Executive functions and speed of mental processing in elderly patients with frontal or nonfrontal ischemic stroke.

Unit of Neuropsychology, Department of Clinical Neuroscience, University of Helsinki, Helsinki, Sweden.
European Journal of Neurology (Impact Factor: 4.06). 12/1999; 6(6):653-61.
Source: PubMed


Impairments in executive functions have been related to aging and frontal lobe lesions. Aging also causes slowing of mental processing. We examined whether ischemic stroke in the frontal brain area results in dysexecutive syndrome, or whether the frontal stroke causes increased slowing of mental processing. Neurological, radiological and neuropsychological examinations were carried out 3 months post-stroke on 250 ischemic stroke patients (55-85 years) and on 39 healthy control subjects. Of the patients, 62 had frontal and 188 had nonfrontal lesions. The neuropsychological examination comprised several cognitive domains, including tests considered to measure executive functions. The frontal group was slower than the nonfrontal group in tasks measuring speed of mental processing which were time-limited (Trail Making A, Stroop dots and fluency). They were also inferior in the Digit Span backwards task. There were no differences between the groups in other cognitive domains, nor in some tests which are considered to be measures of executive functions (e.g. WCST). Impairments in executive functions were evident in both the frontal and the nonfrontal groups compared with the controls, but no dysexecutive syndrome specifically related to frontal lesions was found. Frontal stroke related mainly to the slowing of mental processing.

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    • "It is also important to note that, unlike most prior studies of executive abilities in patients with stroke, patients in our study were assessed within 72 hours of hospital admission. In contrast, the patients studied by Leskelä et al. [15], for example, were assessed approximately 3.4 months following the occurrence of stroke. Nevertheless, our findings are consistent with theirs and extend these results to the Digit Span test. "
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    ABSTRACT: The Trail Making Test and Digit Span are neuropsychological tests widely used to assess executive abilities following stroke. The Trails B and Digits Backward conditions of these tests are thought to be more sensitive to executive impairment related to frontal lobe dysfunction than the Trails A and Digits Forward conditions. Trails B and Digits Backward are also thought to be more sensitive to brain damage in general. Data from the Stroke and Lesion Registry maintained by the Washington University Cognitive Rehabilitation Research Group were analyzed to compare the effects of frontal versus nonfrontal strokes and to assess the effects of stroke severity. Results showed that the performance of patients with frontal and nonfrontal strokes was comparable in each condition of both the Trail Making Test and Digit Span, providing no support for the widely held belief that Trails B and Digits Backward are more sensitive to frontal lobe damage. Further, Trails A was as strongly correlated with stroke severity as Trails B, whereas Digits Backward was more strongly correlated with stroke severity than Digits Forward. Overall, the Trail Making Test and Digit Span are sensitive to brain damage but do not differentiate between patients with frontal versus nonfrontal stroke.
    Behavioural neurology 01/2011; 24(3):177-85. DOI:10.3233/BEN-2011-0328 · 1.45 Impact Factor
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    • "Although there have been reports of left frontal damage affecting WCST performance more than right frontal damage (Goldstein et al., 2004), others report no difference in laterality of damage in the frontal cortex (Demakis, 2003; Giovagnoli, 2001). Moreover, many clinical studies show that damage in non-frontal (Leskela et al., 1999; van den Broek, Bradshaw, & Szabadi, 1993) or diffuse damage in frontal and non-frontal regions (Anderson, Damasio, Jones, & Tranel, 1991; Axelrod et al., 1996) both affect WCST performance. More specifically , many authors have reported that damage to temporal (Corcoran & Upton, 1993; Giovagnoli, 2001; Hermann, Wyler, & Richey, 1988; Horner, Flashman, Freides, Epstein, & Bakay, 1996; Strauss, Hunter, & Wada, 1993), subcortical (Mukhopadhyay et al., 2008), hippocampal (Corcoran & Upton, 1993; Giovagnoli, 2001; Igarashi et al., 2002), and even cerebellar regions (Mukhopadhyay et al., 2008) cause similar impairments on WCST performance as those subsequent to frontal lobe lesions. "
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    ABSTRACT: For over four decades the Wisconsin Card Sorting Test (WCST) has been one of the most distinctive tests of prefrontal function. Clinical research and recent brain imaging have brought into question the validity and specificity of this test as a marker of frontal dysfunction. Clinical studies with neurological patients have confirmed that, in its traditional form, the WCST fails to discriminate between frontal and non-frontal lesions. In addition, functional brain imaging studies show rapid and widespread activation across frontal and non-frontal brain regions during WCST performance. These studies suggest that the concept of an anatomically pure test of prefrontal function is not only empirically unattainable, but also theoretically inaccurate. The aim of the present review is to examine the causes of these criticisms and to resolve them by incorporating new methodological and conceptual advances in order to improve the construct validity of WCST scores and their relationship to prefrontal executive functions. We conclude that these objectives can be achieved by drawing on theory-guided experimental design, and on precise spatial and temporal sampling of brain activity, and then exemplify this using an integrative model of prefrontal function [i.e., Miller, E. K. (2000). The prefrontal cortex and cognitive control. Nature Reviews Neuroscience, 1, 59-65.] combined with the formal information theoretical approach to cognitive control [Koechlin, E., & Summerfield, C. (2007). An information theoretical approach to prefrontal executive function. Trends in Cognitive Sciences, 11, 229-235.].
    Brain and Cognition 04/2009; 71(3):437-51. DOI:10.1016/j.bandc.2009.03.005 · 2.48 Impact Factor
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    • "This might be crucial when examining cognitive functions in a population, such as residents of homes for the elderly, characterized by a decline in numerous cognitive domains. For both fluency and flexibility functions, evidence suggests a concomitant role of both frontal and temporal lobe involvement in test performance (Alessio et al., 2006; Leskelä et al., 1999; Zakzanis, Mraz, & Graham, 2003). The importance of temporal lobe processing in these tasks is further supported by the notion that performance on these tests might be equal or even reduced in patients with Alzheimer's disease compared to vascular dementia patients (who are typically characterized by executive dysfunctioning) (Baillon et al., 2003; Vanderploeg, Yuspeh, & Schinka, 2001). "
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    ABSTRACT: The objective of the present study was to examine whether blood pressure (BP) relates to various executive functions in residents of homes for the elderly. Several cognitive tests measuring flexibility, fluency, inhibition, planning, and working memory were administered. Associations between these executive functions and systolic and diastolic BP (SBP and DBP) were examined. The results revealed that normal SBP (<120 mmHg) related to better fluency and flexibility performance, whereas no significant effects of DBP were noted. The present study indicates that specifically SBP might be important with regard to executive ability in residents of homes for the elderly.
    Archives of Clinical Neuropsychology 09/2007; 22(6):731-8. DOI:10.1016/j.acn.2007.06.001 · 1.99 Impact Factor
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