Neuropsychology of Executive Function

Question 1

What are executive functions?

Answer 1

Controlling mechanisms of the brain, required for goal-directed behaviour, adaptive responses to novel situations, and regulation of emotion and behaviour

Question 2

Give examples of executive functions.

Answer 2

▪️Planning
▪️Initiation
▪️Organisation
▪️Inhibition
▪️Problem solving
▪️Self monitoring
▪️Error correction
▪️Cognitive flexibility

Question 3

What are the two broad categories of clinical executive dysfunction?

Answer 3

▪️Classical ‘cognitive’ executive change
▪️Wider changes involving emotion, social cognition, and reward response

Question 4

What is the single process model of EF?

Answer 4

All EF processing occurs in the central executive

Question 5

What is the multiple process theory of EF?

Answer 5

Executive functions comprise of a number of distinct components working together

e.g., sensory perceptual systems, trigger data base, contention scheduling, supervisory attentional system)

Question 6

What is the supervisory attentional system?

Answer 6

▪️ Proposed action schemas - programmes for the execution of routine behaviours
▪️ Activated automatically in response to environment
▪️ SAS allows for inhibition of automatic responses and activation of appropriate action schema in non-routine situations

Question 7

What processes are necessary for the SAS?

Answer 7

1. Top-down control of action schemas (GDB)
2. Monitoring of behaviour
3. Specification of a memory trace required for GDB)
4. Establishment of future intentions (goal planning, PM)

Question 8

What can TBI tell us about executive dysfunction?

Answer 8

▪️ No unitary prefrontal syndrome - instead dissociable processes
▪️ Lesions remote from frontal cortex can also cause executive symptoms/failure

Question 9

According to Stuss and Alexander, what are the three systems of attentional control?

Answer 9

▪️ Superior medial (energising, initiating/sustaining)
▪️ Left lateral (task setting)
▪️ Right lateral (monitoring)

Question 10

What are the ventromedial and orbitofrontal cortices involved in?

Answer 10

Emotional and behavioural regulation

Question 11

What are the frontopolar areas associated with?

Answer 11

Integrative/meta-cognitive functioning

Question 12

What have fMRI and PET studies of EF found?

Answer 12

▪️ Activation is not specific to location nor task
▪️ Generally increases over whole PFC as any task becomes more complex

Question 13

What is the only cognitive task that is SPECIFIC to dominant frontal lobe function?

Answer 13

Phonemic fluency

Question 14

What are the main principles to considering when assessing EF?

Answer 14

▪️ Not exclusively frontal lobe function
▪️ Wide heterogeneity of prefrontal areas implicated in different tasks that can change with subtle manipulation
▪️ Frontal lobes mainly about the self
▪️ Multiple processes involved, more dissociation than association
▪️ No problem with test does not mean no problem at all

Question 15

What is Struss et al’s three-factor model of executive tasks/skills?

Answer 15

1. Energisation (process of initiation or sustaining responses, e.g., apathy)
2. Task setting (e.g., planning, organising, learning new task)
3. Monitoring (e.g., checking, staying on task)

Question 16

What does the controlled oral word association test/phonemic fluency task assess?

Answer 16

Initiation and perseveration

Question 17

What is the modified six elements task of the BADS?

Answer 17

▪️ Test of multi-tasking and time organisation
▪️ 10 mins to complete some of 6 tasks
▪️ 2 dictations tasks, 2 arithmetic, 2 picture-naming (A and B)
▪️ Cannot do parts A and B together

Question 18

What is the Action Programme subtest of the BADS and what does it assess?

Answer 18

▪️ Get the cork out the tube with the water
▪️ Problem-solving

Question 19

What might influence performance on neuropsychological assessment?

Answer 19

▪️ Language
▪️ Culture
▪️ Socioeconomic status through education, occupation, segregation, exposure to violence

Question 20

What are the main limitations of standard tests in detecting executive and social cognitive problems?

Answer 20

▪️ May not detect change in premorbidly high-functioning individuals
▪️ Doesn’t mimic stress of everyday life
▪️ More sensitive to DLPFC deficits than OFC
▪️ Social cognitive deficits may dissociate from classical executive skills

Question 21

What supplementary information can you use to assess social cognitive deficits?

Answer 21

▪️ Informant report
▪️ Informant standardised measures (e.g., DEX-R, BADS)
▪️ Social cognitive tasks (e.g., reading mind in eyes)
▪️ Experimental tasks (e.g., IGT, CGT)
▪️ Structured behavioural assessment schedules (e.g., multiple errands)

Question 22

What are the three main social cognitive skills?

Answer 22

▪️ Theory of mind
▪️ Emotion recognition
▪️ Judging/modifying social behaviour with change in context (faux pas tests)

Question 23

What is the social situations task?

Answer 23

▪️ 20 vignettes of social situations
▪️ Rate 1 or 2 behaviours in context of each vignette (from fairly normal to shocking behaviour)

Question 24

What can the Iowa gamble task and Cambridge gamble task be used for?

Answer 24

▪️ Assess decision-making under ambiguity and risk and reward-based cognition
▪️ Particularly sensitive to VMPFC/OFC dysfunction in presence of intact performance on executive tasks in substance misuse, MS, and bipolar

Question 25

What is EMOTICOM?

Answer 25

A battery of tests developed to evaluate emotion, reward/motivation, impulsivity, and social cognition

Useful to measure treatment-related change across these domains that may affect QoL, carer burden, and distress

Question 26

How might the frontal paradox be evident in the multiple errands task?

Answer 26

Very deficient performance in those with frontal lobe damage despite intact performance on pencil-paper executive tasks