Executive Difficulties Research Articles

Impact of Evidence-Based Functional Intervention Approach on an Individual with Wernicke’s Aphasia Based on International Classification of Functioning, Disability and Health Framework: A Case Study

Background Severe comprehension impairments in Wernicke’s aphasia (WA) are often seen to be associated with auditory related impairment and phonological processing, including semantic and executive difficulties. This study investigated whether an intensive functional approach regime underpins the improvement in speech, language and cognitive domains in an individual with WA resulting in a positive impact on functional communication skills and quality of life-based on international classification of functioning (ICF), disability and health framework. Aim To study the impact of evidence-based functional treatment approach on the speech, language, cognitive and quality of life (QoL) domains in a patient diagnosed with WA based on ICF Framework. Objective The purpose of this longitudinal case study was to compare before- and after-scores of speech and language abilities, cognitive abilities and QoL in a patient diagnosed with WA after providing an intensive evidence-based functional communication treatment approach. Material and Methods A case aged 60-years-old male with a one-month history of stroke; was diagnosed as WA. The patient received intensive functional treatment approach focusing on language and cognition for one hour continuously per session, for eight sessions, within 2-months which involved different therapy approaches to improve his communication abilities. The measurement of language, cognitive abilities and QoL was assessed using the English adaptation of the Western Aphasia Battery (WAB), Addenbrooke’s Cognitive Examination-Revised (ACE-R) and World Health Organization Quality of Life Instrument, Short Form ((WHOQoLBREF) respectively. The results obtained were analyzed based upon the scores obtained across the domains of WAB, ACE-R, and QoL in two stages i.e. pre- and post-intensive aphasia functional language intervention program. Results The outcome of the current study revealed improved scores in WAB, ACE-R, and WHOQoL which highlighted the fact that aphasia therapy techniques targeting the language and functional goals must be followed and implemented during the therapeutic sessions based on the client’s type of aphasia. Conclusion The findings of the case study suggests that the impact of functional communication approach targeting the maximum participation of the person with aphasia seems to be one of the most effective and efficient way to rehabilitate aphasics to improve their QoL.

Compulsive shopping behaviour and executive dysfunction in young adults

“Compulsive Shopping” is characterized by poorly controlled preoccupations/urges/behaviors focused on shopping and spending, causing significant distress/impairment. This study looked at what roles executive and related memory problems might exist in compulsive shopping. 205 adults completed on-line questionnaires measuring compulsive shopping, mood, as well as working memory and inhibition components of executive function. The Bergen Shopping Addiction Scale was used to assign participants to either a High Compulsive Shopping (HCS) group or Low Compulsive Shopping (LCS) group. Working memory (WM) and inhibition control (IC) were measured as two components of executive function (EF) using the Adult Executive Functioning Inventory (ADEXI), the Dysexecutive Questionnaire Revised (DEX-R) measured general EF. The Hospital Anxiety and Depression Scale measured anxiety and depression. MANCOVA and mediation analyses were carried out controlling for age, gender, anxiety, depression. The HCS group scored significantly higher on all three EF measures, indicating greater executive difficulties. Subsequent mediation analyses with the ADEXI-IC as the mediator removed the significance of the relationship between Group and both the DEX-R and ADEXI-WM outcome variables. Thus, observed Group difference in DEX-R and ADEXI-WM could be fully accounted for by group differences in inhibitory control. The results highlight the role inhibitory control plays in compulsive shopping.

The effect of a mindfulness-based intervention on executive, behavioural and socio-emotional competencies in very preterm young adolescents

Very preterm (VPT) children and adolescents show executive, behavioural and socio-emotional difficulties that persists into adulthood. This study aims to assess the effectiveness of a mindfulness-based intervention (MBI) in improving these competencies in VPT young adolescents using a randomised controlled trial design. 56 young adolescents aged 10–14 years, born before 32 gestational weeks, were randomly assigned to an “intervention” or a “waiting” group and completed an 8-week MBI in a cross-over design. Executive, behavioural and socio-emotional competencies were assessed at three different time points via parent and self-reported questionnaires, neuropsychological testing and computerised tasks. The data were analysed using an intention-to-treat approach with linear regression modelling. Our findings show a beneficial effect of MBI on executive, behavioural and socio-emotional competencies in VPT young adolescents measured by parent questionnaires. Increased executive competencies were also observed on computerised task with enhanced speed of processing after MBI. Two subgroups of participants were created based on measures of prematurity, which revealed increased long-term benefits in the moderate-risk that were not observed in the high-risk subgroups of VPT young adolescents. MBI seems a valuable tool for reducing detrimental consequences of prematurity in young adolescents, especially regarding executive, behavioural and socio-emotional difficulties.Clinical Trial Registration ClinicalTrials, NCT04638101. Registered 20 November 2020—Retrospectively registered, https://clinicaltrials.gov/show/NCT04638101.

A Short Version of the EFECO Online Questionnaire for the Assessment of Executive Functions in School-Age Children.

Executive function (EF) is a group of processes that allow individuals to be goal-oriented and to have adaptive functioning, so that adequate performance is essential for success in activities of daily living, at school and in other activities. The present study aims to create a short version of the Executive Functioning Questionnaire (EFECO) since there is a gap in the Spanish literature due to the lack of behavioural observation questionnaires at school age. A total of 3926 participants completed the online questionnaire. Subsequently, the validity and reliability of the data are analysed. The results show that the short version of the questionnaire, the EFECO-S, has a structure with five dimensions (emotional self-control, initiation, working memory, inhibition, and spatial organisation), as well as a second-order factor (global executive skill) and high reliability (ordinal Alpha = 0.68–0.88). The EFECO is composed of 67 items, while the EFECO-S has 20 items, four per factor, which turns it into a quick and easy to apply test. Therefore, it becomes an interesting alternative to be applied in screening processes with children who may be experiencing executive difficulties.

Executive function ratings in educational settings: concurrent relations with cognitive and affective theory of mind

ABSTRACT The present study examined the way in which behavioural difficulties in cool and hot EFs relate to measures of cognitive and affective ToM in preschoolers. A total of 144 children between 35 and 71 months were assessed with a first-order false-belief task (measuring cognitive ToM), the Test of Emotion Comprehension (measuring affective ToM) and a control task measuring productive language. Teachers filled in the preschool version of the Behavior Rating Inventory of Executive Function (BRIEF-P), a questionnaire examining children's difficulties in educational settings in five different areas tapping both cool (Working Memory, Shift, Plan/Organize) and hot EFs (Inhibition and Emotional Control). Multiple regressions showed that cognitive ToM was predicted by productive language and executive difficulties in the Working Memory subscales of the BRIEF-P, whereas affective ToM was only predicted by age and productive language. Similarities and differences with the results of previous studies are discussed.

Shared and specific patterns of structural and functional thalamo-frontal disturbances in manic and euthymic pediatric bipolar disorder

Bipolar disorder (BD) is clinically defined by alternating depressive and manic episodes with a separated period of euthymia. Thalamo-frontal loop plays vital role in psychotic symptoms, altered motor control and executive difficulties in BD. It remains unclear that structural and functional alterations of thalamo-frontal loop among the different mood states in BD, especially in pediatric BD(PBD).Twenty manic PBD (mPBD), 20 euthymic PBD (ePBD) and 19 healthy controls (HCs) were included in the study. By analyzing the T1 images and fMRI signals, thalamus volume and frontal grey matter cortical thickness were tested, and functional connectivity (FC) between bilateral thalamus and frontal cortex was calculated. Relationship between clinical indices and thalamo-frontal FC was also evaluated in mPBD and ePBD adolescents.Compared to HCs, the cortical thickness of left middle frontal gyrus (MFG), bilateral superior frontal gyrus (SFG) was significantly decreased in both mPBD and ePBD patients, and volume of left thalamus and cortical thickness of right MFG significantly decreased in mPBD patients. Compared to that of the HCs and ePBD subjects, thalamo-frontal hyperconnectivity with MFG was found in mPBD, and compared with that of HCs, thalamo-frontal hypoconnectivity with precentral gyrus/SFG was found in ePBD. In ePBD patients, episode times positively correlated with FC values between thalamus and precentral gyrus.The findings of the present study demonstrate detailed knowledge regarding shared and specific structural and functional disruption in thalamo-frontal loop in mPBD and ePBD subjects. Thalamo-frontal abnormalities reported in adult BD subjects were also observed in adolescent BD patients, and thalamo-frontal dysfunction may be a crucial treatment target in BD.

Predictors of psychosocial functioning in euthymic patients with bipolar disorder: A model selection approach

BackgroundFunctional impairment is a major target in the treatment of bipolar disorder (BD), but the magnitude and type of functional difficulties differ across patients. Findings on predictors of overall functioning and specific functional areas are inconsistent. We aimed to characterize functional difficulties and identify factors associated with global functioning and individual domains in euthymic patients. MethodsThe Functional Assessment Short Test (FAST) was used to assess overall psychosocial functioning and specific functional domains in 80 euthymic participants with BD. Participants also completed a clinical interview and a cognitive assessment. Model selection with elastic net regression was performed to identify predictors of global functioning. We then examined the association of these predictors with individual functional domains using correlation. ResultsFAST scores indicated moderate or severe impairment for 54% of the sample, with occupational functioning showing the highest impairment rate. Elastic net regression selected a model with three variables (higher residual depressive symptoms, lower executive functioning, more perceived cognitive deficits) as predictors of overall functioning. No significant associations were found between these predictors. Depressive symptoms were associated with interpersonal relationships and leisure time, executive skills with occupational functioning, and perceived deficits with cognitive functioning. ConclusionsResidual depressive symptoms were the strongest predictor of overall functioning which highlights the importance of assessing and targeting subthreshold symptoms for recovery. Executive difficulties were associated with functioning, particularly occupational skills, independently of depressive symptoms. Interventions targeting these difficulties, such as cognitive and functional remediation, may be key treatment options towards facilitating functional recovery.

Improving executive, behavioural and socio-emotional competences in very preterm young adolescents through a mindfulness-based intervention: Study protocol and feasibility

BackgroundVery preterm (VPT) children and adolescents show executive, behavioural and socio-emotional difficulties that persist into adulthood. Despite the promising role of mindfulness-based intervention (MBI) in improving theses competences in children and adolescents, the effectiveness of an MBI has not been assessed in a VPT population so far. AimsTo describe the protocol and to evaluate the feasibility and acceptability of a clinical trial on an 8-week MBI program to enhance executive and socio-emotional competences in a cohort of VPT young adolescents. Study designA randomised controlled trial (RCT) and a pre-post intervention designs. Participants164 VPT young adolescents from 10 to 14 years old, born before 32 gestational weeks, without major intellectual, sensory or physical impairments, and attending mainstream school, were invited to participate in an 8-week MBI program. Outcome measuresCompletion rate of the study was recorded. Acceptability, satisfaction and attendance measures of the MBI were collected using self-reported questionnaires and registration of attendance. ResultsOf the 63 participants who were enrolled in the study (38.2% of families invited to participate), 52 (82.5%) completed all assessments. Acceptability was high as shown by the high attendance rate in the sessions and the feedback evaluation questionnaire. ConclusionsOur findings suggest that an MBI is feasible to implement and show a high acceptability among participants. The use of an RCT design in our study constitutes the gold standard for testing the efficacy of such intervention in VPT young adolescents. If effective, the MBI program could potentially be a valuable tool for improving executive and socio-emotional competences in the vulnerable VPT population. Trial registrationClinicalTrials, NCT04638101. Registered 19 November 2020 — retrospectively registered, https://clinicaltrials.gov/show/NCT04638101.

The contribution of beta-amyloid to dementia in Lewy body diseases: a 1-year follow-up study.

Dementia in Lewy Body Diseases (Parkinson’s disease and dementia with Lewy Bodies) affects progression of disabilities, quality of life and well-being. Understanding its pathogenetic mechanisms is critical to properly implement disease-modifying strategies. It has been hypothesized that synuclein- and amyloid-pathology act synergistically aggravating cognitive decline in elderly patients but their precise contribution to dementia is debated. In this study, we aimed at exploring if presence of amyloid deposits influences clinical, cognitive and neuroanatomical correlates of mental decline in a cohort of 40 Parkinson’s disease patients with normal cognition (n = 5), mild cognitive impairment (n = 22), and dementia (n = 13) as well as in Dementia with Lewy Bodies (n = 10). Patients underwent simultaneous 3 T PET/MRI with [18F]-flutemetamol and were assessed with an extensive baseline motor and neuropsychological examination, which allowed level II diagnosis of mild cognitive impairment and dementia. The role of amyloid positivity on each cognitive domain, and on the rate of conversion to dementia at 1-year follow-up was explored. A Kaplan Meier and the Log Rank (Mantel–Cox) test were used to assess the pairwise differences in time-to-develop dementia in Parkinson’s disease patients with and without significant amyloidosis. Furthermore, the presence of an Alzheimer’s dementia-like morphological pattern was evaluated using visual and automated assessment of T1-weighted and T2-weighted MRI images. We observed similar percentage of amyloid deposits in Parkinson’s disease dementia and dementia with Lewy Bodies cohorts (50% in each group) with an overall prevalence of 34% of significant amyloid depositions in Lewy Body Diseases. PET amyloid positivity was associated with worse global cognition (Montreal Cognitive Assessment and Mini Mental State Examination), executive and language difficulties. At 12-month follow-up, amyloid positive Parkinson’s disease patients were more likely to have become demented than those without amyloidosis. Moreover, there was no difference in the presence of an Alzheimer’s disease-like atrophy pattern and in vascular load (at Fazekas scale) between Lewy Body Diseases with and without significant amyloid deposits. Our findings suggest that in Lewy Body Diseases, amyloid deposition enhances cognitive deficits, particularly attention-executive and language dysfunctions. However, the large number of patients without significant amyloid deposits among our cognitively impaired patients indicates that synuclein pathology itself plays a critical role in the development of dementia in Lewy Body Diseases.

Social cognition and executive functioning in multiple sclerosis: A cluster-analytic approach.

Multiple sclerosis (MS) is associated with deficits in social cognition, the process underlying social interaction and cognitive function. However, the relationships between executive impairment and social cognition remain unclear in MS. Previous studies exclusively focused on group comparisons between healthy controls and patients with MS, treating the latter as a homogeneous population. The variability of socio- and neurocognitive profiles in this pathology therefore remains underexplored. In the present study, we used a cluster analytic approach to explore the heterogeneity of executive and social cognition skills in MS. A total of 106 patients with MS were compared with 53 healthy matched controls on executive (e.g., working memory) and social cognition (facial emotion recognition and theory of mind) performances. A cluster analysis was then performed, focusing on the MS sample, to explore the presence of differential patterns of interaction between executive and social cognition difficulties and their links to sociodemographic, clinical and cognitive variables. We identified three distinct functional profiles: patients with no executive or social cognition deficits (Cluster 1); patients with difficulties in facial emotion recognition and theory of mind and, to a lesser extent, executive functioning (Cluster 2); and patients with executive functioning difficulties only (Cluster 3). Clinical characteristics (disease duration, disability, fatigue) did not differ between clusters. CONCLUSIONS: These results suggest that there are qualitative differences in the social cognition and executive difficulties that are commonly found among patients with MS. If replicated, the identification of these profiles in clinical practice could allow for more individualized rehabilitation.

Klinefelter Syndrome and Turner Syndrome.

1. Carole Samango-Sprouse, EdD*,†,‡ 2. Sophia Q. Song, BA‡ 3. Angela E. Lin, MD§ 4. Cynthia M. Powell, MD¶ 5. Andrea L. Gropman, MD*,** 1. *George Washington University, Washington, DC 2. †Florida International University, Miami, FL 3. ‡Department of Research, The Focus Foundation, Davidsonville, MD 4. §Massachusetts General Hospital for Children, Boston, MA 5. ¶University of North Carolina at Chapel Hill, Chapel Hill, NC 6. **Children’s National Medical Center, Washington, DC Sex chromosome aneuploidy (SCA) syndromes refer to disorders with an abnormality of sex chromosome number. The most common are Klinefelter syndrome (KS), resulting from the gain of an X chromosome in males, and Turner syndrome (TS), reflecting the loss of an X chromosome or the presence of a structurally different X chromosome in females. Whereas most patients with KS have nonmosaic 47,XXY, only 40% of women with TS have 45,X; the remainder have a variety of mosaicisms. The syndromes also contrast in that males with KS are characteristically tall, whereas females with TS are typically short unless they receive hormonal treatment. Despite efforts to increase awareness, KS and TS are often underdiagnosed, leading to delayed care. Only 25% of men with KS are ever diagnosed, with fewer than 10% detected prenatally, and with a median age of 27 years for those identified later in life. For TS, the median age at diagnosis is 6.6 years. Although not exclusively, optimal neurocognitive outcomes depend on the timing of diagnosis and access to early targeted treatment, so fortunately the recent development of noninvasive prenatal screening is increasing the early identification of these disorders dramatically. Pediatricians should be aware of signs that allow for early detection, and the importance of prompt referral for testing and therapy. KS occurs in 1 in 660 live births, representing the most common SCA. Affected males have androgen deficiency, which affects endocrine, central nervous system, and neurodevelopmental function. Characteristics include increased height, clinodactyly of the fifth finger, pes planus, and hypogonadism manifesting as …

An autopsy-proven case of Corticobasal degeneration heralded by Pontine infarction

BackgroundNeurodegenerative disorders are characterized by insidious progression with poorly-delineated long latent period. Antecedent clinical insult could rarely unmask latent neurodegenerative disorders. Here, we report an autopsy-proven case of corticobasal degeneration which was preceded by a lacunar infarction.Case presentationA 58-year-old man presented with acute ataxia associated with a lacunar infarction in the right paramedian pons. His ataxia persisted with additional progressive gait difficulty and left arm clumsiness. Six months later, a follow-up neurological examination showed asymmetrical bradykinesia, apraxia, dystonic posturing, postural instability, and mild ataxia of the left limbs. Cognitive examination revealed frontal executive dysfunction and visuospatial difficulties. Dopamine transporter imaging scan demonstrated bilateral reduced uptakes in mid-to-posterior putamen, more prominent on the right side. Levodopa-unresponsive parkinsonism, asymmetric limb dystonia, and ideomotor apraxia became more conspicuous, while limb ataxia gradually vanished. The patient became unable to walk without assistance after 1 year, and died 4 years after the symptom onset. Autopsy findings showed frontoparietal cortical atrophy, ballooned neurons, and phosphorylated tau-positive astrocytic plaques and neuropil threads with gliosis and neuronal loss, confirming the corticobasal degeneration.ConclusionsThe case illustrates that precedent clinical events such as stroke might tip a patient with subclinical CBS into overt clinical manifestations.

Medication preparation program in Liencres Hospital

IntroductionThe need to implement a program of autonomy in the handling of oral medication has been observed at the time of discharge from the hospital.Objectives- That the patient is able to know his medication, differentiating between active ingredient and commercial brand. - That the patient is able to interpret the guideline in the electronic prescription. - That the patient is able to prepare his weekly medication autonomously.Methods- The doctor in charge indicates the Program in those patients susceptible to benefit of the same and after consensus with the multidisciplinary team. He validates and prints the electronic prescription well in advance. Preferably the patient himself (alone or accompanied by family members or Educators) get their medication and a weekly “polydosis” at a pharmacy office bringing him with him to the Unit. - Occupational Therapy helps the patient interpret the electronic prescription guideline and place the weekly medication in the “polydosis” and works with the patient in forecasting execution tasks of medication needs for outpatient follow-up.ResultsThe program is well accepted by patients. None of the patients included so far have had an early relapse.ConclusionsThe program has helped patients interpret the medical indications given mnesical and executive difficulties of patients with severe mental disorder.DisclosureNo significant relationships.

Executive Functions and Theory of Mind Skills of Sexually Abused Female Adolescents and Their Externalizing and the Internalizing Behavioral Problems

ABSTRACT Sexually abused children (SAC) often experience acute and chronic adverse psychological and physiological effects later in life. This study aims to evaluate psychiatric diagnoses, Executive Functions (EF) and Theory of Mind (ToM) skills deficiencies in sexually abused female adolescents and examine the relation of these deficiencies with externalizing and internalizing behavioral problems. The patient group comprised 42 female adolescents aged 14–18 years (mean = 16.42, standard deviation = 1.01). The Kiddie Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version, Dokuz Eylül ToM Index and Reading the Mind in the Eyes test were applied. The Behavior Rating Inventory of Executive Function, Strengths and Difficulties Questionnaire, and Kiddo-KINDL were completed by the participants and their families. A total of 57.2% (n = 24) were classified as SAC with internalizing behavior problems (SAC+I), whereas 66.7% (n = 28) comprised the SAC with externalizing behavior problems (SAC+A) subgroup. SAC+I showed deficits in EF and TOM. Some EF skills were found to be statistically weaker in SAC+A. There was no difference between SAC+A and SAC–A in the TOM tests. The results highlight the need to explore whether these deficiencies are due to psychiatric diseases or whether those who have disabilities in this field carry a higher risk of psychiatric disorder.

Selective executive impairments as neuroimmumological manifestations of the human immunodeficiency virus

Executive processes that predominantly effect people living with human immunodeficiency virus remain to be understood. In the present case-control study, components summarizing executive functions were empirically determined to clarify the nature of executive difficulties observed in individuals with human immunodeficiency virus. One hundred and five seropositive and 62 seronegative healthy adults without comorbidities underwent a comprehensive executive function assessment. Test data were reduced via principal components analysis and component scores were used to investigate whether seropositive adults exhibit selective difficulties in specific executive processes. A three-component solution was found, consisting of updating, inhibition and set-shifting. Group differences between seropositive and seronegative participants were observed only in the updating component. In the present exploratory analyses, significant findings emerged that suggest a selective executive impairment associated with the updating/working memory process in young to middle adulthood seropositive individuals without comorbidities.

Characteristics of Executive Functions in Patients With Cognitive Impairments in the Presence of Depressive Disorders

Introduction. The urgency of the problem of affective pathology and, above all, depression, due to a number of factors: the growing prevalence of depression, reaching 10.0 % in the population, the high risk of chronic such conditions, their maladaptive impact on social functioning, efficiency and quality of life, the burden of economic costs etc. According to epidemiological indicators in Ukraine over the past 10 years, the incidence of affective disorders has increased by 6.13 %, and the prevalence – by 13.16 %. Impaired thinking and executive functions, decreased concentration and difficulty making decisions are key diagnostic signs of depression. Cognitive impairment (CI) has a cumulative effect on the functionality of patients with depression and is associated with a longer duration of depressive episodes, which indicates the need for its diagnosis and treatment. At the present stage, there are no systematic ideas about the specifics of disorders of executive functions in the presence of different types of depressive disorders (DD), which determines the relevance of the study in this direction. The aim of the study. Describe the executive functions in patients with CI in the presence of DD. Materials and methods. The study included 362 patients with CI in the presence of DD, which were stratified into three groups of comparisons by the mechanism of DD: 123 patients with recurrent depressive disorders (RDD), 141 patients with bipolar affective disorder (BAD) and 98 people with prolonged depressive reaction (PDR). The predominant numbers (38.12 %) of patients with CI in the presence of DD were in adulthood (30-44 years). There were more young people (18-29 years) among patients with PDR (21.43 %, DC = 8.19) and among patients with BAD (31.21 %, DC = 9.82), and middle-aged people (45-59 years) (37.40 %, DC = 1.54) and the elderly (60-74 years) (17.07 %, DC = 4.78) – among patients with RDD. A set of research methods was used: clinical-psychopathological, psychodiagnostic and statistical. Results. Peculiarities of executive functions in patients with CI in the presence of DD were established: the moderate and severe disorders of visual-motor coordination (39.84 % and 19.51 %, respectively) and impaired visual-spatial functions (13.72 %), moderate and severe violations of executive functions (54.47 % and 13.01 %, respectively), moderate, severe and weak violations of the executive function of the lexical system (39.84 %, 32.52 % and 23.58 %, respectively) were present in patients with RDD; the moderate violations of verbal performance (58.54 %); moderate and severe violations of visual-motor coordination (41.13 % and 26.24 %, respectively), executive functions (65.96 % и 21.38 %, respectively), executive functions of the lexical system (47.52 % и 39,01 %, respectively) and verbal productivity (58.16 % and 21.28 % respectively) were found in BAD; absence and weak impairments of visual-motor coordination (45.92 % and 36.73 %, respectively), executive functions (23.47 % and 66.33 %, respectively), executive functions of the lexical system (31.63 % and 45.92 %, respectively) and verbal productivity (26.53 % and 58.16 %, respectively) were presented in patients with PDR. Conclusions. The study revealed the features of executive functions in patients with cognitive impairment in the presence of depressive disorders, which should be taken into account in the algorithm of their psychosocial rehabilitation.

PREVALENCE OF EXECUTIVE DYSFUNCTION IN ICU SURVIVORS AND ITS ASSOCIATION WITH DAILY FUNCTIONAL ABILITY

SESSION TITLE: Critical Care Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Cognitive impairment is common in survivors of critical illness and occurs in between 30% and 50% of individuals in the first year after discharge from the ICU. While cognitive impairment has been widely studied in this population, relatively little attention has been paid to the characterization of executive functioning. We undertook the current study both to describe the prevalence and nature of executive deficits in survivors of critical illness and to determine which dimensions of executive functioning were the most predictive of daily functional decrements. METHODS: A total of 184 participants were prospectively enrolled in a sub-study nested within an NIH-funded parent study (BRAIN-ICU). Patients were adult mechanically ventilated ICU survivors from two large medical centers who were followed at 3 months and 12 months after discharge with a comprehensive testing of both executive functioning and daily functional ability (via the Functional Activities Questionnaire or FAQ). Descriptive statistics were employed to characterize patient demographics and the prevalence of executive impairment. Proportional odds logistic regression was used to find the association between executive dysfunction and functional difficulties RESULTS: At 3- and 12-month follow-up, 135 and 105 patients were assessed, respectively. Global executive functioning was impaired (reflecting pervasive deficits across multiple domains) in nearly a quarter (22%) of study subjects at 3-month follow-up and in 10% at 12-months. Executive dysfunction was highly prevalent on tests of fluency (verbal and figural) and set-shifting, reflected in impairment on the Ruff Figural Fluency Test (44 % at 3 months and 30% at 12 months), the Controlled Oral Word Association (COWA) Test (39% at 3 months and 32% at 12 months), and the Trails B Test (31% at 3 months and 24% at 12 months). Deficits in executive ability were closely associated with impaired daily functional ability as seen in significant associations between scores on the Ruff, COWA, and Trails B tests and the FAQ, particularly at 3 months (p<0.001), with this relationship decreasing slightly at 12 months on Trails B. Analysis also revealed that lower (worse) scores on the Ruff, COWA, Trails B, and Color Word tests at 3 months predicted the presence of greater functional impairment (FAQ) (p<0.01) CONCLUSIONS: Executive dysfunction is highly prevalent in ICU survivors up to a year after discharge particularly in areas of fluency and set shifting. The presence of early executive dysfunction appears to be correlated with longer-term deficits in daily functioning. CLINICAL IMPLICATIONS: Future investigations should strive to better characterize executive functioning after critical illness and researchers and clinicians should seek to identify ways to improve executive dysfunction in this ICU survivors DISCLOSURES: no disclosure on file for Wes Ely; No relevant relationships by Timothy Girard, source=Web Response no disclosure on file for James Jackson; No relevant relationships by Amy Kiehl, source=Web Response no disclosure on file for Caroline Lassen Green; No relevant relationships by Deepanjali Radhakrishnan Nair, source=Web Response No relevant relationships by Rameela Raman, source=Web Response

The Relationship Between Media Multitasking Behavior and Executive Function in Adolescence: A Replication Study

The proliferation of digital gadgets and increased media consumption among adolescents has raised interest and concern regarding possible effects on cognitive functioning. Research investigating this relationship has yielded mixed results. This study aims to replicate the research conducted by Baumgartner et al. concerning the relationship between adolescent media multitasking and executive functioning on a sample of 296 Romanian early adolescents. The same methodology as the original study was followed and its findings were partially replicated. Mainly, results of regression analyses indicated that more media multitasking with media activities was related to more self-reported executive difficulties, but not with performance on three computerized executive functioning tasks. Media multitasking with non-media activities was unrelated to executive functioning. When comparing extreme groups, however, heavier media multitasking was associated with faster performance on the task-shifting and inhibition computerized tasks. Implications for cognitive development and research methodology are discussed.

The perceived meaning of occupations among children: correlations with children's socio-emotional characteristics and executive functions.

Participation in meaningful occupations within our everyday environments contributes to health and wellbeing. Therefore, it is important to study perceived meaning and its inter-related factors. The perceived meaning of occupations is the emotional and cognitive qualities people attach to their occupations. However, research on the perceived meaning of occupations among children is limited. The meaning of occupations may be related to personal factors concerning the child. Hence, this study aimed to assess the correlations between socio-emotional characteristics and executive functions of typically developing children and their perceived meaning of occupations-value, challenge, and sense of time and autonomy. A cross-sectional study comprising 80 children (6-13years old) and their parents was conducted. The parents completed the Strengths and Difficulties Questionnaire (SDQ) and the Behaviour Rating Inventory of Executive Function. The children completed the Perceived Meaning of Occupation Questionnaire and the Verbal Working Memory test. Children with higher scores on the SDQ-internalised behaviours and lower working memory-perceived their everyday activities as more challenging (r=.300, r=-.244, p<.05, respectively). Children with higher scores on the SDQ-prosocial behaviours-attached higher value to their everyday activities (r=.23, p<.05). However, increases in executive function difficulties were found to decrease the perceived value (r=.24, p<.05) and to alter the perceived sense of time (r=. 27, p<.05). The meaning children attach to their everyday activities changes when they experience socio-emotional and executive difficulties. Therefore, to inspire positive meaning of occupations among children, practitioners should consider the child's socio-emotional and cognitive strengths and difficulties.

Accepting what we do not know: A need to improve professional understanding of brain Injury in the UK.

Acquired brain injury (ABI) can lead to life-long changes and disability. The complex and extensive nature of behavioural, cognitive, executive, physical and psychological difficulties mean ABI survivors and their families may come into contact with a range of health and social care services as part of their long-term care. This study aimed to understand the ABI knowledge base of professionals across a range of organisations within the UK, and to identify areas for improvement. This was achieved through a mixed methods approach using a mixed methods questionnaire (117 participants) and qualitative semi-structured interviews about service experiences (31 participants) of professionals and service users (families and individuals with ABI). Participants included UK health and social care professionals, ABI specialists, ABI survivors and family members. Data were collected from February 2017 to April 2018. The results of the study identified a lack of knowledge and understanding of ABI among health and social care professionals in the UK, from those involved in acute care through to long-term community services. Poor knowledge was associated with a lack of understanding of "hidden" disabilities associated with ABI, a lack of empathy and a lack of knowledge regarding specific safeguarding. Health and social care professionals across a range of services could benefit in ABI-specific training to improve their knowledge and improve the service currently being provided to individuals with ABI and their families.