Assessment Of Executive Dysfunction Research Articles

Effect of transcranial direct-current stimulation on executive function and resting EEG after stroke: A pilot randomized controlled study

BackgroundThe effects of transcranial direct current stimulation (tDCS) on post-stroke executive impairment (PSEI) remain controversial. Resting stateelectroencephalogram (EEG) can assist in the diagnosis and assessment of executive dysfunction. ObjectivesWe aimed to use EEG to explore the effect of tDCS on executive function among stroke patients. MethodsTwenty-four patients with PSEI were randomly divided into experimental and control groups, which received real and sham stimulation, respectively. Anodal electrical stimulation was applied to the left dorsolateral prefrontal lobe (F3). The stimulation intensity was 2 mA for 20 min once daily for 7 days. Executive function was monitored using neuropsychological scales. ResultsThe experimental group outperformed the control group in clinical scale results, with significant differences in the following scores: symbol digital modalities test, TMT-A, TMT-B, and digital span test. In the left central zone, theta band power was significantly higher after anodal electrical stimulation than before. Analysis of the correlation between EEG power and psychometric scores revealed that the power change was positively correlated with the scores on the symbol digital modality test (r = 0.435, p < 0.05). ConclusionAnodal tDCS can enhance executive function in patients with PSEI, and tDCS-related improvements are related to the enhancement of theta power in the affected region.

Insomnia and falls in older adults: are they linked to executive dysfunction?

Insomnia increases the incidence of falls and impairs executive function. Moreover, falls are associated with executive function impairment. The relationship between falls and executive function in patients with insomnia is not clear. The aim of this study was to evaluate relationship between falls and executive function in individuals with insomnia and a control group. This study involved 122 patients (47 insomnia, 75 controls). The Mini-Mental State Examination, Quick Mild Cognitive Impairment Screen, Trail Making Test A, clock-drawing test, and digit span test were used to measure executive function. Semantic and working memory dual task was also performed. Fall history was recorded and the Falls Efficacy Scale - International administered. The median age of the patients was 71 years (range: 65-89 years), and 60.7% were women. The insomnia group scored lower on the three-word recall than the control group (P = 0.005), but there was no difference between the groups on cognitive tests. Fall history and fear of falling were more frequent in the insomnia group (P = 0.003, P < 0.001). Semantic and working memory dual tasks were correlated with clock-drawing test only in the insomnia group (r = -0.316, P = 0.031; r = -0.319, P = 0.029). Depression (odds ratio (OR) = 9.65, P = 0.001) and Trail Making Test A (OR = 1.025, P = 0.07) were independently associated with insomnia. Four-metre walking speed (OR = 2.342, P = 0.025), insomnia (OR = 3.453; P = 0.028), and the semantic memory dual task (OR = 1.589; P = 0.025) were also independently associated with falls. Our study showed that dual tasking and executive function are related to falls in patients with insomnia. Managing insomnia and assessment of executive dysfunction may have beneficial effects on preventing falls.

The Impact of Idiopathic Generalized Epilepsy on Executive Functions.

Background: Idiopathic generalized epilepsy is defined as seizures with a possible hereditary predisposition without an underlying cause or structural pathology. Assessment of executive dysfunction in idiopathic generalized epilepsies based on standard Indian battery is not available in the literature.Aims and Objectives: To assess specific executive functions affected in patients with idiopathic epilepsy and their association with various variables.Materials and Methods: Type of observational cross-sectional study, where clinical profile of all idiopathic epilepsy patients attending the neurology OPD was studied and their executive higher mental functions were assessed using the NIMHANS battery.Results: A total of 75 idiopathic generalized epilepsy patients were included in the study. Executive functions that were commonly found abnormal in our study were word fluency (P ≤ .001), category fluency (P < .001), verbal n-back (P < .001), Tower of London (p < 0.01), and Stroop test (P < 0.01). Executive functions showed a significant correlation with age at symptom onset, duration of epilepsy, and in those with uncontrolled seizures.Conclusion: Patients of idiopathic generalized epilepsy according to the present study were found to have significant executive dysfunction in multiple domains. This necessitates the screening for executive dysfunctions, which if detected should prompt the clinician to initiate cognitive retraining.

Ecological Assessment of Executive Dysfunction in Anxiety

Introduction: The specialized literature states that anxiety can interfere with cognition, particularly in complex cognitive processes such as those related to executive functioning. Neuropsychological studies in anxiety disorders have confirmed the presence of deficits in executive functions, with significant changes in its components. The main aim of this study was to compare the executive performance of a sample with anxiety disorder to a control group, using an instrument that differs from the others by high ecological validity, revealing a higher predictive evidence on daily tasks. Methods: This study included 60 participants aged between 18 and 53 years that were allocated to an experimental group (n=30; mean = 31.93; standard deviation [SD] =10.99) and a control group (n=30; mean = 29.63; SD=9.07). Anxiety symptoms and the executive functioning were assessed using the Beck Anxiety Inventory (BAI) and the Behavioural Assessment of the Dysexecutive Syndrome (BADS), respectively. Results: Participants with anxiety disorders presented a significant impairment on executive functioning in general. However, we found a significant impact in tasks that involve control inhibition, design of action strategies according to the functionality and probability of success, the ability to predict or estimate and the ability to plan the action. In addition, the EG required significantly more time to execute all the tests (mean = 440.33, SD = 97.17), compared to the CG (mean = 320.90; SD = 51.27). Conclusions: Individuals with anxiety disorders have a significant impairment in their executive functioning in general, which is reflected in activities of daily living. Keywords : Anxiety disorders; executive functions; BADS; cognitive and affective evaluation

Attenuated error-related potentials in amyotrophic lateral sclerosis with executive dysfunctions.

Executive dysfunctions affect up to 50% of the patients with amyotrophic lateral sclerosis (ALS). Executive dysfunctions have been identified as negative prognostic factor and can affect quality of life in patients and their caregivers. Assessment of executive dysfunction may be impeded by the patients' motor impairments. Event-related potentials (ERP) have been proposed as a tool to overcome these assessment difficulties. The error(-related) negativity (Ne/ERN) is an ERP which can be recorded with minimal motor requirements for the patient. We compared response-synchronized ERP amplitudes of 18 ALS patients and 19 healthy controls (HC) obtained on error trials on a flanker task. We also evaluated the relation between Ne/ERN amplitudes and executive functions as assessed by standardized neuropsychological measures. While response-synchronized ERP amplitudes were generally unaffected by ALS, we found an ALS-associated relation between Ne/ERN amplitudes and executive functions. ALS patients with poorer executive functioning showed attenuated Ne/ERN amplitudes. Our data suggest that Ne/ERN amplitudes reflect ALS-associated impairment of executive functions, potentially due to disturbances in neural networks that involve the anterior cingulate cortex. Assessment of Ne/ERN amplitudes might provide a cost-efficient and non-invasive marker for executive dysfunction in ALS.

Executive Impairment Predicts Schizophrenia Diagnosis and Treatment Status in Mid-Term Follow-Up of Early-Onset Psychosis

Objectives: Early-onset psychoses (EOP) vary considerably with regard to diagnostic stability and functional outcome. The aim of this study was the assessment of executive dysfunction as a predictor of outcome in EOP. Method: This was a retrospective cohort study. Twenty-five hospitalized patients with non-affective EOP were assessed with the Wisconsin Card Sorting Test (WCST) during the index admission. Associations with current diagnosis, further admissions, current treatment status and occupational and relationship outcome were analyzed in 6 years of follow-up. Results: The mean age at the index admission and the follow-up was 16.1 ± 1.35 and 22.0 ± 2.1 years, respectively. After discharge, almost all subjects (96%) at least briefly continued psychiatric treatment, and the majority of them (76%) were readmitted. Worse baseline WCST results were associated with a follow-up schizophrenia diagnosis, being a psychiatric in- or outpatient at the moment of follow-up assessment and receiving psychotropic medication. A low number of completed categories correlated with receiving a disability pension at the follow-up. Conclusion: In patients with EOP, baseline executive function impairment was associated with schizophrenia diagnosis and psychiatric treatment at the follow-up. The association between baseline results and psychiatric treatment may explain the limited effect of baseline impairment on follow-up occupational and relationship status.

Neuropsychological assessment of executive dysfunction in men with schizophrenia

Neuropsychological assessment of executive dysfunction in men with schizophrenia

Executive dysfunction among mild traumatic brain injured patients in Northeastern Thailand

Background: Mild traumatic brain injury (TBI) is a common neurological disorder. Cognitive impairment is a result of TBI, and executive function is impaired in various degree of injury. Few data are available for assessment of executive dysfunction in Thai patients. Objective: Examine prevalence and factors influencing executive dysfunction among mild TBI patients in Thailand. Materials and methods: A cross-sectional descriptive study was conducted to determine the prevalence of 60 mild TBI patients. The patients were selected from those who were admitted at Khon Kaen Hospital between September and December 2009. Patients with previously major psychiatric or neurological disorders and currently confused or depressed were excluded. The executive function was measured by the Wisconsin Card Sorting Test (WCST), and the data was analyzed statistically. Results: Prevalence of executive dysfunction among the patients was 21.7%. Primary education level and low monthly salary were two factors to be associated with dysfunction. Alcohol use was associated with WCST score, but not with the dysfunction. However, severity of injury had no significant association with both the dysfunction and WCST score. Conclusion: Executive dysfunction in mild TBI patients was high (21.7% prevalent in Northeastern Thailand). Primary education level and low monthly salary were associated with dysfunction. Keywords: Cognitive function, executive dysfunction, mild traumatic brain injury, Northeastern Thailand

Neuropsychological and symptom predictors of aggression on the psychiatric inpatient service

Neuropsychological assessment of executive dysfunction may identify psychiatric patients who may be at high risk for aggressive behavior because impairment of the prefrontal cortex has been indicated as a possible anatomical correlate of aggression. No consensus, however, has been reached on the extent that executive dysfunction contributes to the formation of psychopathology and to aggressive behavior in psychiatric inpatients. We hypothesized a mediating model wherein patients' executive-functioning deficits contribute to the formation of psychopathological symptoms, which then underlies aggressive behavior. To test this model, we examined the relationship between executive functioning, psychiatric symptomatology, and aggressive behavior in 85 psychiatric inpatients presenting over an acute hospital admission using structure equation modeling techniques. The results revealed that psychiatric inpatients' executive function impairment significantly predicted the formation of psychiatric symptomatology, which in turn significantly contributed to the manifestation of aggressive behavior. Executive dysfunction also directly predicted inpatient aggressive behavior. Combining the indirect and direct effects, 59% of our inpatient aggression measure factor variance was accounted for by our measures of executive dysfunction and clinical symptom severity. These findings suggest that neurocognitive deficits underlie both psychiatric symptom formation and aggression. Patients with executive dysfunction may not possess the behavioral inhibition skills needed to cope with the presence of symptoms and other stressful events that accompany acute psychosis and hospitalization that may result, consequently, in increased manifestations of aggressive behavior.

Executive dysfunction using behavioral assessment of the dysexecutive syndrome in Parkinson's disease

The objective of this study was to evaluate the executive dysfunction (ExD) in Parkinson's disease (PD) using the Behavioral Assessment of the Dysexecutive Syndrome (BADS), which provides a wide-range assessment of ExD. The BADS and the Unified Parkinson's Disease Rating Scale (UPDRS) were investigated in 63 nondemented PD patients who revealed scores of >or=24 points on the Mini-Mental State Examination based on the DSM-IV. Multiple logistic regression analysis was performed to evaluate the predisposing factors to ExD, which was defined as <70 points on the age-controlled standardized score. The total score on the UPDRS was a significant independent predisposing factor to ExD. Among the various parts of the UPDRS, part II was the significant factor for ExD. The profile scores of all subtests on the BADS in patients with ExD were significantly lower than those of patients without ExD. All profile scores decreased with severity of PD, but the changes among these scores differed. ExD in nondemented PD predisposed to a greater severity of PD, particularly as regards the activity of daily living impairment. Nondemented PD revealed wide-range components of ExD. All components of ExD were impaired with severity of PD, but the patterns of each component exhibited variety.

The impact of secondary tasks on multitasking in a virtual environment

One experiment is described that examined the possible involvement of working memory in the Virtual Errands Test (McGeorge et al. (2001). Using virtual environments in the assessment of executive dysfunction. Presence, 10, 375–383), which requires participants to complete errands within a virtual environment, presented on a computer screen. Time was limited, therefore participants had to swap between tasks (multitask) efficiently to complete the errands. Forty-two undergraduates participated, all attempting the test twice. On one of these occasions they were asked to perform a concurrent task throughout (order of single and dual-task conditions was counterbalanced). The type of secondary task was manipulated between groups. Twenty-one participants were asked to randomly generate months of the year aloud in the dual-task condition, while another 21 were asked to suppress articulation by repeating the word “December”. An overall dual-task effect on the Virtual Errands Test was observed, although this was qualified by an interaction with the order of single and dual-task conditions. Analysis of the secondary task data showed a drop in performance (relative to baseline) under dual-task conditions, and that drop was greater for the random generation group than the articulatory suppression group. These data are interpreted as suggesting that the central executive and phonological loop components of working memory are implicated in this test of multitasking.

Assessment of executive dysfunction following traumatic brain injury: Comparison of the BADS with other clinical neuropsychological measures

Traditional neuropsychological measures of executive dysfunction (ED) are widely believed to lack adequate sensitivity and selectivity. This may indicate that existing measures are poorly designed and constructed, although an alternative explanation is that executive cognition is multifactorial, such that its assessment necessarily requires administration of multiple measures. This possibility led to the development of a test battery, the Behavioural Assessment of the Dysexecutive Syndrome (BADS). To investigate the sensitivity of the BADS to ED, it and various other measures of ED were administered to 64 persons who had sustained traumatic brain injury. The treating clinical neuropsychologist and occupational therapist for each participant also completed a behavioural rating scale, the Dysexecutive Questionnaire (DEX). Four factors were found to underlie scores on the neuropsychological measures, but few tests were sufficiently powerful to make a significant unique contribution to predicting scores on the DEX. This confirms that multiple tests, drawn from both the BADS and other sources, may be necessary to detect ED in a clinical population.

Assessment of executive dysfunction during activities of daily living in schizophrenia

Many neuropsychological studies have described deficits of memory and executive functions in patients with schizophrenia, and the severity of these deficits seems to be determinant in predicting the community outcome of these patients [Schizophr. Bull. 26 (2000) 119]. However, neuropsychological evaluation does not provide valuable information about how the cognitive deficits directly affect daily living, that is, which cognitive deficit affects which behavior. The present study aimed at determining whether executive dysfunction in schizophrenia could be directly measured by analyzing three activities of daily living (ADL), in addition to assessing the ecological validity of commonly used neuropsychological tests. Within specific ADL (choosing a menu, shopping the ingredients, cooking a meal), the sequences of behaviors that have been performed by 27 control subjects and 27 patients with schizophrenia were both analyzed by using a preset optimal sequence of behavior. When compared with control subjects, patients with schizophrenia showed more omissions when choosing the menu, more sequencing and repetitions errors during the shopping task, and more planning, sequencing, repetition and omission errors during the cooking task. These behavioral errors correlated significantly with negative, but not with positive symptoms of the patients. Furthermore, they also correlated with the poor performances on executive neuropsychological tests, especially those sensitive to shifting and sequencing abilities, but not with memory tests. These results suggest that executive deficits in schizophrenia may specifically affect ADL and that such deficits can be quantitatively assessed with a behavioral scale of action sequences.

Using Virtual Environments in the Assessment of Executive Dysfunction

A study is reported into the role of virtual environments in the assessment of patients with executive dysfunction. Five patients and five matched controls entered the study. The patients did not differ significantly from normative values on the standard executive dysfunction measure, the Behavioural Assessment of the Dysexecutive Syndrome battery (Wilson, Alderman, Burgess, Emslie, &amp; Evans, 1996); however, care staff reported the patients had problems planning. Patients and controls undertook both real and virtual environment multiple-errand planning tasks. The patients completed significantly fewer errands, and produced significantly worse plans than did controls in both the real and virtual environments. There was a significant correlation between performance in the real and virtual environments. The results suggest that virtual environments may provide a valid means of assessing planning impairments and that there may be patients with executive dysfunction (specifically planning deficits) that may not be detected by the currently available standardized tests.