Executive Dysfunction

Abstract

Purpose of Review: Executive functions represent a constellation of cognitive abilities that drive goal-oriented behavior and are critical to the ability to adapt to an ever-changing world. This article provides a clinically oriented approach to classifying, localizing, diagnosing, and treating disorders of executive function, which are pervasive in clinical practice. Recent Findings: Executive functions can be split into four distinct components: working memory, inhibition, set shifting, and fluency. These components may be differentially affected in individual patients and act together to guide higher-order cognitive constructs such as planning and organization. Specific bedside and neuropsychological tests can be applied to evaluate components of executive function. While dysexecutive syndromes were first described in patients with frontal lesions, intact executive functioning relies on distributed neural networks that include not only the prefrontal cortex, but also the parietal cortex, basal ganglia, thalamus, and cerebellum. Executive dysfunction arises from injury to any of these regions, their white matter connections, or neurotransmitter systems. Dysexecutive symptoms therefore occur in most neurodegenerative diseases and in many other neurologic, psychiatric, and systemic illnesses. Management approaches are patient specific and should focus on treatment of the underlying cause in parallel with maximizing patient function and safety via occupational therapy and rehabilitation. Summary: Executive dysfunction is extremely common in patients with neurologic disorders. Diagnosis and treatment hinge on familiarity with the clinical components and neuroanatomic correlates of these complex, high-order cognitive processes.

The Brain Health Assessment for Detecting and Diagnosing Neurocognitive Disorders

“…All results depicted were significant at a corrected level (P FWE <.05). [Color figure can be viewed at wileyonlinelibrary.com] patterns; Favorites correlated with brain regions important for memory, including the medial temporal lobes 20 ; Match correlated with brain regions important for executive functions and speed in the dorsal frontoparietal network and basal ganglia 21 ; and Line Orientation correlated with a cluster in the right parietal lobe. 22 The remaining BHA cognitive subtest, Animal Fluency (widely used to assess the language domain), is sensitive to temporal and frontal lobe pathologies.…”

A Lesion-Proof Brain? Multidimensional Sensorimotor, Cognitive, and Socio-Affective Preservation Despite Extensive Damage in a Stroke Patient

“…In this sense, the patient exhibited various patterns of damage known to systematically disrupt various domains. For example, putative associations have been established between frontostriatal lesions and motor disability (Zgaljardic et al, 2003), insulo-parietal compromise and somatosensory deficiencies (Meyer et al, 2016), bilateral fronto-insular damage and social cognition deficits (Ibáñez et al, 2010, 2016a; Couto et al, 2013; Baez et al, 2014, 2016b; Melloni et al, 2016), bilateral frontal atrophy and executive dysfunctions (Rabinovici et al, 2015), left perisylvian lesions and language impairment (Ullman, 2008), and right-sided frontal disturbances and altered pragmatic skills (Kaplan et al, 1990; Stemmer, 2008). Moreover, the regions affected should typically disrupt multiple functional networks, such as the salience network (Seeley et al, 2007), the social context network (Ibáñez and Manes, 2012; Baez et al, 2016a), and the fronto-parietal attention network (Ptak, 2012).…”

“…These steps are critical and perhaps unavoidable to characterize the organ's functional organization with some degree of external validity. Indeed, thanks to this approach, replicable associations have been established between damage to circumscribed regions and impairments of specific functions, including motor (Zgaljardic et al, 2003), somatosensory (Meyer et al, 2016), socio-cognitive (Gold and Shadlen, 2007; Ibáñez et al, 2010, 2016b; Couto et al, 2013; Baez et al, 2014, 2016b,c; Melloni et al, 2016), interoceptive (Couto et al, 2015; García-Cordero et al, 2016), executive (Rabinovici et al, 2015; Sedeño et al, 2016), linguistic (Ullman, 2008; Cardona et al, 2014; García and Ibáñez, 2014, 2016; Bocanegra et al, 2015; García, 2015; Melloni et al, 2015; García et al, 2016a,b,c; Abrevaya et al, 2017), and pragmatic (Kaplan et al, 1990; Stemmer, 2008) skills.…”

Depressive behavior induced by unpredictable chronic mild stress increases dentin hypersensitivity in rats

“…The frontal cortex in association with the parietal cortex, basal ganglia, thalamus and cerebellum are involved in high-level cognitive functions such as working memory, set shifting, fluency, focused attention, episodic memory retrieval, abstract thinking, tracking alternative outcomes during decision-making and planning (Rabinovici, Stephens, & Possin, 2015). Recent experiments conducted in both human patients and animal models have demonstrated that the presence of chronic pain is closely associated with significant functional and structural modifications in different cortical regions, including the amygdala, anterior cingulate cortex, hippocampus and prefrontal cortex (Kim & Kim, 2016;Lithwick, Lev, & Binshtok, 2013).…”