Executive Functions In Patients Research Articles

Sentence Comprehension and Its Association with Executive Functions in Patients with Parkinson's Disease

Coexistent impairments in executive functions and language comprehension in patients with Parkinson's disease (PD) have been repeatedly observed. In this study, the aim was to provide insights into the interaction between linguistic representation and processing and executive functioning. Therefore, sentence comprehension and executive functions were assessed in 28 Dutch-speaking PD patients and 28 healthy control subjects. Three aspects of the sentence materials were varied: (1) phrase structure complexity, (2) sentence length, and (3) picture congruence. PD patients with mild-to-moderate disease severity showed decreased sentence comprehension compared to healthy control subjects. The difficulties encountered by PD patients were not limited to one aspect of the sentence materials. The same pattern of results was present in healthy control subjects. Deficits in set-switching were specifically associated with the comprehension of passive sentences. Generally, our study confirms that there does not appear to be a language faculty encapsulated from the influence of executive functions.

Communication Impairments in Parkinson's Disease

Communication Impairments in Parkinson's Disease

Rehabilitation of Executive Functioning in Patients with Frontal Lobe Brain Damage with Goal Management Training

Executive functioning deficits due to brain disease affecting frontal lobe functions cause significant real-life disability, yet solid evidence in support of executive functioning interventions is lacking. Goal Management Training (GMT), an executive functioning intervention that draws upon theories concerning goal processing and sustained attention, has received empirical support in studies of patients with traumatic brain injury, normal aging, and case studies. GMT promotes a mindful approach to complex real-life tasks that pose problems for patients with executive functioning deficits, with a main goal of periodically stopping ongoing behavior to monitor and adjust goals. In this controlled trial, an expanded version of GMT was compared to an alternative intervention, Brain Health Workshop that was matched to GMT on non-specific characteristics that can affect intervention outcome. Participants included 19 individuals in the chronic phase of recovery from brain disease (predominantly stroke) affecting frontal lobe function. Outcome data indicated specific effects of GMT on the Sustained Attention to Response Task as well as the Tower Test, a visuospatial problem-solving measure that reflected far transfer of training effects. There were no significant effects on self-report questionnaires, likely owing to the complexity of these measures in this heterogeneous patient sample. Overall, these data support the efficacy of GMT in the rehabilitation of executive functioning deficits.

Deteriorated Executive Functions in Patients with Successful Surgery for Pituitary Adenomas Compared with Other Chronically Ill Patients

Pituitary adenomas, even after successful treatment, are associated with cognitive impairments. It is unclear whether these deficits are a consequence of unspecific factors associated with having a chronic illness and whether the cognitive dysfunctions exceed those of other chronically ill patients. Thirty-eight patients with transsphenoidal surgery for pituitary adenomas and 38 patients undergoing L-thyroxine replacement therapy after thyroid surgery were studied neuropsychologically with established tests. Executive function was examined with the Trail-Making Test A and B, working memory with the digit span test, attention with the digit symbol test, verbal memory with the German version of the Auditory Verbal Learning and Memory Test, and general verbal intelligence by a vocabulary test. Attention (p = .007), attentional speed (p = .0004), executive control (p = .04), and working memory (p = .01), were significantly reduced in patients with pituitary adenomas compared with other chronically ill patients. In contrast, no differences were found between the groups for verbal memory (all subtests: p ≥ .06). Patients with successful surgery for pituitary adenomas show also in comparison with other chronically ill patients an increased risk for deficits in certain aspects of cognitive function, including attention and working memory, supporting the relevance of the brain lesion and its treatment for these dysfunctions.

Prospective memory in patients with juvenile myoclonic epilepsy and their healthy siblings

Prospective memory (PM) describes the ability to fulfill previously planned intentions and is highly dependent on executive functions. Previous studies have shown deficits in executive functions in patients with juvenile myoclonic epilepsy (JME) and in their unaffected siblings. JME has a strong genetic predisposition and it is hypothesized that cognitive deficits are also genetically determined. The present study aimed at investigating potential differences in PM between patients with JME, their siblings, and healthy controls. Nineteen patients with JME, 21 siblings, and 21 healthy controls were examined with a complex PM paradigm allowing us to evaluate the different phases of PM (i.e., intention formation, intention retention, intention initiation, intention execution). Patients with JME and siblings showed specific deficits during intention formation and intention execution of PM. Patients with JME were more impaired than both siblings and healthy controls. Correlation analysis revealed an influence of planning on prospective memory abilities in patients with JME. The results of this study support the hypothesis of frontal dysfunctions being part of the epileptic syndrome and therefore genetically determined. As in this study patients with JME are more severely cognitively impaired than their siblings, additional influencing factors, such as side effects of anticonvulsants or cognitive effects of subclinical epileptic discharges, might contribute to patients' performance.

Task switching performance reveals heterogeneity amongst patients with mild cognitive impairment.

To assess executive function in patients with mild cognitive impairment (MCI) and to determine whether task switching ability is associated with transition to Alzheimer's disease. Twenty-seven MCI patients and 19 older controls were tested using a cued letter-digit classification switching task. Sixteen patients could perform the task (MCI-able), 6 could not (MCI-unable), and 5 were able only with cognitive support (MCI-cue). Demographic, neuropsychological, event-related potential (ERP), MRI, and genetic data were also collected. The four groups did not differ on age, gender, and APO E4 frequency. Compared to the controls, the MCI-unable group had significantly poorer performance on the Trail Making task (η2 = .430), lower education (η2 = .234), and smaller cortical volume (η2 = .245). Most MCI patients exhibited task-switching deficits but to vastly different degrees and with varying outcomes. The combined pattern of neuropsychological and task switching performance indicates that the MCI-able patients displayed memory retrieval difficulties (F(2,39) = 3.6, p = .036, MSE = 1.44), generally preserved task switching abilities, and had a high probability of remaining dementia-free at follow-up. The MCI-cue patients had increased mixing costs, F(2,39) = 11.0, p < .001, MSE = .07; the MCI-unable patients showed episodic memory deficits, and both groups had a high probability of poor outcome (i.e., developing AD or dying within four years). This study demonstrates that variability in performance on measures of task-switching can highlight important heterogeneity in the MCI population.

Operating Characteristics of Executive Functioning Tests Following Traumatic Brain Injury

The primary purposes of this study were to determine if controls, and mild and moderate/severe traumatic brain injury (TBI) patients performed differently on a battery of executive functioning (EF) tests, and to identify the operating characteristics of EF tests in this population. Participants consisted of 46 brain-injured individuals and 24 healthy controls. All participants completed an extensive battery of EF tests. Results showed that mild TBI participants performed worse than controls on the Trail Making Test Part B, and that moderate/severe TBI participants consistently performed worse than either group on a variety of EF measures. Tests of EF exhibited a wide range of operating characteristics, suggesting that some EF tests are better than others in identifying TBI-related neurocognitive impairment. Predictive values were better for individuals with moderate/severe TBI than mild TBI. Overall, the Digit Span Backward Test showed the best positive predictive power in differentiating TBI. Our results provide useful data that may guide test selection in evaluating EF in patients with traumatic brain injury.

Efficacy of Rivastigmine on Executive Function in Patients with Parkinson's Disease Dementia

Rivastigmine is approved in the USA for the treatment of mild to moderate Alzheimer's disease and Parkinson's disease dementia (PDD). Executive function (EF) deficits are a core symptom of PDD. The current objective was to investigate the effects of rivastigmine capsules versus placebo on EF in PDD, focusing on secondary outcome measures from a large, international, randomized, double-blind, placebo-controlled, 24-week trial (EXPRESS, CENA713B2311). Secondary outcomes included Delis-Kaplan Executive Function System (D-KEFS) measures of EF. Data from three D-KEFS subtests (Card Sorting, Letter Fluency, Color-Word Interference), plus the Symbol Digit Modalities Test were analyzed in the observed case (OC) population. Changes from baseline in the rivastigmine versus placebo groups were evaluated using the van Elteren test blocking for country. Of 541 patients in the EXPRESS study, 402, 71, 97, and 65 patients provided data for Letter Fluency, Card Sorting and Color-Word Interference subtests, and the Symbol Digit Modalities Test, respectively. On Letter Fluency, rivastigmine was associated with improvements in correct responses, set loss errors, and responses made (all P < 0.05), but not repetition errors. Higher Card Sorting recognition description score (P= 0.03), and more correct substitutions on the Symbol Digit Modalities Test (P= 0.02) were also recorded. Rivastigmine was associated with significant improvements over placebo on EF tests evaluating flexibility of thinking, problem solving and planning in patients with PDD. These findings support the hypothesis that rivastigmine may affect frontal subcortical circuits, which potentially contributes to observed clinical improvement associated with EF.

Amphetamine-related improvement in executive function in patients with chronic schizophrenia is modulated by practice effects

Background Amelioration of cognitive impairment is an important treatment goal for a broad range of neuropsychiatric disorders, including schizophrenia. One critical issue in clinical trial design is the extent to which repeated exposure to cognitive tests (i.e., practice effects) may lead to improvement in performance on the cognitive tests in the absence of any true treatment effect. The current study examined the extent to which practice effects on a measure of executive function may influence the sensitivity of that task to detecting the cognitive-enhancing effects of a single acute dose of d-amphetamine in individuals with chronic schizophrenia. Methods Twenty-four men with chronic schizophrenia were randomized to receive a constant or random/matched alternate form version of a hidden maze learning measure of executive function (Groton Maze Learning Test; GMLT) on four separate occasions in one month. They also completed a measure of psychomotor speed. Using a double-blind, placebo-controlled, parallel groups design, cognitive function following administration of a single dose of d-amphetamine (20 mg p.o) or placebo was then assessed. Results The group who received the constant-pathway version of the GMLT showed a large practice effect (d = 2.05) over four practice sessions. Consequently, they did not evidence any improvement on the GMLT following d-amphetamine administration. In contrast, the group who received the random/matched alternate version of the GMLT showed a statistically significant and large effect size (d = .84) improvement on this measure. Both groups showed d-amphetamine-related improvement on a measure of psychomotor speed. Conclusions Results of this study suggest that practice effects associated with repeated exposure to a cognitive test could obscure the sensitivity of the test to detecting true treatment-related cognitive improvement.

Pain, Executive Functioning, and Affect in Patients With Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a chronic inflammatory disease resulting in substantial pain. The physical and emotional effects of RA are well known, but little attention has been given to the potential cognitive effects of RA pain, although intact executive functioning in patients with chronic illness is crucial for the successful completion of many daily activities. We examined the relationship between pain and executive functioning in patients with RA, and also considered the influence of positive and negative affect in the relationship between pain and executive functioning. A sample of 157 adults with RA completed measures of pain and positive and negative affect and were tested for working memory and selective attention using the Letter Number Sequencing subtest from the Wechsler Adult Intelligence Scale-Third Edition and the Stroop Color Word Test tests, respectively. Consistent with prior research, pain was inversely related to executive functioning, with higher pain levels associated with poorer performance on executive functioning tasks. This relationship was not moderated or mediated by negative affect; however, positive affect moderated the relationship between pain and executive functioning. For patients high in positive affect there was a significant inverse relationship between pain and executive functioning, whereas there was no such relationship for patients low in positive affect. These findings are discussed in the context of cognitive research on the effects of positive affect on executive functioning and functional neuroanatomical research suggesting neurocognitive mechanisms for such moderation.

Deep brain stimulation—drawbacks and perspectives. In response to Dr. Saleh

Dear Editor,I am indebted to Dr. Saleh for his thoughtful comments and supplementation of literature in response to our paper concerning modifications of target point in deep brain stimulation of Parkinson patients [2]. In the shortness of a case report, a balanced view may indeed not have emerged, and I am therefore grateful for the opportunity to expand the discussion.I am well aware of the striking ambiguity in the literature concerning negative impacts on mood and cognition. It may partially be explained by different quantity and quality of assessments. This will affect also meta-analyses as cited by Saleh [8]: if changes in incentive, social functioning and disinhibition are not recorded, they will not appear as adverse events. The literature in this domain is relatively scarce compared to the literature on motor outcomes and a recent meta-analysis [4] found only "mild post-operative impairments in verbal learning and executive function in patients who underwent DBS surgery", the... Language: en

Executive function in patients with obstructive sleep apnea treated with continuous positive airway pressure

Obstructive sleep apnea (OSA) is characterized by disrupted breathing and hypoxemia during sleep, daytime sleepiness, and changes in cognition and mood. One important question is regarding the reversibility of cognitive deficits after treatment with continuous positive airway pressure (CPAP). Here, we report the outcomes of CPAP treatment as measured by tests of attention and executive function. Thirty-seven individuals with moderate to severe OSA and compliant on CPAP treatment were studied with working memory tasks, neuropsychological testing, and overnight polysomnographic sleep study and compared to 27 healthy controls. CPAP improved the respiratory disturbance index, minimum and mean oxygen saturation (SpO2), subjective sleep quality, and daytime sleepiness ratings compared to pre-treatment values. In terms of current neurocognitive function, treated individuals with OSA performed at a comparable level to controls on basic working memory storage functions but still showed a significant reduction on tests of working memory requiring the central executive. The OSA group also performed worse on neuropsychological measures of complex attention, executive function, and psychomotor speed. While CPAP is an effective treatment for OSA in terms of ameliorating breathing disruption and oxygen desaturation during sleep, as well as daytime sleepiness, some cognitive deficits may be more resistant to treatment.

Contrasting patterns of deficits in visuospatial memory and executive function in patients with major depression with and without ECT referral

The pretreatment neuropsychological profile of drug-resistant patients with major depressive disorder (MDD) referred for electroconvulsive therapy (ECT) may differ from that of their drug-respondent MDD counterparts. Such differences could help in identifying distinct MDD subtypes, thus offering insights into the neuropathology underlying differential treatment responses. Depressed patients with ECT referral (ECTs), depressed patients with no ECT referral (NECTs) and non-psychiatric Controls (matched groups, n=15) were assessed with memory and executive function tests from the Cambridge Neuropsychological Test Automated Battery (CANTAB). ECTs scored significantly lower than NECTs in the Mini-Mental State Examination (MMSE; p=0.01). NECTs performed worse than Controls in the Paired Associates Learning (PAL) task (p<0.03; Control/NECT p<0.01) and the Spatial Recognition Memory (SRM) task (p<0.05; Controls/NECTs p<0.05); ECTs performed between Controls and NECTs, not differing from either. In the Intra/Extradimensional (IED) set-shifting task, ECTs performed worse that Controls and NECTS (IED: p<0.01; Controls/ECTs p<0.01), particularly in the shift phases, which suggests reduced attentional flexibility. In Stockings of Cambridge (SOC), ECTs abandoned the test early more often than Controls and NECTs (H=11, p<0.01) but ECTs who completed SOC performed comparably to the other two groups. A double dissociation emerged from the comparison of cognitive profiles of ECT and NECT patients. ECTs showed executive deficits, particularly in attentional flexibility, but mild deficits in tests of visuospatial memory. NECTs presented the opposite pattern. This suggests predominantly frontostriatal involvement in ECT versus temporal involvement in NECT depressives.

Nonclinical Obsessive-Compulsive Symptoms and Executive Functions in Schizophrenia

Nonclinical Obsessive-Compulsive Symptoms and Executive Functions in Schizophrenia

P.2.a.019 Memory and executive functions in patients treated with vagus nerve stimulation for refractory depression

P.2.a.019 Memory and executive functions in patients treated with vagus nerve stimulation for refractory depression

A control study on the development of "cool" and "hot" executive functions between cerebral palsy children and normal children

Objective To explore the differences and development of executive function(EF) between cerebral palsy(CP) children and normal children. Methods Forty-eight 4 ～6 years old CP children and fiftyeight normal children were tested by cool and hot EFs. Results There were significant differences between cool EF of CP children(18.34±14.31) and normal children(6.94 ±3. 18) ( t = 3. 83, P<0.01 ) ;and there were significant differences between hot EF of CP children(279.67 ±330. 18) and normal children(709.31 ± 304. 13)( t = -4.93, P< 0.01). There were significant age differences on the cool EF ( F=8.689, P< 0.01) and hot EF ( F=3. 833, P<0.05) of CP children. There were significant age differences on the cool EF ( F= 15.469, P<0.01) and on the hot EF ( F=8.470, P<0.01) of normal children. There was negative correlation between cool EFs and hot EFs( r= -0.440, P<0.01). Conclusion Cool and hot EFs of CP children are lower than those of normal children. Cool and hot EFs can develop from 4 to 6 years old,but the development of EFs are not absolutely consistent between CP children and normal children. There is correlation between cool and hot EFs in patients with CP,but not dissociation. Key words: Cerebral palsy; Executive function; Child

Breakfast improves cognitive function in cirrhotic patients with cognitive impairment

Cognitive disturbances are relatively common in patients with liver disease. High protein load precipitates hepatic encephalopathy in cirrhotic patients. Minimal hepatic encephalopathy (MHE) is a prevalent neurocognitive complication of cirrhosis. Because the influence of nutritional factors on the progression of cognitive impairment has not been explored in depth, this study aimed to investigate the effect on cognition of acute metabolic changes induced by breakfast consumption. Twenty-one subjects (10 women) with Child A cirrhosis and 21 age- and sex-matched healthy controls were enrolled. Patients and controls were divided into 2 groups: those receiving a breakfast of 500 kcal and 21 g protein and those receiving no breakfast. Serum ammonia concentrations and cognitive functions were studied (Mindstreams; NeuroTrax, Fresh Meadows, NY) before and 2 h after breakfast. A mixed model was used to analyze the data. At baseline, cirrhotic patients had significantly lower total scores and significantly lower subscores (P < 0.015 global cognitive score) in 4 of 7 cognitive categories, which is indicative of MHE. Patients with hyperammonemia (>85 mug/dL) scored significantly lower for attention than did patients with normal serum ammonia concentrations (P < 0.003). After 2 h, MHE patients and controls responded differently to breakfast consumption with regard to attention and executive functions (P < 0.003 and P < 0.04, respectively). Although patients' scores improved after breakfast consumption, despite an increase in serum ammonia, healthy controls who continued to fast performed better. Chronic hyperammonemia may negatively affect attention. Eating breakfast improves attention and executive functions of patients with MHE. Prolonged periods of starvation may be partly responsible for these changes. This trial was registered at clinicaltrials.gov as NCT01083446.

Effects of selective serotonin reuptake and dual serotonergic–noradrenergic reuptake treatments on attention and executive functions in patients with major depressive disorder

Several reports suggest that antidepressants may improve cognitive functioning in patients with major depressive disorder (MDD). The present work aims to study the effects of selective serotonin reuptake inhibitors (SSRIs) and serotonergic–noradrenergic reuptake inhibitors (SNRIs) treatments on the performance of working memory, attention and executive functions in patients with MDD. A total of 73 subjects meeting the Diagnostic and Statistical Manual of Mental Disorders version IV (DSM-IV) criteria for MDD, and 37 control subjects were assessed with the Hamilton Depression Rating Scale and a neuropsychological battery. The subjects were medicated with escitalopram ( n = 36) or duloxetine ( n = 37) for 24 weeks. At the end of the trial, the subjects were assessed again with the same tests. The depressed subjects showed alterations in attention and cognitive functions when compared to the control group. The administration of both treatments improved working memory, as well as attention and all the executive functions, but the cognitive functions of depressed patients do not improve enough to reach the levels of performance of the control subjects. Our results suggest that both SSRI and SNRI treatments presented the same efficacy in improving attention and the remaining executive functions.

Machiavellianism and Executive Functioning in Patients with Delusional Disorder

Previous research has demonstrated that patients with Delusional Disorder are impaired in executive functioning that affects performance on social cognitive tasks. In patients with Parkinson's disease, poor executive control induces an increase in "Machiavellianism," a term that refers to opportunistic behaviors that aim at exploiting and manipulating others. Accordingly, the association between Machiavellianism in Delusional Disorder and executive functioning deficits was examined. Machiavellianism and executive functioning were measured in 22 patients with Delusional Disorder and compared with a group of 22 healthy controls matched for sex, (premorbid) intelligence, and education. Patients and controls did not differ regarding Machiavellianism scores, education level, or intelligence. However, patients with Delusional Disorder performed more poorly on an executive functioning task. Impaired executive functioning was associated with greater Machiavellianism, particularly cynical views on human nature, but not with intelligence or illness duration. Similar to findings in patients with Parkinson's disease, Machiavellianism in Delusional Disorder was associated with poorer executive functioning. This finding indicates that frontal lobe dysfunction may influence interpersonal attitudes and personality in Delusional Disorder.

A randomized controlled trial of rivastigmine in patients with cognitive impairment no dementia because of cerebrovascular disease

The safety and efficacy of early acetylcholinesterase inhibitors therapy in patients with cognitive impairment no dementia (CIND) after a cerebrovascular accident have not been examined. In this study, we investigated the safety and efficacy of rivastigmine in cognition, particularly executive function in patients with CIND because of cerebrovascular disease. This study was a 24-week, double-blind, randomized, placebo-controlled trial of ischemic stroke patients seen at a tertiary hospital who had cognitive impairment no dementia because of cerebrovascular disease. The intervention was either rivastigmine or placebo up to 9 mg/day. The primary outcome of interest was mean change from baseline in the Ten-Point Clock Drawing and Color Trails 1 and 2. Fifty patients were randomized into rivastigmine (n = 25) and placebo (n = 25) arms. Patients in the rivastigmine group showed statistically significant improvement (1.70 vs 0.13, P = 0.02) on the animal subtask of the verbal fluency measure compared with placebo. There was also a trend (non-significant) towards improvement in Color Trails II. In this pilot study, we demonstrated that rivastigmine was well tolerated in patients with CIND because of cerebrovascular disease and may potentially improve executive functioning.