Executive Functions In Patients Research Articles

Concomitant diastolic dysfunction further interferes with cognitive performance in moderate to severe systolic heart failure.

BackgroundStudies of the relevance of cardiac functional markers to cognitive performance in heart failure (HF) have primarily focused on systolic markers. In this study, we examine whether concomitant diastolic dysfunction further interferes with cognitive performance in memory, attention, and executive function in patients with HF.Methods and resultsIn this cross-sectional correlational study, 82 patients completed face-to-face interviews for neuropsychological testing for cognitive evaluation. Echocardiographic data were obtained from a review of medical records. Mild to moderate (ejection fraction [EF] ≥ 30%) and severe (EF < 30%) systolic dysfunction were present in 55 (67.1%) and 27 (32.9%) patients, respectively, while 21 (26.3%) had diastolic dysfunction (E/e′ > 15). Those patients who had severe systolic dysfunction had significantly lower attention scores (Digit Span Test [DST] backward, t = 2.62, p = 0.011), while those with concomitant severe diastolic dysfunction had significantly lower verbal fluency (t = 2.84, p = 0.006) and executive function (Korean-Trail Making Test Part B) (t = -2.14, p = 0.036) scores than those without severe diastolic dysfunction. After controlling for age and education, systolic patients with HF with concomitant severe diastolic dysfunction had worse cognitive performance in verbal fluency than those without severe diastolic dysfunction (F = 4.33, p = 0.041, partial eta = 0.057). Concomitant moderate to severe systolic and severe diastolic dysfunction further reduced verbal fluency (F = 8.42, p = 0.005, partial eta = 0.106).ConclusionsCognitive performance, particularly executive function, was worse in patients with HF with systolic dysfunction when diastolic dysfunction was concomitantly present. Routine monitoring of and surveillance for diastolic dysfunction and cognitive screening are warranted in the management of patients with HF.

The Relationship Between Discourse Comprehension and Executive Function in Patients With Amnestic Mild Cognitive Impairment and With Early Stage of Alzheimer’s Disease

The Relationship Between Discourse Comprehension and Executive Function in Patients With Amnestic Mild Cognitive Impairment and With Early Stage of Alzheimer’s Disease

P.6.d.015 - The effect of methylphenidate on executive functioning in patients with co-morbid ADHD and stimulant use disorder

The purpose of this study was to examine the efficacy of an extended release guanfacine hydrochloride supplement relative to a placebo supplement in adults (19–62) with ADHD and a sub-optimal response to a stimulant-only treatment program. The study's primary outcome measures were the Attention Deficit Hyperactivity Disorder Rating Scale and the Clinical Global Impression – Severity. Twenty-six adults who met criteria for attention deficit hyperactivity disorder and sub-optimal functioning were randomly assigned to supplement their existing psychostimulant treatment regimen with either a titrated dose (1–6 mg) of extended release guanfacine hydrochloride or a matching placebo for a 10-week trial. The data were analyzed with standard mixed model analysis of variance procedures, and participants in both the investigational agent group and the placebo group showed statistically significant improvement in their symptoms and functioning over the course of the trial. The treatments did not differ in terms of their efficacy, safety, or tolerability. Although these results do suggest that both treatments were associated with clinical improvement, the possible impacts of socially desirable responding and regression to the mean on these results are discussed.

Effects of dopaminergic drug adjustment on executive function in different clinical stages of Parkinson's disease.

BackgroundEffects of dopaminergic medication on executive function in patients with Parkinson’s disease (PD) are inconsistent.ObjectiveWe examined the effect of dopaminergic medication on executive function in 24 drug-naïve PD patients (de novo group) and in 21 PD patients on chronic dopaminergic medication (chronic medication group).MethodsPD patients without dementia were included in this study. For the de novo group patients, dopaminergic medication was initiated, and the dose was increased to improve motor symptoms. For the chronic medication group patients, dopaminergic medication was adjusted to relieve clinical problems. All participants were tested prior to and at 4–7 months after the drug initiation/adjustment. Executive function was assessed by using the Behavioral Assessment of the Dysexecutive Syndrome (BADS). Motor function was assessed by using the Unified Parkinson’s Disease Rating Scale (UPDRS; part III). Improvement in executive function was compared with a simultaneous change in levodopa equivalent doses (LED) of dopaminergic medication and with improvement in motor functions.ResultsThe mean standardized BADS scores showed no significant improvement in both the groups. In the de novo group, percent improvement in the standardized BADS scores showed a significant positive correlation with the LED, but not with percent improvement in UPDRS part III. In the chronic medication group, percent improvement in the standardized BADS scores was negatively correlated with change in the LED, but not with percent improvement in UPDRS part III. Multiple regression analysis using improvement in the standardized BADS score as a dependent variable and patient’s background factors (ie, age, education, disease duration, and motor and executive assessments at baseline) as independent variable showed that improvement in the executive assessment is significantly correlated with the LED only in the de novo group.ConclusionEffects of dopaminergic drug adjustment on executive function differ according to the patient’s clinical stage and depend on LED in de novo stage.

Odor selectivity of hyposmia and cognitive impairment in patients with Parkinson's disease.

ObjectiveHyposmia is one of the earliest non-motor features of Parkinson’s disease (PD) and can precede the onset of motor symptoms by years. Most of the current olfactory detection tests are targeted at Western populations. The exact relationship between hyposmia and cognitive impairment is unknown. The purpose of the study was to find bromines that can effectively identify olfactory dysfunction and investigate the relationship between hyposmia and cognitive function in early, non-demented, drug-naïve patients with PD in the People’s Republic of China.MethodsSixty-three early, non-demented, drug-naïve patients with PD and 55 healthy controls were enrolled in the study. The T&T olfactometer and a Chinese version of Montreal Cognitive Assessment (MoCA) were applied to assess subjects’ olfactory and cognitive functions. Patients with PD also completed the Modified Unified Parkinson’s disease-rating scale (UPDRS) and Hoehn and Yahr (H&Y) scale.ResultsPatients with PD had lower scores of visuospatial and executive function (p=0.000), attention (p=0.03), and delayed recall (p=0.001) than controls. β-phenylethyl alcohol (floral smell, smell of rose petals) and isovaleric acid (smell of sweat, stuffy socks) were more sensitive for identifying hyposmia in patients with PD than three other odors. Multivariate logistic regression analysis showed that impaired visuospatial and executive function was associated with hyposmia (p=0.013), but was independent of other PD-associated variables.ConclusionHyposmia was common in early, non-demented, drug-naïve PD patients. β-Phenylethyl alcohol and isovaleric acid were more superior for identifying hyposmia in early non-demented Chinese patients with PD. Hyposmia was associated with impaired visuospatial and executive function in patients with PD. Further prospective studies that apply a series of neuropsychological tests and functional magnetic resonance imaging methods in large samples in multicenter studies are needed to confirm our findings and to investigate the relationship between hyposmia and cognitive function with disease progression in patients with PD.

Impact of post-traumatic stress disorder on cognitive functions in French civil and military victims of mild traumatic brain injury by blast

Nowadays, mild traumatic brain injury (mTBI) and post-traumatic stress disorder (PTSD) are common and frequently associated injuries in the military, which may cause invisible disability. The main objective was to show the impact of PTSD on the cognitive functions in our patients who suffered an mTBI by blast. We analyzed the results of neuropsychological tests exploring the main cognitive functions (executive functions, attention, visuo-constructive abilities, memory and language) of all victims of mTBI induced by blast, supported between 2010 and 2015 at the Percy Hospital. Two groups of patients were compared; those with PTSD against those free of any PTSD for over 3 months after the blast. Patients with PTSD had overall poorer results for all the tests than patients only suffering from mTBI. The difference between the two groups was significant for certain tests assessing executive functions: Trail Making Test B (P = 0.011), sub-tests A (P = 0.01) and C (P = 0.002) of the Stroop Test. No significant differences were found for other cognitive functions between the two groups. PTSD could be responsible for a worsening of the executive functions in patients who suffered a mTBI induced by blast.

Evidence of dysexecutive syndrome in patients with acromegaly.

This study aimed to explore different aspects of executive function in patients with acromegaly and investigate the cause of dysexecutive syndrome in these patients. We conducted five typical executive function tests (Stroop test, verbal fluency [VF] test, Hayling Sentence Completion Test [HSCT], N-back test, and Sustained Attention to Response Task [SART]) on 42 acromegalic patients and 42 strictly matched healthy controls. Comparative analyses were conducted for five major executive function domains. The Dysexecutive Questionnaire (DEX) was used to assess patients' subjective feelings about their executive function. All patients underwent a magnetic resonance imaging (MRI) examination and a blood test to determine their pituitary hormone levels before the tests were performed. The patients exhibited worse results on the Stroop test, VF test, HSCT and N-back test compared to the healthy control group. Moreover, part B of the HSCT and the N-back test performance were negatively correlated with IGF-1 concentrations, and the duration of the disease was significantly associated with the Stroop color task results. Acromegalic patients were severely impaired in semantic inhibition, executive processing, working memory and executive inhibition, and they have realized a portion of these deficits. A high level of IGF-1, disease duration may contribute to the impairment of specific aspects of executive function.

P300 Influence of rTMS with high and low frequency stimulation on motor and executive function in Parkinson’s disease. Follow-up study for half year

The non-invasive brain stimulation, like transcranial magnetic stimulation (rTMS) can influence on both cognitive and motor function of Parkinson’s disease (PD). However, a protocol for daily routine is not yet been known. Furthermore, there are not known the predictors of responders or not responders to rTMS treatment. Our main goal was to select the optimal frequency with low intensity for improving executive and motor function in PD. Furthermore, we clarified the importance of age. Three groups of patients with PD were compared with each other and healthy controls in the mental tests. The 1 Hz (N = 28), 5 Hz (N = 13) and 5 + 1 Hz (N = 19) frequency with low intensity was applied daily over both dorsolateral prefrontal cortices (DLPFC) and over the brain stem for 7 days. Patients were followed for six months after the treatment with rTMS. The participants were divided into two groups according to their age (⩽ 65 years and 65 years >). The patients were tested with UPDRS, walking for 6 min, 10 m walk, Trail Making Test, and dual tasks. Only the 1 Hz treatment with low intensity for 7 days had an effect on the motor scores. The rTMS with 1 Hz caused significant improvement in the motor symptoms assessed by UPDRS after one month (before trial (BF) ⩽ 65 UPDRS total score 32.0 ± 15.0 3, after 1 month: 18.1 ± 8.6 p 0.001 , >65 BF: 28.5 ± 15.8, after 1 month: 18.6 ± 10.3 p 0.05 and it was maintained for six months in the group with ⩽ 65 yrs (N = 10, 18.2 ± 8.8 p 0.001 ). However, in the group with >65 yrs (N = 16) the better outcome was observed only after one month (BF: 28.5 ± 15.8, 1 month later 18.6 ± 10.3 p 0.01 , after 6 months: UPDRS total score: 20.8 ± 12.7 p = 0.06). Although, the stimulation with 5 + 1 Hz decrease scores assessed by UPDRS, but neither the stimulation with 5 Hz nor with 5 + 1 Hz with low intensity caused significant changes in PD. Results of Trail Making Test and dual tests in PD ⩽ 65 yrs did not differ from controls (C) below 65 years. However, the executive function of patients over 65 yrs (N = 16) were significantly worse compared to controls (N = 15) (C: Trail B-A: 50.0 ± 25.1 s, PD: Trail B-A > 65 yrs: 76.0 ± 45.1 s p 0.01 ). Six months after treatment with rTMS with 1 Hz an improvement was observed in Trail Making Test compared to onset of treatment (PD: 48.70 ± 21.4 s p 0.05 ). The dual test was deteriorated in the group over 65 years compared to age match controls. The 1 Hz stimulation did not reverse their values. (C: counting back (CB) −3: 50.0 ± 25.9 s, >65 yrs PD CB −3: 57 ± 21, 1 month after rTMS CB −3: 69 ± 20, 6 months after rTMS: 60 ± 19 s; PD BF CB-7 100 ± 45 s, 1 month 102 ± 32 s, 6 months: 82 ± 23 s). Stimulation with rTMS in the group >65 yrs showed shorter effect in motor scores than in the younger age group. Patients over 65 years in PD caused a significant deterioration in the executive function compared with age matched healthy controls. It was influenced temporarily by 1 Hz low intensity stimulation. Both the low and high frequency stimulation with proper intensity may have good outcomes in neurological diseases. Patients over 65 yrs with PD may deteriorate in their executive function compared with age matched healthy controls and decreases in the therapeutic effect of rTMS on motor function.

Comparing executive functions between patients with chronic asthma and healthy subjects

ABSTRACTObjective: Allergic diseases have different levels of prevalence all over the world. Among them, asthma is the most common chronic disease. Up to now, little attention has been paid to the impact of this chronic disease on people's executive functions. The present study aimed at comparing the executive functions in patients with chronic asthma and healthy subjects. Methods: The study population was patients with chronic asthma who were referred to Al-Zahra hospital in Isfahan Province and their visitors who were assigned as the control group. Thirty patients with chronic asthma and 30 patient visitors were enrolled in this study, and three software programs (Wisconsin, Stroop, and Continuous Performance Tests) were used. Results: The results of multivariate variance analysis showed that there is a significant difference between patients with chronic asthma and healthy subjects in terms of set shifting, inhibition, and attention performance. Conclusions: This study revealed that the executive functions of patients with chronic asthma have significant defects.

Childhood adversity and cognitive functioning in patients with major depression

ObjectiveMajor depression is often accompanied by deficits in cognitive functioning and lowered executive functions. However, not all depressed patients show impairments in these domains. The aim of this study was to examine whether different kinds of childhood adversity might account for cognitive deficits in patients with major depression. MethodsNinety-one patients with major depression (DSM-IV) and 40 healthy controls completed a neuropsychological test battery assessing memory, processing speed and executive functions. The Childhood Trauma Questionnaire (CTQ) was used to measure the severity and number of incidences of sexual, physical and emotional abuse and physical and emotional neglect. ResultsPatients with major depression had a significantly higher number of traumas and reported more severe emotional abuse, emotional neglect and physical neglect than healthy controls. Patients performed less well in memory tasks, general knowledge and processing speed than healthy controls. Hierarchical regression analyses indicated that the overall number of traumas was significantly associated with poorer general knowledge, lower processing speed and impaired executive functions in patients with major depression. A second model including all CTQ-subscales simultaneously demonstrated an association between physical neglect and poorer verbal learning, and physical abuse and diminished executive functions. ConclusionA higher number of childhood adversities may influence general knowledge, processing speed and executive functions in patients with major depression. In addition, physical abuse and neglect seemed to be associated with verbal learning deficits and poorer executive functions.

Effects of cognitive reserve depend on executive and semantic demands of the task

BackgroundCognitive reserve (CR) is one factor that helps to maintain cognitive function in patients with Alzheimer’s disease (AD). Whether the effects of CR depend on the semantic/executive components of the...

Examining and Comparing Executive Functions in Patients with Type 2 Diabetes Subjects and Healthy Subjects

Abstract Today, diabetes is a serious problem worldwide, as WHO predicts, in the year 2025, the population suffering from diabetes will be about 333 million adults (Norouzi, Ghafranipour, Heidarnia, Tahmasbi, 2010). Disease Management requires planning and problem solving capabilities which as a range of functions are categorized as executive functions. Executive functions are important structures playing a fundamental role in directing and normalizing behavior. Therefore, the study was designed with the goal of comparing and examining patients suffering from type 2 diabetes in contrast with healthy subjects. The study was conducted using a causative-comparative method in 2013-14 in Tehran. Research population were people referring to Gabric association of whom 36 volunteer patients with diabetes were chosen. The control group were chosen amongst patients’ companions with no disease records and were tested by WCST. Findings showed deficiencies in executive functions of patients with type 2 diabetes. Generally, we can say that these deficiencies can prevent proper disease management of type 2 diabetes.

Validity of the Wisconsin Card Sorting Test in patients with stroke

Background: The Wisconsin Card Sorting Test (WCST) is the most widely used measure for assessing executive functions in patients with stroke. However, no study has examined the ecological, discriminative and convergent validities of the WCST in patients with stroke. This study aimed to examine the above validities of the WCST in patients with stroke.Methods: Ninety-eight patients were administered the WCST, two measures of activities of daily living and one cognitive measure. Seven indexes of the WCST were used in this study.Results: Two WCST indexes (“total number correct” and “number of categories completed”) had moderate correlations with two measures of activities of daily living (Pearson’s r = 0.39–0.49). The other indexes showed low or moderate correlations with two measures of activities of daily living (r = 0.26–0.53). The results of independent t-test showed statistically significant difference between patients with and without disability for the seven WCST indexes (p = 0.001–0.013) and nonsignificant differences between patients with different affected regions of the brain (p > 0.05). Moderate correlations (r = 0.35–0.54) were found among the seven WCST indexes and one cognitive measure.Conclusions: The WCST has poor to adequate ecological validity, acceptable discriminative validity and acceptable convergent validity in patients with stroke. The two WCST indexes (“total number correct” and “number of categories completed”) are recommended for use to reflect the degree of living independence in patients with stroke.Implications for rehabilitationThe Wisconsin Card Sorting Test showed poor to adequate ecological validity, acceptable discriminative validity, and acceptable convergent validity in patients with stroke.Two indexes of the Wisconsin Card Sorting Test (i.e., “total number correct” and “number of categories completed”) can adequately reveal the degrees of living independence in patients with stroke.

Effect of drawing therapy on painting characteristics and executive function of patients with schizophrenia

Effect of drawing therapy on painting characteristics and executive function of patients with schizophrenia

Evaluating executive function in patients with temporal lobe epilepsy using the frontal assessment battery

Previous studies have demonstrated executive dysfunction in patients with temporal lobe epilepsy (TLE). Frontal assessment battery (FAB) is a short neuropsychological tool that was developed for assessment of frontal lobe function in a clinical setting. The aim of the present study is to evaluate the clinical utility of FAB for detection of executive dysfunction in TLE patients.Forty-eight TLE patients and 48 sex and age-matched healthy controls participated in this study. Compared to healthy participants, the total FAB score was significantly lower among the TLE patients. TLE patients performed significantly worse at the mental flexibility, motor programming, sensitivity to interference and inhibitory control tasks. The duration of time has been passed since the last seizure was the only significant predictor of FAB score and patients who had a seizure less than a week before the evaluation time, had significantly lower FAB scores. The number of antiepileptic drugs (AEDs) did not influence the executive function in this study; however, sodium valproate was found to affect the mental flexibility.In conclusion, impaired executive function is common in TLE patients, and we suggest that FAB is a clinically applicable tool to monitor it. Moreover, we found that the time of the last seizure is a significant predictor of executive functioning and patients’ performance may become worse up to seven days after a seizure. We also recommend that clinicians evaluate the cognitive adverse effects of AEDs especially sodium valproate, which was found to affect the mental flexibility in this study.

Postural control and executive functioning in patients with schizophrenia

IntroductionPatients with schizophrenia commonly show deficits in executive functioning that allow a person to make plans, solve problems, do many tasks simultaneously and adapt to unexpected conditions. Executive dysfunction is associated with very simple and automatic activities, such as walking in schizophrenia patients. However, no study exists about its relation to postural control in these patients.AimTo investigate the effect of executive functioning on postural control using dual task paradigms.MethodsFifteen clinically stable schizophrenia outpatients and 15 healthy controls were enrolled in the study. Postural control was assessed with bilateral stance test using the Balance Master system under three different conditions with eyes open and eyes closed (EC): without a task, during a cognitive task (verbal fluency) and during a motor task (holding a cup of water).ResultsStanding on a foam surface with EC resulted in higher postural sway velocities in schizophrenia patients under all conditions (P = 0.009, P = 0.032, P = 0.013). During a cognitive task, both schizophrenia patients and healthy controls showed higher velocities on firm surface with EC in comparison to the condition without a task (P = 0.023). Both schizophrenia patients and healthy controls did not show higher postural sway velocities during the motor task.ConclusionThe effect of verbal fluency on postural sway shows the relationship between executive functioning and postural control in schizophrenia patients. Foam surface also higher postural sway velocities in schizophrenia patients in EC condition suggesting the difficulties in integrating the proprioceptive information in the absence of visual input.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Neuropsychological profile of specific executive functions in patients with deficit and non-deficit schizophrenia

Although it has been shown that there are more profound deficits present in the deficit schizophrenia (DS) patients compared with their non-deficit (NDS) counterparts, there still remain a few matters that require further investigation.Aims(1) Comparison of executive functions between the investigated groups; (2) determining the relationship between their particular aspects within the groups; and (3) drawing up their neuropsychological profile.MethodsOne hundred and forty-eight schizophrenia patients, divided into two groups: patients with DS (n = 70) and NDS (n = 78). Patients were matched for sex, age, number of years of education and their overall cognitive functioning. For the assessment of executive function, we used the Wisconsin Card Sorting Test (WCST), the Trail Making Test (TMT), Verbal Fluency Test Phonemic (VFT P), Stroop Color Word Test (SCWT) and Go/No Go task (GNG).ResultsThe DS patients compared with the NDS ones obtained lower scores in WCST and TMT (relative flexibility). We did not observe any inter-group differences in VFT P, SCWT (relative inhibition) or the GNG. In both patient groups, there appeared significant correlations between their WCST and TMT scores. The general neuropsychological profiles were similar in both groups. The DS patients exhibited slightly greater interference within concept formation and non-verbal cognitive flexibility. Such problems may therefore be specific to that particular subset of schizophrenia. Our results may be useful for the development of new rehabilitation activities, which may increase the chance of the patients’ better social functioning.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Repetitive Transcranial Magnetic Stimulation Improved Symptoms of Obsessive-Compulsive Disorders but Not Executive Functions: Results from a Randomized Clinical Trial with Crossover Design and Sham Condition

Objective: Whereas there is growing evidence that repetitive transcranial magnetic stimulation (rTMS) favorably impacts on symptoms of obsessive-compulsive disorders (OCD), less is known regarding the influence of rTMS on cognitive performance of patients with OCD. Here, we tested the hypothesis that rTMS has a positive impact both on symptom severity and executive functions in such patients. Methods: We assessed 10 patients diagnosed with OCD (mean age: 33.5 years) and treated with a standard medication; they were randomly assigned either to a treatment-first or to a sham-first condition. Symptom severity (experts' ratings) and executive functions (Wisconsin Card Sorting Test) were assessed by independent raters unaware of the patients' group assignments at baseline, after 2 and 4 weeks. After 2 weeks, treatment switched to sham condition, and sham condition switched to treatment condition. Results: Under treatment but not under sham conditions, symptom severity decreased. Performance on the executive function test increased continuously with every new assessment and was unrelated to rTMS treatment. Conclusion: Whereas the present study confirmed previous research suggesting that rTMS improved symptoms of OCD, rTMS did not improve executive functions to a greater degree than sham treatment. More research is needed to investigate the effect of rTMS on executive functions in patients with OCD.

Relationship between executive function and depressive symptoms during the tower of London test in patients with major depressive disorder

Objective To investigate the relationship between executive function and depressive symptoms in patients with major depressive disorder(MDD) under the Tower of London Test (TOL). Methods Thirty depression patients and thirty age-, gender-, education-matched normal controls participated in the study. All subjects received the Tower of London Test. The severity of depressive and anxiety symptoms were assessed by Hamilton Rating Scale for Depression (HAMD), Hamilton Anxiety Rating Scale(HAMA) and Beck Depression Rating Scale(BDI). Results (1)The numbers of correct response and total response of the TOL in MDD(9.1±5.1, 12.1±5.3) were significantly lower than those of the control group(13.8±5.0, 17.3±3.9)(P<0.05). The response time of the TOL test in patients with MDD((10.4±2.8)s) was significantly longer than that of the control group((8.5±2.2)s)(P<0.05). (2)The scores of HAMD , BDI and HAMA were negatively correlated with numbers of total response(r=-0.403, -0.544, -0.495, ) in patients with MDD (all P<0.05). Conclusion The executive function of patients with MDD is impaired and negatively correlated with depressive and anxiety symptoms under the Tower of London Test. Key words: Depression; Tower of London test; Executive function

M35. A Pilot Randomized Controlled Trial of the Occupational Goal Intervention Method for the Improvement of Executive Functioning in Patients With Treatment-Resistant Schizophrenia

M35. A Pilot Randomized Controlled Trial of the Occupational Goal Intervention Method for the Improvement of Executive Functioning in Patients With Treatment-Resistant Schizophrenia