Behavioral Assessment Of Dysexecutive Syndrome Research Articles

Global cognition and executive functions of older adults with type 1 diabetes mellitus without dementia.

This study aimed to characterize the global cognition and executive functions of older adults with type 1 diabetes mellitus in comparison with type 2 diabetes mellitus. This study included 37 patients with type 1 diabetes mellitus aged ≥65 years and 37 age- and sex-matched patients with type 2 diabetes mellitus. Patients with dementia scoring <24 on the Mini-Mental State Examination were excluded. General cognition, memory, classic, and practical executive function were investigated. Patients with type 1 diabetes mellitus demonstrated lower psychomotor speed scores on Trail Making Tests A and B (P < 0.001, P < 0.013) than those with type 2 diabetes mellitus. The dysexecutive syndrome behavioral assessment revealed similar results in patients with types 1 and 2 diabetes mellitus. The Wechsler Memory Scale-Revised verbal episodic memory and Montreal Cognitive Assessment Japanese version were similar in terms of general cognition, but worse delayed recall subset on the latter was associated with type 2 diabetes mellitus (P = 0.038). A worse Trail Making Test-A performance was associated with type 1 diabetes mellitus and age (P < 0.004, P < 0.029). Executive function of psychomotor speed was worse in older outpatient adults without dementia with type 1 diabetes mellitus than in those with type 2 diabetes mellitus but with no significant differences in the comprehensive and practical behavioral assessment of dysexecutive syndrome. Patients with type 1 diabetes had more severely impaired executive function, whereas those with type 2 had greater impaired memory than executive function.

Executive functioning skills of children with listening difficulties

AbstractChildren with normal hearing who present with listening difficulties (LiD) are frequently referred for assessment of auditory processing disorder (APD). Complicating diagnosis is the similarities of APD to other neurodevelopmental disorders, especially attention‐deficit hyperactivity disorder (ADHD). Due to well‐documented deficits in executive functioning (EF) in children with ADHD, we hypothesized that a possible root cause of observed listening deficits may be EF deficits, rather than auditory processing alone. For preliminary investigation into this hypothesis, the current study compared EF skills of children with LiD who were referred for APD assessment, with and without a diagnosis of ADHD. EF skills of 24 children between the ages of 7–16 were assessed utilizing the Behavioral Assessment of Dysexecutive Syndrome in Children, and the Behavior Rating Inventory of Executive Function, 2nd edition. Compelling differences were found between groups of children with LiD. Children without ADHD scored lower on measures of inhibitory control compared to children with a diagnosis of ADHD. Decreased EF skills exhibited in children with LiD, even those without a diagnosis of ADHD, support the need for transdisciplinary identification and management of children with LiD.

Executive Functions and Attention Processes in Adolescents and Young Adults with Intellectual Disability.

(1) Background: We made a comprehensive evaluation of executive functions (EFs) and attention processes in a group of adolescents and young adults with mild intellectual disability (ID). (2) Methods: 27 adolescents and young adults (14 females and 13 males) with ID, aged between 15.1 and 23 years (M = 17.4; SD = 2.04), were compared to a control group free of cognitive problems and individually matched for gender and age. (3) Results: As for EFs, individuals with ID were severely impaired on all subtests of the Behavioral Assessment of Dysexecutive Syndrome (BADS) battery. However, we also found appreciable individual differences, with eight individuals (approximately 30%) scoring within normal limits. On the attention tests, individuals with ID were not generally slower but presented specific deficits only on some attention tests (i.e., Choice Reaction Times, Color Naming and Color–Word Interference, and Shifting of Attention for Verbal and for Visual Targets).The role of a global factor (i.e., cognitive speed) was modest in contributing to the group differences; i.e., when present, group differences were selectively associated with specific task manipulations, not global differences in cognitive speed. (4) Conclusions: The study confirmed large group differences in EFs; deficits in attentional processing were more specific and occurred primarily in tasks taxing the selective dimension of attention, with performance on intensive tasks almost entirely spared.

Developing and evaluating the validity of the behavioural assessment of dysexecutive functioning – intellectual disabilities adaptation (BADS-ID)

PurposeAssessment of executive functioning is an important element of a comprehensive assessment of intellectual abilities. Few assessments available are accessible for individuals with intellectual disabilities (ID) and none have population-specific norms. This paper aims to describe the adaptation of the behavioural assessment of dysexecutive syndrome (BADS).Design/methodology/approachAdaptations were made to the BADS tests to create the BADS – intellectual disabilities (BADS-ID). Data from three doctoral dissertations were combined to explore the utility, reliability, validity and component structure of the BADS-ID. Properties of the BADS-ID were compared with the Cambridge Executive Functioning Assessment (CEFA).FindingsThe BADS-ID is accessible to IQ range 50–70 and has a two-component structure. It has good inter-rater reliability, but poor internal consistency. It has a good face and content validity but evidence for concurrent and discriminative validity is weak. All properties are comparable to or better than the CEFA.Research limitations/implicationsFurther research is needed to improve reliability and validity. The development of an accessible test battery with known reliability and validity for individuals with ID should facilitate research into executive functioning in this population. There is the potential to develop population-specific norms from the data.Practical implicationsAn accessible test battery for individuals with ID is helpful in clinical situations.Originality/valueTo the best of the authors’ knowledge, this is the first study to explore the adaptation of the BADS for use with individuals with ID.

Tactile Discrimination, Praxis and Cognitive Impulsivity in ADHD Children: A Cross-Sectional Study.

Background: The study of attention deficit hyperactivity disorder (ADHD) has traditionally focused on deficit of inhibitory control and cognitive impulsivity. However, the pathophysiology of ADHD has also been associated with the somatosensory cortex. The aim of this study was to explore if there were differences in tactile discrimination and praxis between neurotypical and ADHD children and whether these differences could be explained by cognitive impulsivity. Methods: A cross-sectional study was conducted. The sample comprised 74 children aged 7 to 11 years divided in two groups: 43 with neurotypical development, 31 with ADHD. To assess tactile discrimination, the finger localization and the graphestesia tests were used. Praxis was assessed with the Kaufman Assesment Battery for Children (K-ABC) hand movement subtest, the action program and the Zoo Map subtests of the Behavioral Assessment of Dysexecutive Syndrome, and the complex figure of Rey–Osterrieth test (ROCF). Cognitive impulsivity was assessed using the Magallanes Computerized Impulsivity Scale test (EMIC). Results: Children with ADHD showed greater cognitive impulsivity (p = 0.038) and scored lower in Zoo Map (p = 0.023) and hand-movement subtests (p = 0.002), and in ROCF test (p = 0.004). Differences in praxis skills still remained after controlling by gender and cognitive impulsivity. Conclusion: Praxis deficit might have repercussions not only on the characterization of ADHD but also on its treatment.

Executive functioning and daily living of individuals with chronic stroke: measurement and implications.

Deficits in executive functioning (EF) are often still present at the chronic stage after stroke, which may negatively impact independent living. The objectives of this study were (a) to characterize the EF and independence in daily living of community-dwelling individuals with chronic stroke by using pen-and-paper and performance-based EF assessments, (b) to explore correlations between scores detected by different EF assessments and (c) to assess the correlations between EF and independence in basic activities of daily living (BADL) and instrumental activities of daily living (IADL). This cross-sectional study included 50 (30 men and 20 women) community-dwelling individuals [mean (SD) age 59.8 (9.3)] with chronic stroke. Participants were overall independent in basic activities of daily living, without significant cognitive impairment. Participants underwent EF assessment using two pen-and-paper tools: Trail Making Test, Zoo Map subtest from the Behavioral Assessment of Dysexecutive Syndrome and two performance-based tools; EF Route-Finding Task and bill-paying subtest from the Executive Functions Performance Test. BADL, IADL, depressive symptoms, gait speed and upper extremity motor impairment were also assessed. Participants demonstrated mild to moderate EF deficits with moderate significant correlations between the scores of various EF assessments. Participants varied in their independence in IADL, and EF was significantly correlated to independence in BADL and IADL (-0.31<r<0.48; -0.37<r<-0.42; P<0.05, respectively, depending on the assessment). EF deficits with varying severity are still present at the chronic stage after stroke among independent community-dwelling individuals. These findings can guide the choice of an appropriate assessment tool for the specific needs of individuals with chronic stroke.

An ecological approach to the behavioral assessment of executive functions in anorexia nervosa

The use of ecological tests to assess executive functions (EFs) in patients with anorexia nervosa (AN) has not examined extensively. The objective of this study was to analyze and compare the performance of patients with AN and healthy controls (HCs) on standard versus ecologically valid tests on EFs. Sixty-two females aged between 16 and 42 who were diagnosed with AN and 70 matched HCs completed 2 neuropsychological test batteries: standard tests (WCST, TMT, Stroop, ToL, fluency test) and the Behavioral Assessment of Dysexecutive Syndrome (BADS). On the standard tests, patients with AN produced more perseverative response and were slower than HCs in the TMT; in contrast, they scored as well as HCs on tasks that assessed categorization, interference in color naming, planning and semantic fluency. Conversely, there were differences in the ecological tests with patients with AN systematically slower in the resolution of complex tasks. Results demonstrated the power of ecological tests in capturing selective impairments in multifaceted and unstructured tests. Patients with AN experienced systematic deceleration in the resolution of ecological tasks. Also, the increased time needed to solve the tasks, was not reflected in overall improvement in performance. This evidence is further discussed with respect to central coherence.

Cognitive Function in Patients Before and After Micro-neurosurgical Resection of Frontal Brain Tumors

Patients with lesions of the prefrontal cortex as a result of frontal brain tumors (intra- and extra-axial) can show impairments of executive functions 1 2 3 4. Although there are a large number of psychological tests, the detection of impairments of relevant everyday executive functions in these patients is still extremely difficult. In 30 patients with lesions of the prefrontal cortex, the executive functions were tested with the Behavioral Assessment of Dysexecutive Syndrome (BADS) and 21 patients were also followed up postoperatively. Additionally, if possible, the Wisconsin Card Sorting Test (WCST), a widely used executive function test, and the Wechsler Adult Intelligence Scale (WAIS) for general cognitive performance were conducted. Pre- and postoperatively, a total of 16 patients were followed up with all three tests. The aim was to investigate the neuropsychological assessment pre- and postoperatively, to evaluate it in terms of deficits and changes in performance and to ensure that no new relevant everyday cognitive deficits arose. Preoperatively, only one patient, who could not be tested post-surgery, showed a reduced overall profile value in the BADS. In all tested patients, there was no evidence of deterioration of cognitive status 8 - 12 weeks postoperatively. Further investigations using fMRI should be used to clarify whether the results obtained should be interpreted as neuroplastic adaptations of prefrontal cognitive functions or as a failure to detect deficits due to a lack of sensitivity of the tests used.

Modified Six Elements Test: Earlier diagnosis of the correlation between motor and executive dysfunction in Parkinson's disease without dementia

Background In patients with Parkinson's disease, executive deficits are known to correlate with motor dysfunctions, such as gait and postural instability. However executive deficits are sometimes difficult to detect using common frontal assessment batteries. Behavioral Assessment of Dysexecutive Syndrome includes six subtests to evaluate different aspects of executive function required in daily life. Among these the Modified Six Elements Test examines higher levels of executive function with regard to prospective memory and organization of behavior. Aim Using Behavioral Assessment of Dysexecutive Syndrome we examined which types of executive dysfunction correlate with motor symptoms in Parkinson's disease without apparent dementia. Methods A total of 54 Parkinson's disease patients with Mini-Mental State Examination scores over 24 were assessed with the Unified Parkinson's Disease Rating Scale (total score of parts II and III as general motor function, subscores of tremor, rigidity, bradykinesia, gait disturbance and postural instability) for motor assessment, and both the Behavioral Assessment of Dysexecutive Syndrome (total raw score of all subtests and subscores of each of the 6 subtests) and Frontal Assessment Battery for executive function. Correlation coefficients for executive and motor assessments were compared. Results Among the Behavioral Assessment of Dysexecutive Syndrome subtests, the Modified Six Elements Test showed the strongest correlation with the Unified Parkinson's Disease Rating Scale subscore of gait disturbance, but did not correlate with patient background factors, such as age. Conclusion Even in Parkinson's disease without apparent dementia, deficits in complex executive functions, such as prospective memory and organization of behavior, correlate with motor dysfunctions, especially gait. We believe the Modified Six Elements Test is useful to evaluate early executive deficits.

Understanding the Lived Experience of People with Multiple Sclerosis and Dysexecutive Syndrome

Introduction: While evidence suggests that people with multiple sclerosis experience executive function impairment, there is a lack of understanding as to what this means for people within their occupational lives. This study attempted to explore the meanings constructed by individual participants who live with multiple sclerosis and dysexecutive syndrome on a daily basis. Method: Ten community-dwelling adults, diagnosed with clinically definite/probable multiple sclerosis and having performed within the ‘Impaired’ category of the Behavioural Assessment of Dysexecutive Syndrome, were invited to participate in semi-structured interviews. The data were analysed using interpretative phenomenological analysis. Findings: The reported changes in the occupational lives of the participants contributed to significant alterations in the roles they inhabited. There was a substantial cost to personal identity as the participants withdrew from former roles or perceived themselves to be failing within their existing roles, leading to a loss of self-worth and self-esteem. Conclusion: It is evident from the findings of this study that the actual cognitive deficits did not represent the main issue for people within their everyday lives; rather, the putative consequences of executive dysfunction were of much greater concern for them.

Effects of integrative body-mind training with cognitive rehabilitation based on the sensory integration training theory on executive function and anxiety and depression mood in patients with traumatic brain injury

Objective To study the effects of integrative body-mind training with cognitive rehabilitation based on the sensory integration training theory on executive function and anxiety and depression mood in patients with traumatic brain injury.Methods 85 cases were randomly divided into the control group (42 cases) and the treatment group (43 cases).The control group took targeted cognitive rehabilitation with sensory integration training theory and the treatment group was given targeted integrative bodymind training based on this training.Before training and after 3 months,the cognitive function and executive function were detected by the Behavioral Assessment of Dysexecutive Syndrome (BADS); the cognitive dysfunction were evaluated by Loewenstein Occupation Therapy Cognitive Assessment (LOTCA); Anxiety and Depression were evaluated by Self-rating Depression Scale (SDS) and Self-Rating Anxiety Scale (SAS).Results There was no marked differences in BADS,LOTCA,SDS and SAS scores before treatment; Compared with the control group,they were much improved after training; Moreover,they were much more improved in the treatment group than those of the control group.Conclusions Integrative bodymind training with cognitive rehabilitation based on the sensory integration training theory can improve the executive function and regulate the mood on cognitive dysfunction in patients with traumatic brain injury. Key words: Sensory integration training; Body-mind training; Traumatic brain injury; Executive function; Anxiety and depression

Behavioral Assessment of the Dysexecutive Syndrome for Children

The present study evaluated the utility of the Behavioral Assessment of Dysexecutive Syndrome for Children for discerning differences in executive functioning between attention-deficit hyperactivity disorder (ADHD) children and normal controls and examined its associations with real-life executive function as rated by parent reports on the Dysexecutive Questionnaire for Children. Sixty-three children diagnosed with ADHD and 60 normal healthy peers were recruited for this study. All participants completed the Behavioral Assessment of Dysexecutive Syndrome for Children, while their parents completed the Dysexecutive Questionnaire for Children. Results revealed that the ADHD group exhibited significantly poorer performance than the controls on 3 subtests of the Behavioral Assessment of Dysexecutive Syndrome for Children (ie, Playing Cards Test, Water Test, and Zoo Map Test 2), as well as on the total Dysexecutive Questionnaire for Children. Significant correlation was found between the total Dysexecutive Questionnaire for Children and the 6-Part Test. Findings suggested that some subtests of the Behavioral Assessment of Dysexecutive Syndrome for Children were particularly useful for detecting real-life executive dysfunction in ADHD. Yet, further studies are needed to provide extended validity data.

The Executive Dysfunctions Most Commonly Associated with Multiple Sclerosis and Their Impact on Occupational Performance

Introduction: The relationship between executive dysfunction and functional status in people with multiple sclerosis (MS) is not fully understood. This study attempts to provide empirical evidence of the executive dysfunctions most commonly associated with MS and to develop an understanding of the impact of this on occupational performance. Method: This cross-sectional study explores the relationships between an MS group (n = 69) and a healthy control group (n = 30) using the Behavioural Assessment of Dysexecutive Syndrome and the Dysexecutive Questionnaire. Results: More than a third of people with MS experienced some impairment of executive function sufficient to interfere with occupational performance. The most commonly occurring problems included planning, problem solving, behavioural regulation, lack of insight, apathy and lack of motivation. Executive function deficits were evident from the early stages of the disease, although participants with a secondary progressive form of MS appeared to demonstrate greater difficulties. Conclusion: While the Behavioural Assessment of Dysexecutive Syndrome may reliably identify the presence of executive dysfunction within this clinical population it does not inform clinicians of the impact on occupational performance. Self-reported executive function demonstrates heightened awareness of occupational performance deficits and may lead to more accurate reporting of executive dysfunction. The impact of depression, fatigue and anxiety, however, requires further investigation.

Assessment of Executive Functions in Prader–Willi Syndrome and Relationship with Intellectual Level

The aim of the present study was to determine whether individuals with Prader-Willi syndrome (PWS) have impaired global executive functioning and whether this deficit is linked with intellectual disability. Another objective focussed on the variability in performance of intellectual quotient (IQ) and executive functions (EF) depending on the genotypic subtype. A final objective investigated whether the relationships between IQ and EF are different according to the genotypic subtype. Twenty individuals with PWS and mild-to-moderate IQ (standard scores between 55 and 90, age range 19 and 49years old, SD=28.1) were administered an ecological battery of executive functioning (behavioural assessment of dysexecutive syndrome, BADS, adapted from Wilson etal. (1996) Behavioural Assessment of the Dysexecutive Syndrome. Thames Valley Test Company: Bury St Edmunds, UK.). The BADS contains six tests evaluating EF. The sample comprised 14 deletion subtype and six maternal uniparental disomy (m-UPD) subtype. Behavioural assessment of dysexecutive syndrome scores were below the level of the standardized healthy populations of the battery and equivalent to those of the neuropathological standardized population. Most scores on EF tasks were relatively highly correlated with Full Scale and Verbal IQs but were not significant or moderately correlated with Performance IQ. Lastly, underlying differences were found in scores on two EF tasks (the Rule Shift Card and the Zoo Map subtests) between the deletion and m-UPD subtypes. These data suggest a deficit of executive functioning in PWS that is linked more with verbal skills than performance skills. They also suggest that the impact on executive functioning may differ according to the genotype.

Specific vs general cognitive remediation for executive functioning in schizophrenia: A multicenter randomized trial

BackgroundThis study assesses the benefits of an individualized therapy (RECOS program) compared with the more general cognitive remediation therapy (CRT). Methods138 participants took part with 65 randomized to CRT and 73 to RECOS. In the RECOS group, participants were directed towards one of five training modules (verbal memory, visuo-spatial memory and attention, working memory, selective attention or reasoning) corresponding to their key cognitive concern whereas the CRT group received a standard program. The main outcome was the total score on BADS (Behavioural Assessment of Dysexecutive Syndrome) and the secondary outcomes were: cognition (executive functions; selective attention; visuospatial memory and attention; verbal memory; working memory) and clinical measures (symptoms; insight; neurocognitive complaints; self-esteem). All outcomes were assessed at baseline (T1), week 12 (posttherapy, T2), and follow-up (week 36, i.e., 6months posttherapy, T3). ResultsNo difference was shown for the main outcome. A significant improvement was found for BADS' profile score for RECOS at T2 and T3, and for CRT at T3. Change in BADS in the RECOS and CRT arms were not significantly different between T1 and T2 (+0.86, p=0.108), or between T1 and T3 (+0.36, p=0.540). Significant improvements were found in several secondary outcomes including cognition (executive functions, selective attention, verbal memory, and visuospatial abilities) and clinician measures (symptoms and awareness to be hampered by cognitive deficits in everyday) in both treatment arms following treatment. Self-esteem improved only in RECOS arm at T3, and working memory improved only in CRT arm at T2 and T3, but there were no differences in changes between arms. ConclusionsRECOS (specific remediation) and CRT (general remediation) globally showed similar efficacy in the present trial.

Detecting executive deficits in children with ADHD or acquired brain injury using the Behavioural Assessment of Dysexecutive Syndrome (BADS)

Relationships between executive functioning (EF), attention and behavioural inhibition in children with attention deficit hyperactivity disorder (ADHD) or acquired brain injury (ABI) were explored using the Behavioural Assessment of Dysexecutive Syndrome (BADS), a test battery originally developed for use with adults. Children with ADHD-Combined (ADHD-C; n=20), ABI (n=10) and matched controls (n=20) were administered a battery of EF tasks designed for adults. Executive functions including goal-directed behaviour, planning and organisational abilities, temporal judgement and set shifting ability were assessed using BADS. Literacy skills, sustained attention and behavioural inhibition were also assessed to explore potential associations between these cognitive domains. Significant differences between ADHD, ABI and controls were observed on measures of attention, behavioural inhibition and EF. Children with ADHD performed more poorly on tests of attention and inhibition. However, children with ADHD performed...

Determinants of irritability in Huntington's disease.

Nimmagadda SR, Agrawal N, Worrall-Davies A, Markova I, Rickards H. Determinants of irritability in Huntington's disease.Objectives: Irritability is a common and disabling problem associated with Huntington's disease (HD). However, the underlying causes of such irritability remain unclear. This study investigates the association of irritability in HD with possible aetiological factors including dysexecutive syndrome, depression, anxiety (state and trait) and movement disorder.Methods: Thirty patients with genetically confirmed HD and their carers were recruited from a regional HD neuropsychiatry service. Patients completed two self-reported questionnaires (Irritability, Anxiety and Depression Scale and State Trait Anxiety Inventory). Their carers filled in the Burns Irritability Scale. Patients were also administered the Behavioural Assessment of Dysexecutive Syndrome (BADS), Montgomery and Asberg Depression Rating Scale (MADRS) and the Motor component of the Unified Huntington's Disease Rating Scale (UHDRS).Results: Both self-rated and carer-rated irritability scales showed significant positive correlation with trait anxiety. The self-rated irritability scales also showed significant positive correlation with state anxiety and depression. No association was observed between irritability and dysexecutive syndrome or motor impairment.Conclusions: Trait anxiety might serve as a predictor for irritability in HD. Irritability is unrelated to motor or cognitive features of HD indicating that it is an independent neuropsychiatric manifestation of HD.

Executive dysfunction and influencing factors in convalescent patients with traumatic brain injury

Objective To explore and analyze the executive function of patients with traumatic brain injury in recovery phase and reveal its influential factors.Methods Behavioral Assessment of Dysexecutive Syndrome (BADS) was conducted in 104 patients with brain injury at 5 ～ 6 months after discharging and matched healthy comparison subjects in this study.Basic information in patients with the clinical data were collected by self-designed questionnaire to analyze the relevant factors.Results BADS findings showed that the individual scores and total standard scores of brain injury patients( 12.05 ± 2.54 ) were significantly lower than those of health population ( 19.02 ± 3.77 ) (P ＜ 0.05 ).Action program test, temporal judgment test, modified six elements test and total sub-standard scores ( 14.83 ±3.86)in junior high school education level and below group were significantly lower than that in high school and higher education group ( 17.67 ± 4.10 ).The individual scores and total standard scores ( 10.13 ± 3.86 )in heavier group were significantly lower than that in the lighter group ( 15.68 ± 4.10 ).The group without complication' action program test, key search test, zoo map test, modified six elements test were significantly lower than the group with complication.The BADS scores were related to education, illness condition,and complication (hypertension, hyperglykemia, hyperlipemia) (P＜0.05).Conclusion There is executive dysfunction in traumatic brain injury patients.The executive dysfunction is mainly correlated with education, illnesscondition and complication.Medical staff should provide pertinent intervention and treatment according to the above aspects, in order to obtain better effects of rehabilitation therapy . Key words: Traumatic brain injury; Recovery phase; Executive dysfunction; Factors

DEX and executive dysfunction in activities of daily living in Alzheimer's disease and frontotemporal dementia

The questionnaire DEX was designed by Wilson et al. in 1996 to explore the disturbances of executive functions (EF) in activities of daily living (ADL). This study was performed to explore the specificity of the DEX to evaluate executive dysfunction in ADL, and its contribution to the distinction between Alzheimer's disease (AD) and frontotemporal dementia (FTD). 13 patients with the frontal variant of FTD, 19 patients with FTD associated with amyotrophic lateral sclerosis, FTD/SLA, 18 patients with Alzheimer's disease, AD, and 24 controlled subjects. The scores on the DEX completed by a proxy as well as those on two scales assessing ADL (the Cognitive Difficulties Scale by McNair & Kahn, and a composite scale (NADL) including the evaluation of basic (BADL) and instrumental (IADL) by the Lawton & Brody scales, and of social activities (SADL) from Katz & Lyerly) were compared to neuropsychological tests assessing EF (Behavioural Assessment of Dysexecutive Syndrome (BADS), Wisconsin Card Sorting Test, Stroop test, Trail Making Test B, lexical and categorical verbal fluencies, WAIS-III similarities). No correlation was found between the scores on the DEX or the other ADL scales, and the BADS scores. Scores on DEX showed some weak correlations with some executive tasks, but no stronger than those found with the other ADL scales. Analysis of the most frequently perturbed DEX items failed to show a characteristic profile for EF dysfunction. No significant difference was found between patients with AD and DFT on the scores on the DEX as well as on other ADL scales, when adjusted for dementia severity (assessed by the Mattis Dementia Rating Scale (MDRS)). No difference was found between MA and DFT patients neither in the profile of the most frequently perturbed DEX items, nor in decreased awareness of the disorders assessed by comparison of the scores on the DEX completed by patients and familiars. In this study, DEX does not appear as a specific tool for assessing EF dysfunction in ADL compared to other ADL scales. It was more related to global cognitive difficulties as assessed by the CDS and the MDRS. Scores on the DEX as well as on other ADL scales do not contribute to the distinction between AD and FTD.

Cognitive insight in psychosis: The relationship between self-certainty and self-reflection dimensions and neuropsychological measures

Cognitive insight in schizophrenia encompasses the evaluation and reinterpretation of distorted beliefs and appraisals. We investigated the neuropsychological basis of cognitive insight in psychosis. It was predicted that, like clinical insight, cognitive insight would be associated with a wide range of neuropsychological functions, but would be most strongly associated with measures of executive function. Sixty-five outpatients with schizophrenia or schizoaffective disorder were assessed on tests of intelligence quotient (IQ), executive function, verbal fluency, attention and memory, and completed the Beck Cognitive Insight Scale, which includes two subscales, self-certainty and self-reflection. Higher self-certainty scores reflect greater certainty about being right and more resistant to correction (poor insight), while higher self-reflection scores indicate the expression of introspection and the willingness to acknowledge fallibility (good insight). The self-certainty dimension of poor cognitive insight was significantly associated with lower scores on the Behavioural Assessment of Dysexecutive Syndrome; this relationship was not mediated by IQ. There were no relationships between self-reflection and any neuropsychological measures. We conclude that greater self-certainty (poor cognitive insight) is modestly associated with poorer executive function in psychotic individuals; self-reflection has no association with executive function. The self-certainty and self-reflection dimensions of cognitive insight have differential correlates, and probably different mechanisms, in psychosis.