DOCSLIB.ORG

Treating Executive Dysfunction to Improve Insight in Psychiatric

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Treating Executive Dysfunction to Improve Insight in Psychiatric Archives of Neurology and Neuro Disorders ISSN: 2638-504X Volume 1, Issue 2, 2018, PP: 27-30 Treating Executive Dysfunction to Improve Insight in Psychiatric Disorders Prajjita Sarma Bardoloi, MBBS, FRCPC Department of Psychiatry, Queen Elizabeth II Hospital, Grande Prairie, Alberta, Canada. [email protected] *Corresponding Author: Prajjita Sarma Bardoloi, Department of Psychiatry, Queen Elizabeth II Hospital, Grande Prairie, Alberta, Canada. Abstract Executive dysfunction is not a primary psychiatric diagnosis in DSM 5, but it plays an important role in insight. This in turn determines treatment adherence, relapse prevention and functional improvement. This article shades light into importance of addressing executive dysfunction in treating acute mental illness, in order to improve overall outcome. Introduction Th ive functioning and many researchers have described Executive Function (EF) is an umbrella term that ere is no consensus definition of execut encompasses a cluster of very important cognitive overall, included similar functions. functions needed for an individual to survive in today’s these complex functions in their own definitions but critical world. The expression “Executive Function” Components of executive function became a favored title to describe those functions, because of the complexity and their roles in a person’s various researchers which include: life e.g. to guide him /her in making everyday decisions, Several components of EF have been identified by Working Memory to have goal directed activities, planning & organizing, to be able to adapt to the changes of environment, • Response Inhibition inhibit impulses and to be socially appropriate (1,4). • Set shifting Executive dysfunction is often used synonymously • Initiation frontal network syndrome. • Anticipation with frontal lobe deficits, prefrontal syndrome or The study of the functions of the brain , specially • Attention the frontal lobes, attained more attention after the • Planning & organizing famous railroad accident case of Phineas Gage in 1848, where, Mr. Gage, a young 25 year old healthy • Fluency male had a penetrating brain injury from a blast. An • Monitoring self or metacognition iron road entered through his left cheek, frontal lobe Goal directed activities and exited through his skull. He completely recovered • physically following his injuries but was left with •Working Memory serious behavioral changes. Lauria in 1966, used the Is short term memory, where an individual uses term “Frontal lobe syndrome” to describe similar cognitive function to retain information for a short symptom executive dysfunction, that was caused by period of time in order to prepare for the next step of decision making, planning and organizing. People used by Baddeley in 1986, to describe this array of functionsfrontal lobe (4). deficit. The term “Executive” was first attention, decision making, planning and organizing. with working memory problems have difficulty with Archives of Neurology and Neuro Disorders V1 . I2 . 2018 27 Treating Executive Dysfunction to Improve Insight in Psychiatric Disorders Response Inhibition Monitoring Self or Metacognition Is the ability to hold back on responding inappropriately Is the ability to monitor one’s own action or behavior, or impulsively based on previously learned responses, ability to compare and judge whether or not it is which may not be appropriate at the present scenario. appropriate to the situation or the circumstances. Goal Directed Activities becomePeople with easily difficulty distracted with and response impulsive.Patients inhibition havemay The ability to initiate and sustain one’s activities as exhibitdifficulty utilization ignoring behaviorsunnecessary (picking external up objectsstimuli withand planned and organized. Again this too needs intact no clear intent), echolalia and echopraxia. (4) other functions like working memory, attention, Set Shifting or Flexibility response inhibition, planning, organizing etc. Is the ability to change one’s action and behavior Psychiatric Disorders and Executive depending on the changes of the environment or Dysfunction Executive dysfunction is found in many psychiatric result in rigidity and perseveration. People with disorders. The neurodevelopmental disorders like circumstances. Deficit in this cognitive function would Autism, ADHD, Schizophrenia, Mood disorders, both and socialization. depression and Bipolar disorder, neurocognitive problem with flexibility find difficulty in relationships Initiation disorders, Personality disorders like borderline and antisocial personality disorders are associated with Is an important cognitive function for an individual to executive dysfunction (3). lack motivation to start a planned task. It is often found Neurobiology of Executive Function tothrive be associated in his or her with life. traumatic Persons withbrain initiation injury. deficits Executive functions are delivered like a highly Anticipation synchronized orchestra with their conductor Is the ability to predict an outcome based on previous prefrontal cortex along with areas through their experience and the circumstances. Humans have highly developed network system. The brain areas some innate abilities to predict time, place, space, responsible for EF are the prefrontal cortex, parietal comparability, causality and based on those abilities cortex, basal ganglia, thalamus and cerebellum and the they are able to anticipate a probability. This is an networks between these areas are crucial for proper important cognitive function for decision making EF. (1,5). In order for the executive functions to be and impairment of this ability would cause impaired delivered properly, the prefrontal cortex continuously decision making. monitors and controls other cortical and subcortical areas (6). The controlling of the other areas is done Attention by “Top down mechanism” by which the PFC sends is the ability to ignore the unwanted external and inhibitory signals to the subcortical areas to control internal stimuli and to covert unwanted thoughts. It is their activities. These Top down mechanism of integral to working memory functioning. functioning of PFC has been demonstrated by various Planning & Organizing studies including Trans cranial magnetic imaging studies and fMRI studies (6). By top down action PFC are the higher order cognitive functions where is able to down regulate the overactive limbic system, an individual has to have good working memory, so called emotional brain, and by this it controls an anticipation and initiation to put the gathered individual’s emotional overreaction. information into a blueprint to act on. So, we can actually call it a secondary or tertiary level of executive The executive functions develop parallel to the functioning. myelination and synapse formation in the frontal lobes. Executive functions are vulnerable to white Fluency matter injury and disturbances in cholinergic, Is the ability to maximize the production of responses noradrenergic, serotonergic and dopaminergic neurotransmitter systems in the brain (4). within28 a specific time period. Archives of Neurology and Neuro Disorders V1 . I2 . 2018 Treating Executive Dysfunction to Improve Insight in Psychiatric Disorders Dr. Arnsten and colleagues at Yale University have lesion. Amador argued that lack of insight causes been researching the role of PFC in various cognitive inability to self-monitor and self-correct leading to functions and it’s molecular biology. The dorsal and lateral PFC networks regulates the attention, thought with schizophrenia have poor insight as well as and action whereas, the ventral and medial PFC deficit in awareness (Lack of metacognition). People networks are associated with emotion regulation and regulation of the physiological state. The abstract beencognitive inconsistent. difficulties. Several studies were done to find relationship of insight and EF, but results have thinking is operated by more rostral part of the PFC. The Neurobiology of Insight PFC which is a part of the neocortex is composed of six layers of neurons, which are minutely interconnected Studies of neurobiology of insight using fMRI studies to form complex neural networks (2). Dr. Patricia Goldman-Rekic from Yale University, a pioneer of PFC lack of insight and executive dysfunction, which have found specific common areas involved in both research found that the layer III of the PFC expands are PFC, basal ganglia, parietal cortex and limbic most during primate evolution and is associated with areas (9). neuropil loss in schizophrenia. Another important Improving Executive Function to Improve discovery was that Dopamine (DA) inputs in PFC have Insight in Acutely Ill Psychiatric Patients memory which can be impaired in schizophrenia as a If we consider insight as a cognitive process and resultmodulatory of impaired effects DA on secretion dorsolateral (7). PFC and working that it shares commonalities with executive function e.g. metacognition, then hypothetically, if we Besides DA, Norepinephrine (NE) is also found to be improve executive functioning by improving the PFC equally important for PFC functioning. NE works via functioning, we will also be able to improve insight. Although it may not be as simple as it sounds. Referring to studies done by imminent researchers like Dr. postsynapticInsight ∝2A adrenoceptor stimulation (7). Goldman- Rekik and Dr. Arnsten, who emphasized Insight is a multidimensional construct which is associated with treatment adherence, global stimulation
Load more

Recommended publications
  • Cognitivebehavioral Therapy for Adults with ADHD (WWK
    4/12/2015 Cognitive-Behavioral Therapy for Adults with ADHD (WWK 21) Print Document Close Window Cognitive­Behavioral Therapy for Adults with ADHD (WWK 21) Can't find what you're looking for? Our health information specialists are here to help. Contact us at 800­233­ 4050 or online. WWK refers to the What We Know series of information sheets on ADHD. See the complete list. See the PDF version of this sheet. There is much interest in ­ but also apparently much confusion about ­ the nature of cognitive­behavioral therapy (CBT) and the way it can be used to help adults with ADHD. Cognitive­behavioral therapy refers to a type of mental health treatment in which the focus is on the thoughts and behaviors that occur "in the here and now." This approach is quite different from traditional forms of psychoanalytic or psychodynamic therapy which involve recapturing and reprocessing the childhood experiences that are understood to have given rise to current emotional problems. A difference of CBT over these earlier therapies is that its goals and methods are quite explicit. As such, it lends itself more readily to measuring whether or not desired goals have been achieved. Origins and Early Uses of CBT CBT originated in a melding of "cognitive therapy," developed in the 1960's by Aaron Beck and popularized by Albert Ellis, and "behavior therapy," developed by B.F. Skinner, Joseph Volpe and others. Beck and Ellis postulated that we all have "automatic thoughts" that occur immediately in response to an event, situation, or other stimulus. These thoughts (or "cognitions") may be helpful ­ that is, they lead to positive feelings and effective coping ­ or they may be negative, in that they lead to feelings of depression or anxiety and maladaptive behavior.
    [Show full text]
  • Executive Functions in Children with Autism Spectrum Disorders
    Brain and Cognition 71 (2009) 362–368 Contents lists available at ScienceDirect Brain and Cognition journal homepage: www.elsevier.com/locate/b&c Executive functions in children with Autism Spectrum Disorders Sally Robinson a,*, Lorna Goddard b, Barbara Dritschel c, Mary Wisley c, Pat Howlin a a Department of Psychology, Institute of Psychiatry, London SE5 8AF, United Kingdom b Department of Psychology, Goldsmiths University of London, London SE14 6NW, United Kingdom c Department of Psychology, University of St. Andrews, Fife KY16 9AJ, United Kingdom article info abstract Article history: Executive dysfunction is a characteristic impairment of individuals with Autism Spectrum Disorders Accepted 24 June 2009 (ASD). However whether such deficits are related to autism per se, or to associated intellectual disability Available online 22 July 2009 is unclear. This paper examines executive functions in a group of children with ASD (N = 54, all IQP70) in relation to a typically developing control group individually matched on the basis of age, gender, IQ and Keywords: vocabulary. Significant impairments in the inhibition of prepotent responses (Stroop, Junior Hayling Test) Autism and planning (Tower of London) were reported for children with ASD, with preserved performance for Asperger syndrome mental flexibility (Wisconsin Card Sorting Task) and generativity (Verbal Fluency). Atypical age-related Autistic spectrum disorder patterns of performance were reported on tasks tapping response inhibition and self-monitoring for chil- Executive functions Development dren with ASD compared to controls. The disparity between these and previous research findings are dis- Children cussed. A multidimensional notion of executive functions is proposed, with difficulties in planning, the Mental flexibility inhibition of prepotent responses and self-monitoring reflecting characteristic features of ASD that are Planning independent of IQ and verbal ability, and relatively stable across the childhood years.
    [Show full text]
  • 15 EXECUTIVE FUNCTIONS Rochette Et Al., 2007)
    functional deficits lead to restrictions in home, work, and but overlapping disciplines, including neurorehabilitation, community activities, even if by clinical assessment the cognitive psychology, and cognitive neuroscience (Elliot, deficits are considered "mild" (Pohjasvaara et al., 2002; 2003). Rather than exhaustively review the decades of 15 EXECUTIVE FUNCTIONS Rochette et al., 2007). The cognitive deficits associated research pertinent to executive functions, including the with stroke vary in type and severity from individual to large bodies of research carried out on working memory individual, based on site and lesion(s) location, but Zinn, and attention, we decided to use this chapter as an oppor­ SUSAN M. FITZPATRICK and CAROLYN M. BAUM Bosworth, Hoenig, and Swartzwelder (2007) found that tunity to explore how the concept "executive function" is nearly 50% of individuals show deficits in executive func­ used by different disciplines, in what ways the uses of the tion. We suspect this number underestimates the true inci­ concept are similar or difrerent, and the opportunities dence of high-level cognitive difficulties. and challenges to be met when integrating findings from The Cognitive Rehabilitation Research Group (CRRG) across the disciplines to yield a coherent understanding at at Washington University in St. Louis maintains a large the neural, cognitive, and behavioral/performance levels, database of information regarding stroke patients admit­ so that research findings can be used to inform clinical ted to Barnes-Jewish Hospital. As of December 2009, the practice aimed at ameliorating executive dysfunction. It is CRRG research team had classified 9000 patients hospi­ our goal to identify the language and knowledge gaps that talized for stroke.
    [Show full text]
  • Executive Dysfunction Or State Regulation
    Louisiana State University LSU Digital Commons LSU Doctoral Dissertations Graduate School 8-17-2017 Executive Dysfunction or State Regulation: A Dimensional Comparison of Two Neuropsychological Theories of Attention Disorder Symptoms Using RDoC Paradigms Justin Hull Ory Louisiana State University and Agricultural and Mechanical College, [email protected] Follow this and additional works at: https://digitalcommons.lsu.edu/gradschool_dissertations Part of the Clinical Psychology Commons Recommended Citation Ory, Justin Hull, "Executive Dysfunction or State Regulation: A Dimensional Comparison of Two Neuropsychological Theories of Attention Disorder Symptoms Using RDoC Paradigms" (2017). LSU Doctoral Dissertations. 4094. https://digitalcommons.lsu.edu/gradschool_dissertations/4094 This Dissertation is brought to you for free and open access by the Graduate School at LSU Digital Commons. It has been accepted for inclusion in LSU Doctoral Dissertations by an authorized graduate school editor of LSU Digital Commons. For more information, please [email protected]. EXECUTIVE DYSFUNCTION OR STATE REGULATION: A DIMENSIONAL COMPARISON OF TWO NEUROPSYCHOLOGICAL THEORIES OF ATTENTION DISORDER SYMPTOMS USING RDOC PARADIGMS A Dissertation Submitted to the Graduate Faculty of the Louisiana State University and Agricultural and Mechanical College in partial fulfillment of the requirements for the degree of Doctor of Philosophy in The Department of Psychology by Justin Hull Ory B.A., Southeastern Louisiana University, 2005 M.A., Southeastern Louisiana University, 2008 December 2017 ACKNOWLEDGMENTS I thank my dissertation chair, Wm. Drew Gouvier, for critiquing the manuscript and offering his technical and moral support as I conducted my research. I also thank the members of my dissertation committee, Alex Cohen, Mike Hawkins, and Paolo Chirumbolo, for their patience as I stumbled through learning the skills necessary to complete this project.
    [Show full text]
  • Assessing Auditory Processing Endophenotypes Associated with Schizophrenia in Individuals with 22Q11.2 Deletion Syndrome Ana A
    Francisco et al. Translational Psychiatry (2020) 10:85 https://doi.org/10.1038/s41398-020-0764-3 Translational Psychiatry ARTICLE Open Access Assessing auditory processing endophenotypes associated with Schizophrenia in individuals with 22q11.2 deletion syndrome Ana A. Francisco 1,2,JohnJ.Foxe 1,2,3,DouweJ.Horsthuis1, Danielle DeMaio1 and Sophie Molholm1,2,3 Abstract 22q11.2 Deletion Syndrome (22q11.2DS) is the strongest known molecular risk factor for schizophrenia. Brain responses to auditory stimuli have been studied extensively in schizophrenia and described as potential biomarkers of vulnerability to psychosis. We sought to understand whether these responses might aid in differentiating individuals with 22q11.2DS as a function of psychotic symptoms, and ultimately serve as signals of risk for schizophrenia. A duration oddball paradigm and high-density electrophysiology were used to test auditory processing in 26 individuals with 22q11.2DS (13–35 years old, 17 females) with varying degrees of psychotic symptomatology and in 26 age- and sex-matched neurotypical controls (NT). Presentation rate varied across three levels, to examine the effect of increasing demands on memory and the integrity of sensory adaptation. We tested whether N1 and mismatch negativity (MMN), typically reduced in schizophrenia, related to clinical/cognitive measures, and how they were affected by presentation rate. N1 adaptation effects interacted with psychotic symptomatology: Compared to an NT group, individuals with 22q11.2DS but no psychotic symptomatology presented larger adaptation effects, whereas those with psychotic symptomatology presented smaller effects. In contrast, individuals with 22q11.2DS showed increased effects of presentation rate on MMN amplitude, regardless of the presence of symptoms.
    [Show full text]
  • THE CLINICAL ASSESSMENT of the PATIENT with EARLY DEMENTIA S Cooper, J D W Greene V15
    J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.2005.081133 on 16 November 2005. Downloaded from THE CLINICAL ASSESSMENT OF THE PATIENT WITH EARLY DEMENTIA S Cooper, J D W Greene v15 J Neurol Neurosurg Psychiatry 2005;76(Suppl V):v15–v24. doi: 10.1136/jnnp.2005.081133 ementia is a clinical state characterised by a loss of function in at least two cognitive domains. When making a diagnosis of dementia, features to look for include memory Dimpairment and at least one of the following: aphasia, apraxia, agnosia and/or disturbances in executive functioning. To be significant the impairments should be severe enough to cause problems with social and occupational functioning and the decline must have occurred from a previously higher level. It is important to exclude delirium when considering such a diagnosis. When approaching the patient with a possible dementia, taking a careful history is paramount. Clues to the nature and aetiology of the disorder are often found following careful consultation with the patient and carer. A focused cognitive and physical examination is useful and the presence of specific features may aid in diagnosis. Certain investigations are mandatory and additional tests are recommended if the history and examination indicate particular aetiologies. It is useful when assessing a patient with cognitive impairment in the clinic to consider the following straightforward questions: c Is the patient demented? c If so, does the loss of function conform to a characteristic pattern? c Does the pattern of dementia conform to a particular pattern? c What is the likely disease process responsible for the dementia? An understanding of cognitive function and its anatomical correlates is necessary in order to ascertain which brain areas are affected.
    [Show full text]
  • View / Open Oswald Oregon 0171A 10511.Pdf
    RELATIONS AMONG THEORY OF MIND AND EXECUTIVE FUNCTION ABILITIES IN TYPICALLY DEVELOPING ADOLESCENTS AND ADOLESCENTS WITH ASPERGER’S SYNDROME AND HIGH FUNCTIONING AUTISM by TASHA MIRAJA OSWALD A DISSERTATION Presented to the Department of Psychology and the Graduate School of the University of Oregon in partial fulfillment of the requirements for the degree of Doctor of Philosophy September 2012 DISSERTATION APPROVAL PAGE Student: Tasha Miraja Oswald Title: Relations Among Theory of Mind and Executive Function Abilities in Typically Developing Adolescents and Adolescents with Asperger’s Syndrome and High Functioning Autism This dissertation has been accepted and approved in partial fulfillment of the requirements for the Doctor of Philosophy degree in the Department of Psychology by: Louis Moses Chairperson Jennifer Pfeifer Member Edward Vogel Member Laura Lee McIntyre Outside Member and Kimberly Andrews Espy Vice President for Research & Innovation/Dean of the Graduate School Original approval signatures are on file with the University of Oregon Graduate School. Degree awarded September 2012 ii © 2012 Tasha Miraja Oswald This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs (United States) License. iii DISSERTATION ABSTRACT Tasha Miraja Oswald Doctor of Philosophy Department of Psychology September 2012 Title: Relations Among Theory of Mind and Executive Function Abilities in Typically Developing Adolescents and Adolescents with Asperger’s Syndrome and High Functioning Autism The aim of the current study was to bring greater clarity to our understanding of the relation between theory of mind (ToM) and executive function (EF), specifically working memory (WM) and inhibitory control (IC), during typical adolescent development and of the specific nature of impairments in ToM and EF in the cognitive profile of individuals with Asperger’s Syndrome and High Functioning Autism (AS/HFA).
    [Show full text]
  • The Three Amnesias
    The Three Amnesias Russell M. Bauer, Ph.D. Department of Clinical and Health Psychology College of Public Health and Health Professions Evelyn F. and William L. McKnight Brain Institute University of Florida PO Box 100165 HSC Gainesville, FL 32610-0165 USA Bauer, R.M. (in press). The Three Amnesias. In J. Morgan and J.E. Ricker (Eds.), Textbook of Clinical Neuropsychology. Philadelphia: Taylor & Francis/Psychology Press. The Three Amnesias - 2 During the past five decades, our understanding of memory and its disorders has increased dramatically. In 1950, very little was known about the localization of brain lesions causing amnesia. Despite a few clues in earlier literature, it came as a complete surprise in the early 1950’s that bilateral medial temporal resection caused amnesia. The importance of the thalamus in memory was hardly suspected until the 1970’s and the basal forebrain was an area virtually unknown to clinicians before the 1980’s. An animal model of the amnesic syndrome was not developed until the 1970’s. The famous case of Henry M. (H.M.), published by Scoville and Milner (1957), marked the beginning of what has been called the “golden age of memory”. Since that time, experimental analyses of amnesic patients, coupled with meticulous clinical description, pathological analysis, and, more recently, structural and functional imaging, has led to a clearer understanding of the nature and characteristics of the human amnesic syndrome. The amnesic syndrome does not affect all kinds of memory, and, conversely, memory disordered patients without full-blown amnesia (e.g., patients with frontal lesions) may have impairment in those cognitive processes that normally support remembering.
    [Show full text]
  • Pragmatic and Executive Dysfunction in Schizophrenia
    Journal of Neurolinguistics 23 (2010) 285–296 Contents lists available at ScienceDirect Journal of Neurolinguistics journal homepage: www.elsevier.com/locate/ jneuroling Pragmatic and executive dysfunction in schizophrenia Maud Champagne-Lavau a,c,*, Emmanuel Stip b,c a Hoˆpital du Sacre´-Cœur de Montre´al, Pavillon Albert-Pre´vost, Montreal, Canada b Centre de recherche Fernand-Seguin, Hoˆpital Louis-H. Lafontaine, Montreal, Canada c Psychiatry Department, University of Montreal, Montreal, Canada article info abstract Article history: Many studies have reported that patients with schizophrenia (SZ) Received 6 January 2009 can be impaired in their pragmatic abilities, typically affecting the Received in revised form 23 August 2009 processing of non-literal speech acts (e.g., metaphors, indirect Accepted 25 August 2009 requests). Various hypotheses have been proposed to account for impairments in understanding non-literal language, such as Keywords: executive dysfunction or problems attributing mental states to Pragmatic others; the latter is referred to as theory of mind (ToM) abilities. Non-literal language Executive function The aim of this study was to explore whether pragmatic deficits do Theory of mind or do not coexist with ToM impairments and/or impairments of Schizophrenia executive functions in schizophrenia. Twenty SZ patients and twenty matched healthy control (HC) participants – all right- handed and native French-speakers – were tested individually for three abilities: (a) pragmatic, (b) ToM (original first- and second- order mental state attribution tasks) and (c) executive functions. The main results showed that SZ patients exhibit pragmatic impairments which co-occurred with an executive dysfunction such as a lack of flexibility and a ToM deficit.
    [Show full text]
  • Frontal-Executive Dysfunction Affects Dementia Conversion in Patients
    www.nature.com/scientificreports OPEN Frontal-executive dysfunction afects dementia conversion in patients with amnestic mild cognitive impairment Young Hee Jung1,2,3, Seongbeom Park2,3,4, Hyemin Jang 2,3,4, Soo Hyun Cho2,3,8, Seung Joo Kim2,3,9, Jun Pyo Kim2,3,4, Sung Tae Kim10, Duk L. Na2,3,4,5,6,7, Sang Won Seo2,3,4,7 & Hee Jin Kim2,3,4* Among mild cognitive impairment (MCI) patients, those with memory impairment (amnestic MCI, aMCI) are at a high risk of dementia. However, the precise cognitive domain, beside memory, that predicts dementia conversion is unclear. Therefore, we investigated the cognitive domain that predicts dementia conversion in a longitudinal aMCI cohort. We collected data of 482 aMCI patients who underwent neuropsychological tests and magnetic resonance imaging at baseline and were followed for at least 1 year. The patients were categorized according to number (1–4) and type of impaired cognitive domains (memory, language, visuospatial, and frontal-executive function). We evaluated dementia conversion risk in each group when compared to single-domain aMCI after controlling for age, education, diabetes and dyslipidemia. Baseline cortical thickness of each group was compared to that of 410 cognitively normal controls (NCs) after controlling for age, intracranial volume, diabetes and dyslipidemia. Compared to single-domain aMCI, aMCI patients with frontal-executive dysfunction at baseline had a higher risk of dementia conversion than aMCI patients with visuospatial or language dysfunction. Compared to NCs, aMCI patients with frontal-executive dysfunction had overall cortical thinning including frontal areas. Our fndings suggest that aMCI patients with frontal-executive dysfunction have poor prognosis and,thus, should be considered for intervention therapy with a higher priority among aMCI patients.
    [Show full text]
  • Type and Severity of Cognitive Decline in Older Adults After Noncardiac Surgery Catherine C
    Ⅵ CLINICAL INVESTIGATIONS Anesthesiology 2008; 108:8–17 Copyright © 2007, the American Society of Anesthesiologists, Inc. Lippincott Williams & Wilkins, Inc. Type and Severity of Cognitive Decline in Older Adults after Noncardiac Surgery Catherine C. Price, Ph.D.,* Cynthia W. Garvan, Ph.D.,† Terri G. Monk, M.D., M.S.‡ Background: The authors investigated type and severity of onstrate that individuals 60 yr or older are at increased cognitive decline in older adults immediately and 3 months risk for developing cognitive impairment after major, after noncardiac surgery. Changes in instrumental activities of noncardiac surgery. To date, however, little is known daily living were examined relative to type of cognitive decline. Methods: Of the initial 417 older adults enrolled in the study, about the type of cognitive change experienced by this 337 surgery patients and 60 controls completed baseline, dis- population group. Within the disciplines of behavioral charge, and/or 3-month postoperative cognitive and instru- neurology and neuropsychology, brain function is typi- mental activities of daily living measures. Reliable change meth- cally subdivided into domains or systems.3 For example, ods were used to examine three types of cognitive decline: our capacity for learning and remembering is an essential memory, executive function, and combined executive function/ memory. SD cutoffs were used to grade severity of change as brain function (i.e., represents the memory domain). mild, moderate or severe. Another critical function is our ability to efficiently pro- Results: At discharge, 186 (56%) patients experienced cogni- cess information, concentrate, and self-monitor (i.e., ex- tive decline, with an equal distribution in type and severity.
    [Show full text]
  • Brief Evaluation of Executive Dysfunction: an Essential Refinement in the Assessment of Cognitive Impairment By: Gary J
    dementia series Best Practices in Nursing Care to Older Adults with dementia From The Hartford Institute for Geriatric Nursing, New York University Rory Meyers College of Nursing, and the Alzheimer’s Association Issue Number D3, Revised 2018 Editor-in-Chief: Sherry A. Greenberg, PhD, RN, GNP-BC Managing Editor: Robin Coyne, MSN, RN, AGACNP-BC New York University Rory Meyers College of Nursing Brief Evaluation of Executive Dysfunction: An Essential Refinement in the Assessment of Cognitive Impairment By: Gary J. Kennedy, MD, and Suhey Franco Cadet, MD, Division of Geriatric Psychiatry, Albert Einstein College of Medicine, Montefiore Medical Center WHY: In the familiar environment and daily routine of the older adult’s home life, slowly progressive subtle cognitive changes may not be apparent. Such changes, however, often become obvious in the disorienting setting of the hospital provoking family members to report “my mother was never like this at home.” Even when delirium has cleared with resolution of the acute event, unrecognized cognitive impairment can jeopardize safe return to the community. This Try This:® recommends assessing executive function for older patients not thought to have dementia prior to hospitalization, but where the patient, family or staff feel the patient has not returned to baseline cognitive status at the time of discharge. Particularly when the older patient is alert, and verbal and memory is not obviously impaired, screening for executive dysfunction can be critical to a safe, realistic treatment and discharge plan. Patients who exhibit executive dysfunction should be referred to their primary care provider, or to a provider with expertise in dementia assessment.
    [Show full text]