the preservation of higher executive function may influence the ability to initiate and plan suicidal behaviour.

Adult↗

PubMed2002

[Cognitive aspects of attention deficit hyperactivity disorder in children].

Inattention, excessive motor activity and impulsivity observed in children with attention deficit hyperactivity disorder (ADHD) are presently considered as an executive function deficit. Certain authors suggest that children with ADHD, combined and inattentive types, present distinct attention disorders. Cognitive aspects in ADHD children are measured with an intellectual functioning scale, cognitive and executive function tests. Experimental data show mixed results concerning these subjects. Similar deficits are found between ADHD children, combined and inattentive types, on motor inhibition and different cognitive aspects. However, other executive function aspects need to be explored among the two ADHD sub-groups.

Attention Deficit Disorder with Hyperactivity↗

PubMed2005

Unilateral pallidotomy versus bilateral subthalamic nucleus stimulation in PD--a comparison of neuropsychological effects.

OBJECTIVE: To compare the cognitive and behavioural effects of unilateral pallidotomy and bilateral subthalamic nucleus (STN) stimulation. METHODS: After baseline examination 34 patients were randomly assigned to unilateral pallidotomy (4 left-sided, 10 right-sided) or bilateral STN stimulation (n = 20). At baseline and six and twelve months after surgery we administered neuropsychological tests of language, memory, visuospatial function, mental speed and executive functions. Also a depression rating scale, and self and proxy ratings of memory and dysexecutive symptoms were administered. RESULTS: Six months after surgery, the STN group and the pallidotomy group differed significantly in change from baseline in number of errors on two tests of executive functioning. After 12 months the STN group reported less positive affect compared with baseline than the pallidotomy group. One patient in the STN group showed an overall cognitive deterioration due to complications. CONCLUSIONS: Although we need larger groups to draw firm conclusions, our results suggest that bilateral STN stimulation has slightly more negative effects on executive functioning than unilateral pallidotomy.

Deep Brain Stimulation↗

PubMed2003

Patterns of neurocognitive deficits and unawareness of illness in schizophrenia.

It has been alternately theorized that poor insight in patients with schizophrenia results from deficits in executive function and a preference for denial as a coping strategy. One possibility is there are two distinct groups of persons with poor insight: those with impairments in executive function and those with a generally avoidant coping style. To examine this question, the authors performed a cluster analysis on 64 persons with schizophrenia spectrum disorders on the basis of the PANSS insight and judgment item and executive function assessed with the Wisconsin Card Sorting Test. As predicted, three groups were found: good insight-average executive function (N = 28), poor insight-average executive function (N = 13), and poor insight-poor executive function (N = 23). When self-reported coping styles were compared among groups, as predicted, the poor insight-average executive function group endorsed a significantly greater preference for denial as a coping strategy than the poor insight-poor executive function group, even after controlling for differences in executive function. The coping scores of the good insight group did not differ significantly from either poor insight group. Results suggest that denial may play a role in the unawareness of illness in some persons with schizophrenia who have average executive function.

Adaptation, Psychological↗