Presence Of Executive Dysfunction Research Articles

Exploratory study of the prevalence of food addiction and its relationship with executive functioning, depression, and reinforcement sensitivity in a sample of Mexican adults.

The study of food addiction (FA) has become relevant due to its high prevalence, the negative impact on quality of life, and its association with neuropsychological and psychiatric symptoms. Several studies have provided scientific support for these associations, however, the results are contradictory. Additionally, studies have unsuccessfully elucidated the true nature of the failures in executive functioning in people with FA symptomatology, particularly when it comes to executive deficits. Therefore, the purpose of this research was to establish whether the presence of executive dysfunction, depressive symptoms and binge eating problems, as well as high reward sensitivity entails a greater severity in FA traits and high body mass index (BMI) in a sample of Mexican adults. The sample consisted of Mexican men and women between 21-59 years (n = 36); who completed self-report questionnaires and performance tests to measure the study variables. Additionally, BMI was estimated with self-reported height and weight. Our results showed that a high number of FA symptoms were associated with higher executive dysfunction scores, greater reward sensitivity, and more severe depressive and binge eating problems. Furthermore, factors that are more strongly associated with higher scores of FA include severe executive deficits, greater activation of the punishment avoidance system, and persistence in the search for reward when the depressive symptoms increased. The factors that best explained changes in the estimated BMI of women were a decreased crystallized intellectual capacity and the inability to control food intake as the number of FA symptoms increased. In summary, the cognitive functioning profile characterized by general failure of the executive functioning, as well as a greater activation of the Punishment Avoidance System and persistence in the search for reward, were associated with greater severity of FA symptoms, especially when the depressive symptomatology was severe. In parallel, the psychopathology in participants associated with FA confirms the contribution of anxious and depressive symptomatology and borderline personality traits which could facilitate the expression of clinically relevant FA symptoms in women. Finally, we found that decreased crystallized intellectual capacity and inability to control food intake were linked to higher BMI when the number of FA symptoms increased.

Hippocampal α-synuclein pathology correlates with memory impairment in multiple system atrophy.

Recent post-mortem studies reported 22-37% of patients with multiple system atrophy can develop cognitive impairment. With the aim of identifying associations between cognitive impairment including memory impairment and α-synuclein pathology, 148 consecutive patients with pathologically proven multiple system atrophy were reviewed. Among them, 118 (79.7%) were reported to have had normal cognition in life, whereas the remaining 30 (20.3%) developed cognitive impairment. Twelve of them had pure frontal-subcortical dysfunction, defined as the presence of executive dysfunction, impaired processing speed, personality change, disinhibition or stereotypy; six had pure memory impairment; and 12 had both types of impairment. Semi-quantitative analysis of neuronal cytoplasmic inclusions in the hippocampus and parahippocampus revealed a disease duration-related increase in neuronal cytoplasmic inclusions in the dentate gyrus and cornu ammonis regions 1 and 2 of patients with normal cognition. In contrast, such a correlation with disease duration was not found in patients with cognitive impairment. Compared to the patients with normal cognition, patients with memory impairment (pure memory impairment: n = 6; memory impairment + frontal-subcortical dysfunction: n = 12) had more neuronal cytoplasmic inclusions in the dentate gyrus, cornu ammonis regions 1-4 and entorhinal cortex. In the multiple system atrophy mixed pathological subgroup, which equally affects the striatonigral and olivopontocerebellar systems, patients with the same combination of memory impairment developed more neuronal inclusions in the dentate gyrus, cornu ammonis regions 1, 2 and 4, and the subiculum compared to patients with normal cognition. Using patients with normal cognition (n = 18), frontal-subcortical dysfunction (n = 12) and memory impairment + frontal-subcortical dysfunction (n = 18), we further investigated whether neuronal or glial cytoplasmic inclusions in the prefrontal, temporal and cingulate cortices or the underlying white matter might affect cognitive impairment in patients with multiple system atrophy. We also examined topographic correlates of frontal-subcortical dysfunction with other clinical symptoms. Although no differences in neuronal or glial cytoplasmic inclusions were identified between the groups in the regions examined, frontal release signs were found more commonly when patients developed frontal-subcortical dysfunction, indicating the involvement of the frontal-subcortical circuit in the pathogenesis of frontal-subcortical dysfunction. Here, investigating cognitive impairment in the largest number of pathologically proven multiple system atrophy cases described to date, we provide evidence that neuronal cytoplasmic inclusion burden in the hippocampus and parahippocampus is associated with the occurrence of memory impairment in multiple system atrophy. Further investigation is necessary to identify the underlying pathological basis of frontal-subcortical dysfunction in multiple system atrophy.

Forward to the past: Revisiting the role of immediate recognition in the assessment of episodic memory

ABSTRACTIntroduction: During the clinical assessment of episodic memory, encoding ability is typically inferred from immediate recall performance. This dependency on effortful retrieval may not be optimal for estimating encoding, particularly in the presence of executive dysfunction. We examined whether a test of immediate recognition memory could meaningfully supplement recall in estimating encoding and provide unique information about memory retention.Method: Fifty older adult outpatients were administered a neuropsychological test battery including original and revised versions of the Hopkins Verbal Learning Test; the former (HVLT) assesses recognition memory immediately after learning trials, while the latter (HVLT-R) assesses only delayed recognition. Hierarchical regressions evaluated the incremental value of immediate recognition in predicting both delayed verbal and visual recognition. ANCOVA was performed on subgroups defined by the number of impaired performances on executive functioning tests (EF-intact, EF-1, EF-2) to examine the influence of executive impairment on measures of immediate recall and recognition. Recall- and recognition-based estimates of verbal memory retention were also compared across groups to determine whether they yield distinct patterns of memory consolidation.Results: Immediate verbal recognition accounted for significant variance in both delayed verbal and visual recognition beyond immediate recall, age, and education. Although subgroups were demographically similar, EF-1 and EF-2 performed significantly worse than EF-intact across verbal and visual memory recall. Contrastingly, there were no group differences in immediate recognition. Subgroups attained similar scores on a conventional, recall-based memory retention measure, but EF-2 showed relatively greater forgetting on a recognition-based retention measure.Conclusions: Immediate verbal recognition is an independent determinant of delayed memory performance but is not captured in current test paradigms. Study results provide proof-of-concept that recognition testing at learning can provide a more comprehensive index of encoding ability than recall alone, may facilitate disentangling memory functions from executive deficits, and could have important downstream implications for estimating memory consolidation.

Relación entre recuerdo demorado en la Figura Compleja de Rey-Osterrieth y funcionamiento ejecutivo

El Test de la Figura Compleja de Rey-Osterrieth (TFCR) es un instrumento neuropsicológico diseñado para la evaluación de habilidades visoconstructivas y memoria visoespacial. Estudios recientes enfatizan la implicación de las funciones ejecutiva en esta prueba. Objetivos. Examinar la relación del recuerdo demorado de la prueba de Rey-Osterrieth con medidas de funcionamiento ejecutivo y mnésico visual. Sensibilidad del TFCR para detectar déficits ejecutivos. Método. Estudio retrospectivo de las evaluaciones neuropsicológicas realizadas a 70 pacientes con diversa patología. Resultados. Existe correlación significativa entre puntuación TFCR-Demorado y Matrices (r=.50; p<.001), TMT-B (r=.47; p<.001), medida de flexibilidad cognitiva (WCST) (r=.41; p=.001), porcentaje de respuestas de nivel conceptual (r=.40; p=.001) y recuerdo visual demorado (r=.26; p=.032). Existe correlación significativa entre la puntuación TFCR -Copia con Matrices (r=.40; p=.001) y con TMT-B (r=.37; p=.003), pero no con el resto de pruebas ejecutivas o de memoria. En los análisis ROC se observa una adecuada sensibilidad y especificidad en las medidas ejecutivas, con áreas bajo la curva significativas semejantes a las obtenidas con la puntuación TFCR-Demorado (A=.754; p=.001). Discusión. TFCR-Demorado refleja el funcionamiento ejecutivo relacionado con la planificación, más que la memoria visual. La planificación no se refleja en la puntuación TFCR-C, que puede ser normal en presencia de disfunción ejecutiva.

Executive dysfunction and survival in patients with amyotrophic lateral sclerosis: Preliminary report from a Serbian centre for motor neuron disease

Our objective was to determine whether the presence of executive dysfunction in non-demented amyotrophic lateral sclerosis (ALS) patients might affect the longevity of survival. Forty-eight consecutive non-demented ALS patients (mean age = 52.93 ± 12.37) were followed for five years. All patients underwent clinical and neuropsychological assessments at baseline visit. Further, a yearly follow-up check for associated dementia (ALS-Dem) was completed and the time of death was recorded, when applicable. Executive deficits were shown in 49.5% of ALS patients, with the most striking differences found on the tests of verbal fluency (both phonemic and category, p < 0.01); as well as inefficient strategy on a working memory test (p < 0.05); as on the more demanding levels of the planning and problem solving task (p < 0.01). It appears that the baseline executive status might predict survival in ALS (p = 0.075), and the patients presenting executive dysfunction could have up to three times greater risk of death, after adjustment by several potential confounding factors. In conclusion, this study suggests that executive dysfunction could potentially influence survival in ALS patients. The cognitive testing might give us important clues about the prognosis of the disease. Further studies with larger sample size are necessary.

Course and etiology of dysexecutive MCI in a community sample

BackgroundAmnestic mild cognitive impairment (aMCI) is associated with an elevated risk of progressing to Alzheimer's disease. Much less is known about the course of dysexecutive mild cognitive impairment (dMCI). The goals of this study were to determine how the profile of cognitive deficits differs over time between patients with dMCI and aMCI, and control subjects; if the type of dementia differs between dMCI and aMCI in patients who progress to dementia; and if dMCI is more associated with stroke and white matter hyperintensity on magnetic resonance imaging (MRI) than aMCI. MethodsThe authors undertook a prospective evaluation of an inception cohort of 1167 ethnically diverse elders recruited from an urban community-based sample monitored with clinical and neuropsychological testing for an average of 4.5 years (standard deviation, 0.8 year). A subset of the subjects underwent MRI. We compared four groups of MCI patients: single-domain amnestic and dysexecutive MCI, and multiple-domain MCI with and without executive dysfunction. ResultsCompared with aMCI, dMCI was less likely to involve other areas of cognition over time and progress to dementia. None of the 33 single-domain dMCI patients progressed to dementia. The presence of executive dysfunction in multiple-domain MCI did not increase risk of progression to dementia. Patients with multiple-domain MCI with executive dysfunction who progressed to dementia were less likely to have an Alzheimer's–type dementia than MCI patients without executive dysfunction. Patients with dMCI were more likely to experience stroke, but not white matter hyperintensity, detected via MRI than patients with aMCI. ConclusionsdMCI appears to follow a different course, and is less associated with Alzheimer's disease and more associated with stroke than aMCI.

Physical Aggression, Diagnostic Presentation, and Executive Functioning in Inpatient Adolescents Diagnosed with Mood Disorders

While a relationship has been identified between physical aggression and executive functioning within the adult population, this relationship has not yet been consistently examined in the adolescent population. This study examined the association between physical aggression towards others, self-reported depressive symptoms, and executive functioning within an adolescent inpatient sample diagnosed with a mood disorder. This study consisted of a retrospective chart review of 105 adolescent inpatients (ages 13-19) that received a diagnosis of a mood disorder (excluding Bipolar Disorder). Participants were grouped based on history of aggression towards others, resulting in a mood disorder with physically aggressive symptoms group (n=49) and a mood disorder without physically aggressive symptoms group (n=56). Ten scores on various measures of executive functioning were grouped into five executive functioning subdomains: Problem Solving/Planning, Cognitive Flexibility/Set Shifting, Response Inhibition/Interference Control, Fluency, and Working Memory/Simple Attention. Results from analyses of covariance indicated that there were no significant differences (p<.01) between aggression groups on any executive functioning subdomains. Correlation analyses (p<.01) indicated a negative correlation between disruptive behavior disorders and response inhibition/interference control, while anxiety disorders were negatively correlated with problem solving/planning. These findings provide important information regarding the presence of executive dysfunction in adolescent psychiatric conditions, and the specific executive subdomains that are implicated.

Deficits in emotional and social cognition in amyotrophic lateral sclerosis.

These studies investigated whether non-demented ALS patients display impairments on tests of emotional decision making and social and emotional cognition, sensitive to frontal variant Frontotemporal Dementia (fvFTD). Previous studies have shown predominant executive dysfunction and dorsolateral prefrontal involvement in ALS, but evidence of other prefrontal dysfunction implicated in fvFTD is sparse. In Study A, 19 ALS patients and 20 healthy controls undertook a test of affective decision making, modified Iowa Gambling Task (IGT). Behavioral measures included the Frontal Systems Behavior Scale. In Study B, 14 ALS patients and 20 controls undertook tests of social and emotional cognition (Judgment of Preference based on eye gaze, the Mind in the Eyes, recognition of Facial Expressions of Emotion). In Study A, ALS patients demonstrated a significantly different performance profile from healthy controls on the IGT and did not learn to avoid the disadvantageous stimuli (Block 3, d = 0.60, Block 4 days = 0.68). Behavior ratings showed increased apathy from premorbid levels. In Study B, ALS patients were impaired on attentionally demanding (d = 3.12) and undemanding (d = 7.52) conditions of the Judgment of Preference task, despite many showing intact executive functions. A smaller subset showed impaired emotion recognition. Behavior change was also evident. The findings reveal a Theory of Mind deficit on a simple test that was dissociated from the presence of executive dysfunction and suggests a profile of cognitive and behavioral dysfunction indicative of a subclinical fvFTD syndrome. The relative contribution of prefrontal pathways to the cognitive profile in ALS is considered.

Neuropsychiatric symptoms in MCI subtypes: the importance of executive dysfunction

Mild cognitive impairment (MCI) is a syndrome thought to be a prodrome of dementia for some patients. One subtype, amnestic MCI (aMCI), may be specifically predispose patients to develop Alzheimer's dementia (AD). Since dementia has been associated with a range of neuropsychiatric symptoms (NPS), we sought to examine the prevalence of NPS in MCI and its subtypes. One thousand seven hundred seventy-nine participants in the National Alzheimer's Coordinating Center (NACC) with MCI were included in this study. All participants were evaluated systematically with a thorough cognitive battery, clinical interview, and consensus diagnoses, and subtyped as: (1) amnestic (aMCI) (single- or multiple-domain) versus non-amnestic (non-aMCI); (2) executive dysfunction-MCI (exMCI) (single- or multiple-domain) versus no executive dysfunction-MCI (non-exMCI); (3) both aMCI and exMCI; and (4) neither aMCI nor exMCI. Additionally, aMCI versus non-aMCI and exMCI versus non-exMCI dichotomies were explored. NPS were assessed with the Neuropsychiatric Inventory Questionnaire (NPI-Q) and Geriatric Depression Scale (GDS). 1379 participants (77.5%) met criteria for aMCI and 616 (34.6%) for exMCI. No differences were observed in the prevalence of NPS between aMCI versus non-aMCI. However, exMCI was associated with greater severity of depression, anxiety, agitation, disinhibition, irritability, and sleep problems, although these differences do not persist after adjustment for multiple comparisons. While there were few associations between aMCI and NPS, the presence of executive dysfunction in MCI was associated with greater severity of symptoms and specifically with depression (evidenced by GDS score) and anxiety. These findings may have implications for MCI prognosis and need to be explored in longitudinal studies.

Nonclinical Obsessive-Compulsive Symptoms and Executive Functions in Schizophrenia

Nonclinical Obsessive-Compulsive Symptoms and Executive Functions in Schizophrenia

Executive dysfunction in vascular cognitive impairment in the consortium to investigate vascular impairment of cognition study

Background and purpose The importance of executive dysfunction is increasingly recognized in the dementia syndrome. Although executive dysfunction has been associated with subcortical ischemic lesions, it may not be unique to VCI or to its clinical subtypes. Methods Secondary analysis of the CIVIC study, a multi-centre memory clinic cohort study. An executive dysfunction index variable was created using 30 items from the clinical evaluation. Results Of 1347 patients, 151 had a baseline diagnosis of no cognitive impairment (NCI), 463 had AD, 324 had VCI, 97 had vascular cognitive impairment not dementia (VCI-ND) and 253 had non-vascular CIND. Those with VCI and AD had higher mean executive dysfunction index values than those with NCI ( F = 160.2, p < 0.01). Within the VCI subtypes, people with VaD and mixed dementia had the highest mean executive dysfunction index values ( F = 92.5, p < 0.01). Higher executive dysfunction index values were significantly correlated with lower MMSE scores ( R = 0.70, p < 0.01), higher Functional Rating Scale scores ( R = 0.77, p < 0.01) and higher Geriatric Depression Score values ( R = 0.11, p < 0.01). Compared to those who had a lower burden of executive dysfunction, patients with more executive dysfunction (index values > = 0.2) were more likely to be institutionalized (HR = 5.2, p < 0.01) or to die (HR = 2.4, p < 0.01) during the next 30 months. Conclusions Executive dysfunction is common in both AD and VCI. It is associated with poor performance on other measures of cognition and function. The presence of executive dysfunction is associated with worse near-term outcomes.

Comparison of EXIT-25 and the Frontal Assessment Battery for Evaluation of Executive Dysfunction in Patients Attending a Memory Clinic

Background/Aims: The Frontal Assessment Battery (FAB) and the EXIT-25 have emerged as 2 widely used screening instruments for executive dysfunction, but their screening properties have not been evaluated in a head-to-head comparison. Methods: Prospective cohort study of 92 individuals presenting for cognitive assessment at a community hospital. Results: The EXIT-25 took longer than the FAB to complete (mean difference = 9.27 min, 95% CI: 9.86–8.68). EXIT-25 and FAB scores showed significant correlation (Spearman’s r = –0.79, p < 0.001) with one another, and each showed acceptable convergent validity and divergent validity. Conclusions: The 2 tests provide similar information about the presence of executive dysfunction. The FAB takes less time to complete, and appears to be less frustrating for patients, making it more feasible as a screening test for executive dysfunction in a memory clinic setting.

Frequency and Prognostic Value of Cognitive Disorders in Stroke Patients

Background: Stroke is one of the most common diseases to cause cognitive disorders in adults. Aims: To assess the frequency of cognitive deficits in stroke patients and to evaluate the prognostic value of cognitive syndromes for functional recovery. Methods: 200 consecutive patients were examined using a clinical screening battery for cognitive assessment in the second week after their first-ever stroke. 80 were re-examined after a 1-year follow-up. Results: In the post-acute stage, 78% patients were impaired in one or more cognitive domains. The most frequently affected cognitive abilities were attention (48.5%), language (27%), short-term memory (24.5%) and executive functions (18.5%). At the 1-year follow-up, attention deficits were still the most frequent symptom. In contrast, executive dysfunction, aphasia, and long-term memory disorder were significantly less frequent than in the post-acute period. Logistic regression analysis showed that older age, lower score on the Barthel Index, and the presence of executive dysfunction on initial examination were significant predictors of a poor functional outcome at the 1-year follow-up examination. Conclusions: Cognitive-behavioral syndromes are frequent and often chronic consequences of stroke. Executive deficits proved to be the most robust cognitive predictor of poor functional recovery after stroke.

Executive Function in Charge Syndrome

This study addressed the presence of executive dysfunction in children with CHARGE syndrome, a genetic disorder with multiple physical anomalies and severe challenging behaviors. Ninety-eight children were included in the study. More than half received clinically significant scores on the Behavior Rating Inventory of Executive Function (BRIEF; Gioia et al., 2000) scales of Shift, Monitor, and the Behavioral Regulation Index, with additional high scores on Inhibit and the Global Executive Composite. Associations were found with the age the child first walked, scores on the Autism Behavior Checklist (ABC; Krug et al., 1993), and being classified as deafblind. Difficulties with making transitions and flexible problem solving, monitoring their work and their effect on others, and acting on impulse, may be related to the behavioral difficulties exhibited by children with CHARGE. Interventions targeting improved self-regulation may help to manage this challenging behavior.

Pre- and post-operative Wisconsin card sorting test performance in patients with temporal lobe epilepsy due to hippocampal sclerosis.

Patients with temporal lobe epilepsy due to hippocampal sclerosis (TLE/HS) have a distinct neuropsychological profile, but there is still debate on whether executive dysfunction is part of this profile and also whether temporal lobe surgery can modify this dysfunction.ObjectiveTo study the presence and reversibility of executive dysfunction in patients with unilateral TLE/HS.MethodsTwenty-five patients with refractory seizures due to TLE/HS underwent presurgical evaluation which included the application of the Wiconsin Card Sorting Test (WCST). Nineteen were re-evaluated in follow up, at least 6 months after selective amygdalo-hippocampectomy (SAH). Twenty-two control subjects matched for age and education also performed the WCST.ResultsSixteen of the 25 patients (64%) completed fewer than four categories in the WCST whereas only 4 of the 22 controls (18%) did not complete at least four categories (p<0.005). In addition, the performance of the patients involved significantly more perseverative responses and errors compared to controls. The patient group demonstrated significant post-operative improvement in many measures of the WCST following SAH.ConclusionsThese findings support the presence of executive dysfunction in patients with TLE/HS and suggest that such dysfunction can be partially reversed by selective resection of epileptogenic mesial temporal structures.

Executive dysfunction and domestic violence

Primary objective: To replicate previous studies which have reported a high prevalence of traumatic brain injury (TBI) in partner-abusive men and to extend research in this area by determining the prevalence of executive dysfunctions, which have been linked with both TBI and violent behaviour.Research design: Thirty-eight men with criminal convictions for violence and who were receiving treatment for abusing their partners were assessed.Methods and procedures: Subjects with a self-reported history of TBI (n = 22) were compared to the non-TBI group (n = 16) on various psychological measures.Main outcomes and results: The two groups were not significantly different on the variables of age, pre-morbid IQ, self-esteem and alcohol use. The TBI group scored more poorly than the non-TBI group on a measure of current IQ and two of the three measures of executive functioning.Conclusion: The presence of executive dysfunction has implications for the design of successful intervention programmes with this sub-group of batterers.

Executive dysfunction in major depressive disorder

Executive dysfunction is commonly seen in major depression. The types of executive deficits seen in depression include problems with planning, initiating and completing goal-directed activities. Executive dysfunction may vary as a function of the severity of depression. In addition, a subset of geriatric depression is also characterized by prominent deficits in executive functioning. The presence of executive dysfunction in depression is associated with vocational disability and possibly poorer treatment response. While few studies have examined the treatment of executive dysfunction in depression, preliminary work suggests that both pharmacologic interventions and psychosocial interventions such as problem solving therapy may be efficacious.