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PubMed2001

Severe impairment in grammar does not preclude theory of mind.

Debates about the role of language in human thinking are increasingly prominent in the cognitive sciences. There are claims that certain forms of reasoning can only be performed through access to the resources of the language faculty. In particular, a component of social cognition involving the representation of the mental states of others ('theory of mind' reasoning) has been claimed necessarily to involve propositions of natural language. A recent case study reported a man (SA) with severe agrammatic aphasia who was unable to understand or produce language propositions in any modality of language use, but who was able to complete theory of mind tasks. We report a replication of this finding using a modified picture theory of mind task with a second patient (MR). Despite severe aphasia and impaired performance on a test of executive function, MR demonstrated retained theory of mind reasoning. These results reveal the functional autonomy of theory of mind from the capacity for propositional/grammatical language, and support its independence from executive function.

Aphasia, Broca↗

PubMed2004

Clinical implications and methodological challenges in the study of the neuropsychological correlates of cannabis, stimulant, and opioid abuse.

Chronic consumption of several drugs of abuse (cannabis, stimulants, opioids) has been associated with the presence of neuropsychological impairments in a broad range of functions. Nevertheless, in recent years neuropsychological research on substance abuse has focused on the study of impairments in the executive functions linked to the prefrontal cortex and their influence on the personality, cognitions, and behaviors of the substance abusers. The aim of our review is, first, to summarize the main neuropsychological impairments shown by classic studies, as well as these new discoveries in executive functioning; second, to consider the mediating role of neuropsychological status on treatment outcomes and analyze the impact of these impairments in clinical practice with drug addicts; and third, to review the principal methodological challenges associated with research in the field of the neuropsychology of substance abuse. We also highlight the convenience of intervening in those functions most relevant to the abusers' persistence in consumption and risk of relapse.

Central Nervous System Stimulants↗

PubMed2004

[Disorders of executive consciousness].

UNLABELLED: Executive function is a higher order cognitive capacity that involves memory, perception and performance of complex tasks. Disorders of the executive functions are sign of lesions in the prefrontal cortex, involving the prefrontal-striatal-thalamic networks and the parietal association areas. According to signs and localization, five basic prefrontal syndromes are recognised. 1. Damage in posterior dorsolateral prefrontal cortex and subcortical nuclei causes the dorsolateral syndrome with impaired decision making, working memory and planning. 2. The ventromedial-orbitofrontal syndrome: if lesion spares the basal forebrain, memory can be preserved, but poor social decision making develops. 3. The dorsomedial syndrome consists of attention disorder, akinesia, mutism and apathy. 4. The bilateral ventrolateral prefrontal regions serve perception of self and environment. 5. The ventral lateral (verbalizer) area of the dominant hemisphere coordinates language. Executive impairments can be found in cerebrovascular, Parkinson's and other diseases of basal ganglia, and in frontotemporal lobar degeneration. The dorsolateral syndrome can be examined by the use of Wisconsin card sorting test, self ordered pointing task and the delayed response task. Prefrontal-basal function can be assessed by Gambling-, Faux Pas-, and Emotion identification tasks. CONCLUSIONS: 1. A dysexecutive syndrome does not fulfil the criteria of dementia. 2. A "frontal syndrome" is an indefinite eponym. Focal lesions in prefrontal systems lead to localization-specific symptoms, which can be defined by psychometric tests. 3. In neurological diseases associated with multifocal damage of the brain neuropsychologic tests may help to determine strategic lesions, which are responsible for the actual syndromes.

Akinetic Mutism↗

PubMed2004

Neuropsychological profile of young adults with spina bifida with or without hydrocephalus.

OBJECTIVES: To determine the relative impact of hydrocephalus and spinal dysraphism in young adults on intellectual and cognitive functioning. Sub-groups of patients with congenital hydrocephalus and/or spina bifida were assessed between 1995 and 2003. The entry criteria were that individuals should have (i) intact global function, (ii) average verbal intelligence (or above), and (iii) should not have clinical depression. There were three sub-groups: patients with hydrocephalus and spina bifida, patients with hydrocephalus without spina bifida, and patients with spina bifida without hydrocephalus. METHODS: Patients were neuropsychologically assessed as part of their normal clinical assessment during their annual medical review. Each individual completed a screening battery assessing global functioning, verbal intelligence, and mood. In addition they completed additional tests including measures of emotional intelligence, memory, attention, and executive function. Results were analysed to compare the performance of the patient sub-groups and to compare them to a healthy control group. RESULTS: Patients with hydrocephalus (with or without spina bifida) were significantly impaired on the vast majority of all test scores as compared to patients with spina bifida and healthy controls. They were particularly poor on measures assessing executive function. By contrast for patients with spina bifida with no associated hydrocephalus, the significant majority of all test scores fell within the average range or above. CONCLUSIONS: The neuropsychological profile of patients with hydrocephalus is one of relative impairment and this is so whether or not spina bifida is present. In spina bifida alone, in the absence of hydrocephalus, cognitive function is relatively spared.

Adult↗

PubMed2006

Characterizing cognition in ADHD: beyond executive dysfunction.

The hypothesis that Attention-Deficit/Hyperactivity Disorder (ADHD) reflects a primary inhibitory executive function deficit has spurred a substantial literature. However, empirical findings and methodological issues challenge the etiologic primacy of inhibitory and executive deficits in ADHD. Based on accumulating evidence of increased intra-individual variability in ADHD, we reconsider executive dysfunction in light of distinctions between 'hot' and 'cool' executive function measures. We propose an integrative model that incorporates new neuroanatomical findings and emphasizes the interactions between parallel processing pathways as potential loci for dysfunction. Such a reconceptualization provides a means to transcend the limits of current models of executive dysfunction in ADHD and suggests a plan for future research on cognition grounded in neurophysiological and developmental considerations.

Attention Deficit Disorder with Hyperactivity↗

PubMed2002

A PET study of stimulus- and task-induced semantic processing.

To investigate the neural correlates of semantic processing, previous functional imaging studies have used semantic decision and generation tasks. However, in addition to activating semantic associations these tasks also involve executive functions that are not specific to semantics. The study reported in this paper aims to dissociate brain activity due to stimulus-driven semantic associations and task-induced semantic and executive processing by using repetition and semantic decision on auditorily presented words in a cognitive conjunction design. The left posterior inferior temporal, inferior frontal (BA 44/45), and medial orbital gyri were activated by both tasks, suggesting a general role in stimulus-driven semantic and phonological processing. In addition, semantic decision increased activation in (i) left ventral inferior frontal cortex (BA 47), right cerebellum, and paracingulate, which have all previously been implicated in executive functions, and (ii) a ventral region in the left anterior temporal pole which is commonly affected in patients with semantic impairments. We attribute activation in this area to the effortful linkage of semantic features. Thus, our study replicated the functional dissociation between dorsal and ventral regions of the left inferior frontal cortex. Moreover, it also dissociated the semantic functions of the left posterior inferior temporal gyrus and anterior temporal pole: The posterior region subserves stimulus-driven activation of semantic associations and the left anterior region is involved in task-induced association of semantic information.

Adult↗

PubMed2005

Cognitive recovery from Encephalitis Lethargica.

The cognitive profile and outcome of Encephalitis Lethargica has not been systematically described in the literature. Treatment has typically focused upon medical management. The first case report of a patient with Encephalitis Lethargica who underwent a systematic programme of cognitive rehabilitation is presented. Initial neuropsychological assessment conducted during her acute presentation indicated generalized cognitive dysfunction, including memory and executive function impairments. An outpatient cognitive rehabilitation programme addressed the development of awareness and the remediation of memory and executive function impairments. Repeat assessment indicated significant improvement in cognitive function. The components of her rehabilitation programme are discussed. She has been able to successfully return to her pre-morbid level of work responsibility within 8 months of her admission.

Adult↗

PubMed2005

Does executive dysfunction affect treatment outcome in late-life mood and anxiety disorders?

Rates of treatment response among the elderly are typically lower than those found in younger samples. This article discusses specific biological and psychological aspects of aging that may impact the effectiveness of treatments for late-life mood and anxiety disorders. Although empirical evidence for the role of executive skills in treatment outcome is currently quite limited, the small number of existing studies suggest that some older adults with deficits in executive skills may respond poorly to popular treatments for depression and anxiety compared with those with intact executive functions. However, there are likely to be additional mediating factors. This article provides a definition and description of executive functions, including a summary of popular assessment tools. The literature on treatment outcome is reviewed, and future directions are discussed.

Age of Onset↗

PubMed1996

A brief assessment of executive control dysfunction: discriminant validity and homogeneity of planning, set shift, and fluency measures.

The current study evaluated the discriminant validity and homogeneity of category fluency, Stroop interference, and planning measures of executive dysfunction and introduced a new measure of planning behavior. We compared performance of patients with schizophrenia, Parkinson's disease, and Huntington's disease, which are disorders associated with some impairment of executive function. Findings indicated that all three measures successfully discriminated between patient groups and controls. Correlational analysis suggested a strong association between test scores on these measures, which were only moderately related to performance on nonexecutive function measures. It is concluded that the three tasks are sensitive and relatively homogeneous in their recruitment of executive functions.

Journal Article↗

PubMed1995

Cognitive deficits in patients with small cell lung cancer before and after chemotherapy.

We conducted a prospective study of cognitive function in patients with small cell lung cancer (SCLC). A previous study had shown SCLC patients to have deficits in memory, frontal lobe executive functioning, and motor skills before they received prophylactic cranial irradiation (PCI). This study was performed to determine whether these deficits were related to chemoradiation treatment. We evaluated two groups of patients: one newly diagnosed and untreated, the other post-chemoradiation and before PCI. Strict eligibility criteria were used to minimize any preexisting factors that might influence cognitive functioning. Results showed that patients with SCLC have cognitive deficits before receiving chemoradiation, specifically on tests of verbal memory, frontal lobe executive functions, and motor coordination. There was no difference between the treated and untreated patients on any test. Etiologic considerations currently under study include paraneoplastic phenomena.

Adolescent↗

PubMed2005

Executive inhibition and semantic association in schizophrenia.

Research indicates that some patients with schizophrenia display aberrant inhibition of semantic memory, which may underpin formal thought disorder (FTD). We administered a novel Stroop-like paradigm to three groups of participants: 15 schizophrenic patients with formal thought disorder (FTD), 16 with low FTD ratings, and 15 healthy matched controls. They were required to inhibit a prepotent response for a (previously instructed) required response. Four conditions examined the effect of executive demands by manipulating the relatedness between prepotent and required responses (i.e., identical, semantically related, or unrelated). Two further conditions examining executive function working memory demands required the naming of real or abstract pictures that did and did not necessitate inhibition, respectively. Patients with and without FTD experienced increased difficulty when executive function working memory was required. Moreover, those with FTD also showed increased executive inhibition, but the pattern of errors suggested that the result of this was an automatic activation of semantically related representations. The findings support the notion that increased inhibition underpins the disorganised access to semantic memory in patients with FTD.

Association↗

PubMed2006

The functional neuroanatomy of autobiographical memory: a meta-analysis.

Autobiographical memory (AM) entails a complex set of operations, including episodic memory, self-reflection, emotion, visual imagery, attention, executive functions, and semantic processes. The heterogeneous nature of AM poses significant challenges in capturing its behavioral and neuroanatomical correlates. Investigators have recently turned their attention to the functional neuroanatomy of AM. We used the effect-location method of meta-analysis to analyze data from 24 functional imaging studies of AM. The results indicated a core neural network of left-lateralized regions, including the medial and ventrolateral prefrontal, medial and lateral temporal and retrosplenial/posterior cingulate cortices, the temporoparietal junction and the cerebellum. Secondary and tertiary regions, less frequently reported in imaging studies of AM, are also identified. We examined the neural correlates of putative component processes in AM, including, executive functions, self-reflection, episodic remembering and visuospatial processing. We also separately analyzed the effect of select variables on the AM network across individual studies, including memory age, qualitative factors (personal significance, level of detail and vividness), semantic and emotional content, and the effect of reference conditions. We found that memory age effects on medial temporal lobe structures may be modulated by qualitative aspects of memory. Studies using rest as a control task masked process-specific components of the AM neural network. Our findings support a neural distinction between episodic and semantic memory in AM. Finally, emotional events produced a shift in lateralization of the AM network with activation observed in emotion-centered regions and deactivation (or lack of activation) observed in regions associated with cognitive processes.

Autobiographies as Topic↗

PubMed2004

Cognitive-neuropsychological function in chronic physical aggression and hyperactivity.

Histories of violence and of hyperactivity are both characterized by poor cognitive-neuropsychological function. However, researchers do not know whether these histories combine in additive or interactive ways. The authors tested 303 male young adults from a community sample whose trajectories of teacher-rated physical aggression and motoric hyperactivity from kindergarten to age 15 were well defined. No significant interaction was found. In a 1st model, both histories of problem behavior were independently associated with cognitive-neuropsychological function in most domains. In a second model controlling for IQ, General Memory, and test motivation, none of the three Working Memory tests (relevant to executive function) remained associated with physical aggression or hyperactivity. These results support an additive model but no specificity to executive function [corrected].

Adolescent↗

PubMed2004

Cognitive factors in schizophrenia: causes, impact, and treatment.

Greater attention has been given to the cognitive dimension in schizophrenia in recent years. This has resulted from increased recognition that cognitive impairment and negative symptoms of the disease have a greater impact on quality of life (QOL) compared to positive symptoms. Successful treatment of positive symptoms in patients with schizophrenia has not been shown to robustly translate into improvements in employment status or social relationships, while cognitive improvements are strongly associated with these important aspects of QOL and independence. These findings are based on extensive testing with standard cognitive tests for measuring executive function, verbal learning and memory, word recall, verbal working memory, spatial working memory, attention, and vigilance. Verbal learning and executive function, in particular, have been found to be valid predictors of employment success independent of the degree of severity of positive symptoms.

Antipsychotic Agents↗

PubMed2004

The nature of hyperactivity in children and adolescents with hydrocephalus: a test of the dual pathway model.

To determine the strength and nature of the association between hydrocephalus and hyperactivity and to test the dual pathway model (DPM) of AD/HD, we compared a group of 51 children and adolescents with hydrocephalus with 57 normally developing controls from the general population on a battery of neuropsychological assessments. The mean hyperactivity scores were significantly greater in the group with hydrocephalus (effect size = 0.94). This association was not just part of a general elevated rate of behavior problems and was not affected by sex or age. Variation in the clinical features of hydrocephalus was not related to the severity of hyperactivity. Path analysis was used to examine the relation between IQ, delay aversion, and executive function. In accordance with the DPM, the effect of hydrocephalus on hyperactivity was completely mediated via delay aversion and executive functions.

Adolescent↗

PubMedDate not supplied

Gas exchange and exercise capacity affect neurocognitive performance in patients with lung disease.

OBJECTIVE: This study examined the relationship between cognitive functioning and the severity of underlying lung disease in patients awaiting lung transplantation. METHODS: Ninety-four patients with end-stage lung disease completed a test battery to assess cognitive performance in two domains: executive functioning/attention (Trails A and B, COWA, Animal Naming, Stroop Color-Word Test, Digit Symbol, and the 2 & 7 Test) and verbal memory (Digit Span-Backward and Forward, WMS-R Logical Memory and Paired Verbal Associates). RESULTS: Thirty-seven percent of the patients demonstrated moderate to severe cognitive impairment data on two or more tests. Adjusting for age and education, there were no statistically significant differences on executive functioning or verbal memory as a function of specific lung disease diagnosis. Lower PCO2 values were associated with better cognitive performance on latent measures of executive functioning and attention (p = .006) and verbal memory (p = .009), whereas higher PO2 values tended to be associated with better performance on the executive functioning/attention measure (p = .064). Distance walked in 6 minutes was positively related to verbal memory (p < .023). CONCLUSIONS: Impaired neurocognitive functioning may be relatively common in patients awaiting lung transplantation and is associated with ineffective pulmonary gas exchange and reduced exercise tolerance.

Adult↗

PubMed2004

Effects of recurrent major depressive disorder on behavior and cognitive function in female depressed patients.

Little is known about the effects of recurring depressive episodes on cognition and behavior. The objective of the study was to compare cognitive function and depression-related behavior between healthy female subjects and female outpatients with early-onset DSM-IV recurrent major depressive disorder and to investigate the effect of cumulative depressive duration. Neuropsychological tests and scales for apathy, anhedonia and psychomotor retardation were assessed in 23 female patients and 60 healthy age-matched female controls. Significantly higher levels of apathy, anhedonia and psychomotor retardation, and worse performance on tests of executive function were found in the patient group compared with the healthy controls. In the patient group, cumulative depression duration was not significantly correlated with cognitive function, apathy, anhedonia or psychomotor retardation. The deficits in executive function were not related to the actual level of depression. Mild executive dysfunction may be the effect of the illness process underlying recurrent depressive disorder. Repeated or extensive depressive episodes do not seem to additionally affect cognitive deficits or behavior in depressed patients.

Aged↗

PubMed2002

Relationship between neuropsychological and emotional functioning in severe chronic alcoholism.

Previous studies of patients with severe chronic alcoholism have shown a high prevalence of emotional distress such as anxiety and depression, and neuropsychological impairments such as executive deficits, but few have examined the relationship between these disorders. We addressed this issue in 51 abstinent patients with histories of severe chronic alcoholism utilizing the Minnesota Multiphasic Personality Inventory (MMPI) and the Halstead-Reitan Neuropsychological Test Battery (HRNTB). Applying factor analysis to the MMPI clinical and validity scales, we derived four dimensions accounting for 78% of the available variance. We found that Factor 1, which loaded on most clinical scales of the MMPI, was significantly correlated (p <.01) with performance on the Halstead Category Test (HCT), a measure of executive functioning. Further, group analysis with MANOVA using HCT (impaired and nonimpaired) as the independent variable revealed a significant main effect for Factor 1 (p <.004), which was maintained and strengthened when age and education were controlled as covariates (p <.001). The results suggest a relationship between emotional distress and executive functioning as measured by the HCT, reflecting differing facets of frontal lobe dysfunction common to cognitive and affective domains in patients with severe chronic alcoholism.

Adult↗