ABSTRACT
Executive function disorders arise from damage to brain areas mediating complex aspects of human behavior, including self-regulation, social cognition, planning, and organization. These functions are especially necessary to everyday adaptation, independence, and productivity. Executive function disorders have multiple causes and are expressed through different patterns of cognitive, emotional, social, and behavioral impairment. Treatment approaches target specific symptoms, especially in attention, working memory, problem solving, social cognition, and self-control of behavior and emotions. Interventions draw upon behavioral training, compensatory processing techniques, self-awareness and metacognitive training, environmental aids, and medications along with family/caregiver education. The evidence base for identifying effective treatments is promising but remains limited with a need to broaden the focus on real world functional outcomes.
Subject(s)
Cognition Disorders/rehabilitation , Cognitive Behavioral Therapy/methods , Executive Function/physiology , Adaptation, Psychological , Humans , Neuropsychological TestsABSTRACT
BACKGROUND: Amyotrophic lateral sclerosis (ALS) is a multisystem disorder in which frontotemporal dysfunction without overt dementia is relatively common. Accordingly, there is need for a valid, brief, motor-free cognitive examination conducive to the ALS Clinic. OBJECTIVE: To validate a brief examination against a comprehensive neuropsychological battery to determine its sensitivity in identifying deficits in judgment and problem solving. We enrolled 13 individuals with intact brief examinations, 25 individuals with 1 or more impaired brief examination measures, and 18 healthy volunteers. Cognitive brief examination measures were classified into factors based on Guilford's Structure of Intellect theory. Cognitive anosognosia ratios were calculated to examine the degree of "unawareness of cognitive deficit." RESULTS: Statistically significant correlations were evidenced for each brief examination and comprehensive examination measure categorized by the same Guilford factor. In comparison to healthy controls, insight to level of cognitive abilities was significantly compromised for cognitively impaired ALS patients, with respect to their ratings of their responses to comprehension tasks assessing convergent and divergent production. CONCLUSIONS: Brief examination measures of verbal fluency and problem solving may serve as sensitive indicators of emerging difficulties in ALS patients with frontotemporal dysfunction. The prevalence of cognitive anosognosia warrants further attention because of its impact on treatment compliance, safety and quality of life for ALS patients with frontotemporal dysfunction.
Subject(s)
Amyotrophic Lateral Sclerosis/psychology , Awareness , Cognition Disorders/diagnosis , Frontotemporal Lobar Degeneration/diagnosis , Self Concept , Aged , Agnosia/complications , Agnosia/diagnosis , Agnosia/psychology , Amyotrophic Lateral Sclerosis/complications , Amyotrophic Lateral Sclerosis/pathology , Case-Control Studies , Cognition Disorders/etiology , Cognition Disorders/psychology , Diagnostic Self Evaluation , Female , Frontal Lobe/pathology , Frontotemporal Lobar Degeneration/complications , Frontotemporal Lobar Degeneration/psychology , Humans , Male , Middle Aged , Neuropsychological Tests , Problem Solving , Reference Values , Temporal Lobe/pathology , Time FactorsABSTRACT
The neuropsychological bases of cognitive, social, and moral development are minimally understood, with a seemingly wide chasm between developmental theories and brain maturation models. As one approach to bridging ideas in these areas, we review 10 cases of early prefrontal cortex damage from the clinical literature, highlighting overall clinical profiles and real life developmental outcomes. Based on these cases, there is preliminary evidence to support distinctive developmental differences after: (1) dorsolateral, (2) mesial, and (3) orbital-polar prefrontal lesions, for more profound impairments after bilateral damage, and possibly for recovery differences after very early vs. later childhood lesion onset. Further case and group studies are needed to confirm reliable effects of specific lesion locations, the influence of age of lesion onset, and related experiential and treatment variables in determining adult outcomes. Rather than a single underlying deficit associated with early prefrontal cortex damage, we interpret the findings to suggest that it is the altered integration and interplay of cognitive, emotional, self-regulatory, and executive/metacognitive deficits that contribute to diverse developmental frontal lobe syndromes. The findings support the fundamental importance of prefrontal cortex maturation in protracted cognitive, social-emotional, and moral development.
