Abstract
BackgroundExecutive functions (EF) in Alzheimer’s disease (AD), classically related to the prefrontal cortex, have been forgotten in mild stages, given more importance to temporal lobe associated disorders, such as memory. The study of disexecutive syndrome (DS) has been relegated to advanced stages of the disease. Our goal is to demonstrate that EF are already present in amnesic mild cognitive impairment (aMCI). Furthermore, we are interested in knowing whether poor scores in EF tests are related to the progression to AD or another kind of dementia.MethodsWe studied patients with aMCI (n = 81) and healthy controls (n = 142) from neurological departments of several centers of Basque Country with a cross-sectional design. Patients underwent a complete neuropsychological evaluation, neuroimaging testing APOE genotype and 3 year of prospective follow-up.ResultsIn the first visit, patients with aMCI showed more alterations in tests that evaluate EF such as Stroop, trail-making and categorical verbal fluency. More alterations were also found in NPI scale (P <0.05). Stroop and Trail-Making test were not associated with the future development of AD, but fluency (p = 0.01) and apathy (p = 0.031) did. No patient developed a different kind of dementia different from AD.ConclusionsDS is a broad concept not confined to frontal lobes, and can be found in early stages of aMCI. DS impacts negatively on patient autonomy and may have prognostic value.
Highlights
Executive functions (EF) in Alzheimer’s disease (AD), classically related to the prefrontal cortex, have been forgotten in mild stages, given more importance to temporal lobe associated disorders, such as memory
Our study aims is to demonstrate that disexecutive syndrome (DS) in AD is present in previous stages, such as amnesic mild cognitive impairment (aMCI)
There were differences in years of schooling: higher values were found in controls than in aMCI (Table 1)
Summary
Executive functions (EF) in Alzheimer’s disease (AD), classically related to the prefrontal cortex, have been forgotten in mild stages, given more importance to temporal lobe associated disorders, such as memory. Executive functions (EF), a term coined by Lezak [1] following the footsteps of Luria, are those mental capacities necessary for formulating goals, planning how to achieve them, and carrying out the plans effectively, encompassing tasks such as inhibition, interference control, working memory and cognitive flexibility. Neurodegeneration in AD typically begins in the medial temporal lobe [4] leading to episodic memory deficits and to an inability to learn new information. In general terms we can face the model of the prototypical AD to frontotemporal dementia (FTD), in which degeneration begins in frontal and temporal lobes There are atypical forms of AD such as frontal variant, with a severe and disproportionate early alteration in the frontal functions and greater prominence of neurofibrillary tangles in the frontal cortex than in patients with classical Alzheimer’s disease [5].
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