Clinical Neuropsychology executive functioning Flashcards
What is the dorsomedial frontal lobes main function?
Located at the top (dorsal/fin) part of the frontal lobe, its main function is planning and problem solving. Most neuropsychological test of executive functioning target this area.
What is the function of the medial frontal lobe?
The medial frontal lobe is responsible for initiation and drive. It links intention and behaviour and is connected with the limbic system. It shares some common syndromes with the ventral fl. Can be confused for depression (akinetic mutism then abulia and apathy)
What is the role of the ventral/orbital lobe?
Main function is to regulate, inhibit and emotional processing. Closely connected with the limbic system
What does damage to the ventral lobe present as?
Difficulties with higher order decision making, reversal of previous stimulus response learning, impulsivity, irritability, poor judgement
What is the US definition of executive functions?
They are adaptive behaviour patterns most often required in novel situations and where established patterns are not successful.
LEZAK (2012) US definition
- Volition - intentional behaviour, determining a need and conceptualising some future realisation of this
- Planning - identifying and organising the steps and elements needed to achieve a goal
- Purposive action - translation of a plan to productive activity, initiate maintain switch and stop sequences of behaviour.
- Effective performance - monitor, regulate qualitative aspects e.g. Intensity
What is the UK definition of executive functioning?
BURGESS & ALDERMAN (2004) defines executive functioning as the abilities that enable a person to:
- Determine goals
- Formulate new and useful ways of achieving them
- Adapt their proposed course in the face of competing demands or changing circumstances
Some common reported symptoms of dysexecutive syndrome are:
BURGESS (2003) lists 20 common symptoms of executive dysfunction. Some of which are:
Impulsivity Confabulation Disinhibition Perseveration Know-do dissociation
What is dysexecutive syndrome?
Term originally coined by BADDELEY (1986) to refer to the constellation of behaviour and cognitive deficits seen in patients with FL damage.
Following introduction of imaging techniques, the definition has been amended to remove the focus on the localisation of the FL and consider the connections and areas (posterior and sub cortical)
Why might reference to DES as a syndrome be inappropriate?
Since a syndrome suggests a fixed set of symptoms. In DES only a few of the symptoms may be present but clinically significant.
What are the impacts of DES in daily life?
Headway (2011) -
Often lack insight into difficulties making it hard to explain difficulties and behaviours
Misunderstood as depression, aggression, selfish which can impact on relationships
Emotional impact - frustration, embarrassment, isolation
Work - hard due to problems with multi tasking, organisation and motivation.
Who wrote about the supervisory attention system?
Shallice and Burgess (1996)
Who the theorised about goal selection and neglect ‘G’?
Duncan et al., 1996
Somatic marker hypothesis
Damasio et al 1996
Clinical model of executive functioning
Mateer (1999)
What is the SAS?
A decision making model of executive functioning. Contention scheduling initiates appropriate scheme under well learned routine situations.
In situations involving: Decision making or planning Error correction or trouble shooting Novel Well learned responses are ineffective Dangerous or difficult Overcoming strong habitual responses or resisting temptation ... The SAS steps up as a supervisor
Oversees contention scheduling by influencing schema activation and allowing general strategies to be applied to novel processes
What is stage one of SAS model
Construction of temporary new schema. Can take three routes.
Problem orientation (Des can fail here, fail to notice a problem)
Goal setting
Aspiration setting
- Spontaneous schema generation - try random
- Progressive deopening phase - continue to try and evaluate in stage 2
- Episodic memory retrieval - more delayed, consider previous experiences that have worked before
What is stage 2 of the SAS?
Implement new strategies and form temporary new schema
What is stage 3 of the SAS?
Temporary new schema are monitored and assessed. May be rejected or stored as a future strategy
What does the SAS hypothesise about those with fl damage?
dorsolateral - more likely to rely on CS, hard to problem solve and generate new ideas
Medial - take easiest option, lacks drive unable to set goals or aspirations
Ventral - continue to try same schema that haven’t worked, unable to learn stimulus response, may use a spontaneous strategy
What does the SAS model suggest assessment should cover as a minimum?
- General measure in inhibitory ability e.g verbal fluency, TMT
- Executive memory abilities in St and lt (WCST, Brixton, story and figure recall, word list recall, observation of real life event recollections)
- Multi tasking (6 elements BADs, multiple errands)
What is Duncan’s theory of g?
The PFC main function is control of action for desired results. Forming selecting and monitoring goals.
More recently proposed PFC main function is to support ‘g’ (fluid intelligence) used in the control of diverse behaviours
Goal neglect is a failure to translate intention into action. Mostly occurs in novel and unstructured settings. Sensitive to prompts and verbal mediation (goal management training)
