Bibliographical Review on Rehabilitation of Executive Functions in Patients With Developmental Coordination Disorder(DCD)

The present study aims to establish a literature review on intervention programs for executive functions(EFs)through the use of fundamental motor skills,from a neuropsychopedagogical perspective in subjects with Developmental Coordination Disorder(DCD).An exploratory study was carried out through an integrative literature review.The research was carried out in the Scientific databases Electronic Library Online(SciELO),Latin American and Caribbean Literature in Health Sciences(LILACS),Virtual Health Library-Psychology Brazil(BVSPSI),Electronic Journals of Psychology(PePSIC),in the periodicals available in the Brazilian Digital Library of Theses and Dissertations(BDTD)and on the website of the Coordination for the Improvement of Higher Education Personnel(CAPES).The covering publications took place from 2018 to 2023,14 articles were selected for analysis.This literature review made it possible to create strategies for stimulating EF and Visuomotor Functions so that educators and other professionals can better deal with students with DCD.It was perceived the need to carry out and develop more empirical research regarding the intervention of EFs and Visuomotor Functions by educators and professionals,with a greater sampling amplitude,to increase the number of studies that enable interventions both in children and in teenagers with DCD.

Cerebral arterial blood flow,attention,and executive and cognitive functions in depressed patients after acute hypertensive cerebral hemorrhage

BACKGROUND Intracerebral hemorrhage mainly occurs in middle-aged and elderly patients with hypertension,and surgery is currently the main treatment for hypertensive cerebral hemorrhage,but the bleeding caused by surgery will cause damage to the patient's nerve cells,resulting in cognitive and motor dysfunction,resulting in a decline in the patient's quality of life.AIM To investigate associations between cerebral arterial blood flow and executive and cognitive functions in depressed patients after acute hypertensive cerebral hemorrhage.METHODS Eighty-nine patients with depression after acute hypertensive cerebral hemorrhage who were admitted to our hospital between January 2019 and July 2021 were selected as the observation group,while 100 patients without depression who had acute hypertensive cerebral hemorrhage were selected as the control group.The attention span of the patients was assessed using the Paddle Pin Test while executive function was assessed using the Wisconsin Card Sorting Test(WCST)and cognitive function was assessed using the Montreal Cognitive Assessment Scale(MoCA).The Hamilton Depression Rating Scale(HAMD-24)was used to evaluate the severity of depression of involved patients.Cerebral arterial blood flow was measured in both groups.RESULTS The MoCA score,net scores I,II,III,IV,and the total net score of the scratch test in the observation group were significantly lower than those in the control group(P<0.05).Concurrently,the total number of responses,number of incorrect responses,number of persistent errors,and number of completed responses of the first classification in the WCST test were significantly higher in the observation group than those in the control group(P<0.05).Blood flow in the basilar artery,left middle cerebral artery,right middle cerebral artery,left anterior cerebral artery,and right anterior cerebral artery was significantly lower in the observation group than in the control group(P<0.05).The basilar artery,left middle cerebral artery,right middle cerebral artery,left anterior cerebral artery,and right anterior cerebral artery were positively correlated with the net and total net scores of each part of the Paddle Pin test and the MoCA score(P<0.05),and negatively correlated with each part of the WCST test(P<0.05).In the observation group,the post-treatment improvement was more prominent in the Paddle Pin test,WCST test,HAMD-24 score,and MoCA score compared with those in the pre-treatment period(P<0.05).Blood flow in the basilar artery,left middle cerebral artery,right middle cerebral artery,left anterior cerebral artery,and right anterior cerebral artery significantly improved in the observation group after treatment(P<0.05).CONCLUSION Impaired attention,and executive and cognitive functions are correlated with cerebral artery blood flow in patients with depression after acute hypertensive cerebral hemorrhage and warrant further study.

Acute exercise is associated with specific executive functions in college students with ADHD:A preliminary study

Purpose： The relationship between acute exercise and executive functions in college students with attention deficit hyperactivity disorder （ADHD） has not been clearly established. The purpose of this preliminary study was to examine the difference in cognitive performance between college students with and without ADHD and to explore the effects of acute exercise on multiple aspects of executive functions and on serum brain derived neurotrophic factor （BDNF）. Methods： College students （normal： n = 10; ADHD： n = 10） performed the Stroop Test, Trail Making Test, and Digit Span Test prior to and after an acute exercise intervention. Blood samples were obtained prior to the pre-test cognitive test performance and then again after exercise and prior to the post-test cognitive test performance. Results： Students with ADHD exhibited impaired executive functions, particularly on inhibition. Additionally, while acute exercise improved all aspects of executive functions in those without ADHD, acute exercise only improved inhibitory performance for those with ADHD. Further, BDNF was not influenced by acute exercise regardless of the subjects＇ ADHD status. Conclusion： These results provide preliminary evidence for exercise as a potential adjunct treatment for benefitting inhibition in college students with ADHD.

Processing Environmental Stimuli in Paranoid Schizophrenia:Recognizing Facial Emotions and Performing Executive Functions

Objective To study the contribution of executive function to abnormal recognition of facia expressions of emotion in schizophrenia patients. Methods Abnormal recognition of facial expressions of emotion was assayed according to Japanese and Caucasian facial expressions of emotion （JACFEE）, Wisconsin card sorting test {WCST）, positive and negative symptom scale, and Hamilton anxiety and depression scale, respectively, in 88 paranoid schizophrenia patients and 75 healthy volunteers. Results Patients scored higher on the Positive and Negative Symptom Scale and the Hamilton Anxiety and Depression Scales, displayed lower JACFEE recognition accuracies and poorer WCST performances. The JACFEE recognition accuracy of contempt and disgust was negatively correlated with the negative symptom scale score while the recognition accuracy of fear was positively with the positive symptom scale score and the recognition accuracy of surprise was negatively with the general psychopathology score in patients. Moreover, the WCST could predict the JACFEE recognition accuracy of contempt, disgust, and sadness in patients, and the perseverative errors negatively predicted the recognition accuracy of sadness in healthy volunteers. The JACFEE recognition accuracy of sadness could predict the WCST categories in paranoid schizophrenia patients. Conclusion Recognition accuracy of social-/moral emotions, such as contempt, disgust and sadness is related to the executive function in paranoid schizophrenia patients, especially when regarding sadness.

Executive function impairments in high IQ children and adolescents with ADHD

Objective: To demonstrate that high IQ children and adolescents diagnosed with ADHD tend to suffer from executive function (EF) impairments that: a) can be identified with a combination of standardized measures and normed self-report data;and b) occur more frequently in this group than in the general population. Method: From charts of 117 children and adolescents aged 6 to 17 years with high IQ ( ≥ 120) who fully met DSM-IV diagnostic criteria for ADHD, data on 8 normed measures of executive function (EF) were extracted: IQ index scores for working memory and processing speed, a standardized measure of auditory verbal memory, and 5 clusters of the Brown ADD Scale, a normed, age-graded rating scale for ADHD-related executive function impairments in daily life. Significant impairment was computed for each individual relative to age-appropriate norms for each measure and comparisons were made to base-line rates in the general population. Results: Sixty-two percent of participants were significantly impaired on at least 5 of these 8 markers of EF. Chi-square comparisons of scores from these high IQ participants were significantly different (p < 0.001) from standardization norms for each of the eight EF measures. Conclusions: High IQ children and adolescents with ADHD, despite their cognitive strengths, tend to suffer from significant impairments of executive functions that can be assessed with these measures;incidence of these impairments is significantly greater than in the general population. These results are fully consistent with data on high IQ adults diagnosed with ADHD.

Executive functioning in TBI from rehabilitation to social reintegration: COMPASS^(goal), a randomized controlled trial(grant: 1I01RX000637-01A3 by the VA ORD RR&D, 2013–2016)

Background: Traumatic brain injury is a major health problem that frequently leads to deficits in executive function. Self-regulation processes, such as goal-setting, may become disordered after traumatic brain injury, particularly when the frontal regions of the brain and their connections are involved. Such impairments reduce injured veterans' ability to return to work or school and to regain satisfactory personal lives. Understanding the neurologically disabling effects of brain injury on executive function is necessary for both the accurate diagnosis of impairment and the individual tailoring of rehabilitation processes to help returning service members recover independent function.Methods/design: The COMPASSgoal(Community Participation through Self-Efficacy Skills Development) program develops and tests a novel patient-centered intervention framework for community reintegration psychosocial research in veterans with mild traumatic brain injury. COMPASSgoal integrates the principles and best practices of goal self-management. Goal setting is a core skill in self-management training by which persons with chronic health conditions learn to improve their status and decrease symptom effects. Over a three-year period, COMPASSgoal will recruit 110 participants with residual executive dysfunction three months or more post-injury. Inclusion criteria combine both clinical diagnosis and standardized scores that are >1 SD from the normative score on the Frontal Systems Rating Scale. Participants are randomized into two groups: goal-management(intervention) and supported discharge(control). The intervention is administered in eight consecutive, weekly sessions. Assessments occur at enrollment, post-intervention/supported discharge, and three months post-treatment follow-up.Discussion: Goal management is part of the "natural language" of rehabilitation. However, collaborative goal-setting between clinicians/case managers and clients can be hindered by the cognitive deficits that follow brain injury. Re-training returning veterans with brain injury in goal management, with appropriate help and support, would essentially treat deficits in executive function. A structured approach to goal self-management may foster greater independence and self-efficacy, help veterans gain insight into goals that are realistic for them at a given time, and help clinicians and veterans to work more effectively as true collaborators.

Association between central obesity and executive function as assessed by stroop task performance:A functional near-infrared spectroscopy study

Recent studies have suggested a link between executive function(EF)and obesity.Studies oftenadopt body mass index(BM),which reflects the distribution of subcutaneous fat,as the solemarker of obesity;however,BMI is inappropriate to distinguish central obesity,which indicatesthe centralized distribution of visceral fat.Visceral fat compared with subcutaneous fat repre-sents greater relative lipid turnover and may increase the risk of cognitive decline in older adults.However,the relationship between EF and central obesity is largely unknown,particularly inyoung adults.Therefore,we used waist circumference(WC)as a marker of central obesity andinvestigated diferent sensitivities between BMI and WC in the brain function.A total of 26healthy young adults(aged 18-25 years;42%female)underwent functional near-infrared spec-troscopy assessments.EF was assessed using the Stroop task,which is a classical measurementof EF.A significant Stroop effect was observed in the behavioral and hemodynamic data.Inaddition,we observed that behavioral interference on the Stroop task varied much more insubjects with higher BMI and WC than those subjects with lower.Elevated BMI and WC wereassociated with a decreased hemodynamic response during the Stroop task specifically in the pre-frontal cortex(PFC).Compared to BMI,WC was more closely connected with inhibitory controland revealed right lateralized PFC activation.Our findings suggest that WC is a reliable indicatorof brain function in young adults and propose a relationship bet ween EF and central obesity.

Language, executive functioning and symptomatology—Is fluency a transversal tool in schizophrenia?

Despite a large number of studies on fluency disorders in schizophrenia, it is still not clear whether executive functioning and fluency tasks are empirically linked and how symptomatology could specifically get involved on these influences. We carried out analyses of performances in several verbal fluency tasks, a non-verbal fluency task and an executive test (FAB) in 25 schizophrenics and 25 healthy subjects matched in terms demographic data. Patients also completed the Positive and Negative Symptoms Scale in order to control for their clinical profile. Our results suggest that schizophrenic patients show both category and letter fluency deficits with a greater impairment for letter fluency. They also display poorer performances for the non-verbal fluency task. In patients, all the verbal and non-verbal fluencies are significantly correlated with the FAB total score. By contrast, in controls, only letter fluency correlates with the FAB total score, which is congruent with previous literature on the healthy mechanisms of verbal fluency. Besides, factorial analyses show that symptomatology is specifically related to particular indexes of fluency tasks. Taken together, these data lead to support the hypothesis of retrieval rather than semantic difficulties and alargest involvement of executive functioning in schizophrenics during tasks that require a certain degree of efficiency, with performance being influenced by the clinical profile. Yet, the relation between fluency scores and executive functioning has to be more intensively explored and further studies should include semantic memory measures that fit with pathology’s constraints and characteristics.

Impact of Auditory-Verbal Therapy on executive functions in children with Cochlear Implants

Objective: Auditory-Verbal Therapy(AVT) can be considered one of the best practices for children with Cochlear Implants(CIs) who show impairments in cognitive skills such as executive functions. Hence,this research examined the impact of AVT on the executive functions in children with CIs.Methods: This was a randomized case control study with pre-and post-intervention assessments. The participants were 36 children with CIs and their mothers. They were randomly selected from rehabilitation centers and deaf pre-schools, and randomly allocated to a control(n = 18) and a study(n = 18)group. The mean age of the children in the study and control groups was 3.11 ± 0.31 years and 3.20 ± 0.29years, respectively. Participants in the study group received 20 sessions of AVT over 10 weeks at twice a week, while those in the control group did not. All mothers completed the Behavior Rating Inventory of Executive Function Pre-school Version(BRIEF-P) before and after children in the study group completed their AVT intervention. Data were analyzed by MANCOVA.Results: The results suggest that AVT significantly influenced executive functions and all subscales including shifting, inhibition, emotional control, working memory and organization/planning in children with CIs.Conclusions: These findings suggest that AVT may be effective in resulting in positive outcomes and may play an important role in improving executive functions in children with CIs.

Effectiveness of Mindfulness Training in Enhancing Executive Function and Decreasing Symptoms of Depression and Anxiety in Patients with Multiple Sclerosis (MS)

The purpose of the present study was to evaluate the effectiveness of mindfulness training in enhancing executive function and decreasing symptoms of depression and anxiety in multiple sclerosis patients. The population in this study consisted of people with MS who referred to Karaj city MS society in 1394. These people didn’t experience medicinal changes during the study period and their expanded disability status score (EDSS) was between 0 and 5.5. 40 of them were randomly selected and placed into two experimental and control groups (20 for the experimental and the other for the control group). The treatment of mindfulness training was held in 8 sessions of group training, once a week and for 2 hours. The statistical method of multivariate analysis of covariance was used. The measurement tools were the State-Trait Anxiety Inventory (STAI), the Beck Depression Inventory-II (BDI-II) and the Wisconsin Card Sorting Test (WCST). After all, the results in both groups were compared and evaluated by the use of analysis of covariance. The results showed significant differences in symptoms of anxiety and depression between the two groups (p 0.05). Generally, the results of this research showed positive effects of mindfulness training on reducing anxiety and depression among patients with MS and ineffectiveness of mindfulness training on their executive function. Therefore, considering that there is no certain treatment for MS plus results of this study, the application of mindfulness training can be quite useful to reduce levels of anxiety and depression in patients with MS.

Assessment of Stress Cognitive Control and Executive Function with Stress Control Rating Scale (ECOSTRESS) and Low Resolution Brain Electromagnetic Tomography (LORETA) (In Portuguese People in Situations of Unemployment and Economic Insufficiency)

This article reviews the constructs of stress, appraisal, coping, according to a transactional perspective, and executive function, and presents a stress control rating scale (ECOSTRESS), which design is founded in these constructs. This psychometric tool is useful in the assessment of cognitive control of stress, correlated with the function of dorsolateral prefrontal cortex. It has been validated for its use in the assessment of Portuguese people in situations of stress related to unemployment and economic insufficiency. Also, within the context of the cognitive control of stress, it is highlighted the usefulness of low resolution brain electromagnetic tomography (LORETA).

Executive and Non-Executive Functions in Attention Deficit Hyperactivity Disorder of the Inattentive Type (ADHD-I): A Cognitive Profile

Objective: This study examined the hypothesis that individuals with attention deficit hyperactivity disorder, predominantly inattentive type (ADHD-I), show both executive function (EF) deficits and non-EF deficits. Method: A group with ADHD-I (n = 16) and a paired control group (n = 21) completed a battery of tasks covering the major domains of EF (planning, working memory, flexibility and inhibition) and non-EF (alertness, divided attention, flexibility, sustained attention, visual field and visual scanning). Results: EF impairments in planning, spatial working memory, flexibility, and inhibition as well as non-EF impairments in divided attention, flexibility, sustained attention and visual scanning were observed in the ADHD-I group. Conclusion: Our results do not support the traditional model of ADHD. Given that neither EF nor non-EF tests typically distinguish ADHD-I from ADHD-C, alternative methodologies are required to confirm the validity of ADHD subtypes in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition.

Intrusive Thoughts and Executive Functions in Obsessive Compulsive Disorder

Objectives: Our aim was to compare the effects of an unwanted intrusive thought on executive function in a group of people with Obsessive Compulsive Disorder (OCD) and in a healthy group. Method: The Behavior Rating Inventory of Executive Function Adult (BRIEF-A) was used to measure executive dysfunction in everyday life in people with OCD. The study participants underwent either an intrusive thought induction or neutral thought induction prior to the administration of three computer-based tests of executive function. Results: The BRIEF-A results confirmed the impairment of executive function in everyday life for patients with OCD. In the number-letter task, patients with OCD displayed a longer reaction time (relative to the controls). There were no intergroup differences in the local-global task. In the go/no-go task, there was a significant impairment (p = 0.03) in the OCD group (with more commission errors than controls). There was a non-significant trend towards an effect of thought induction in both groups in the number-letter task. However, intrusive thought induction did not have a greater effect than neutral thought induction on the OCD group in any of the tasks. Conclusions: Intrusive thought induction has no effect on executive function in the two groups. The two groups differed with regard to two executive tasks.

Executive Functions Assessment in Adult Patients with Idiopathic Epilepsy

Objective: Cognitive impairments are common complaints among people with epilepsy with its occurrence to emanate a great topic in the course of the illness, so our study aimed to examine the executive functions in adult patients with idiopathic epilepsy. Methods: Forty consecutive adult patients with idiopathic epilepsy (either generalized or focal) with age range from 18 - 45 years old, IQ > 85, treated with either monotherapy or polytherapy, matched with forty healthy adult volunteers by age, sex and educational level. They were examined in executive functions tests: cognitive flexibility and set shifting (Wisconsin Card sorting Test), Planning (Tower of London), response inhibition (Continuous Performance Test) and working memory (verbal and visuospatial). Results: Patients with epilepsy showed deficits in all executive functions tests, with no difference between patients with generalized and focal epilepsy except for correct response time mean in CPT. There was significant positive correlation between frequency of seizures and mean total time, mean number of extra movies in TOL, in verbal working memory (digit back word), and omission errors in CPT;at the same time there was significant negative correlation between target accuracy rate and frequency of seizures in CPT, and in visuo-spatial part of working memory (Corsi Block-Tapping Test). Conclusion: Adult patients with idiopathic epilepsy had executive dysfunctions than healthy control, with no difference between generalized and focal epilepsy except for correct response time mean in CPT;the increase of the frequency of seizure is associated with impairment in planning, attention and working memory (either verbal or viuso-spatial).

Impaired Executive Function in Everyday Life: A Predictor of OCD Relapse?

Objectives: In the present study, we set out to establish whether executive function in everyday life is impaired in obsessive-compulsive disorder patients, and if it is more impaired (or not) in patients who relapsed after cognitive behavioural therapy than in treatment-na?ve obsessive-compulsive disorder patients. Method: The Behavior Rating Inventory of Executive Function— Adult Version (BRIEF-A) was used to measure executive function in everyday life in three groups of 19 participants: treatment-na?ve obsessive-compulsive disorderpatients, obsessive-compulsive disorder patients having relapsed after CBT, and healthy controls. Results: The BRIEF-A results revealed an impairment in executive function in the treatment-na?ve and relapsed obsessive-compulsive disorder groups, relative to the healthy control group. There was no significant difference in executive function between the two groups of patients. Conclusions: These results show that impaired executive function is not associated with relapse in patients with obsessive-compulsive disorder having undergone cognitive behavioural therapy.

Failure to identify an acute exercise effect on executive function assessed by the Wisconsin Card Sorting Test

Purpose： Acute exercise has been linked to the facilitation of executive function, but little is known regarding executive function assessed by the Wisconsin Card Sorting Test （WCST）. The present research consisted of two experiments aimed to determine whether acute aerobic exercise influences successive WCST performance. Methods： In Study 1, 27 young adults were randomly assigned to the exercise or reading control group and then instiucted to perform the WCST before and after assigned treatment. In exercise group, participants completed a single bout aerobic exercise with moderate intensity for 20 min on a stationary bike. A similar experimental protocol was replicated in Study 2 with 24 late middle-aged adults to look for age differences during adulthood and control for a potential ceiling effect at young adult age. Results： Although a significant time effect was observed in young adults, both studies revealed that there was no main effect for treatment or an interaction between treatment and time on any of the WCST indices. Conclusion： Acute aerobic exercise failed to influence executive function as assessed by the WCST, revealing that this classical neuropsy- chological test tapping executive function may not be sensitive to acute exercise. Our findings suggest that acute exercise does not broadly affect the entire family of executive functions, or its effect on a specific aspect of executive function may be task-dependent, as proposed by Etnier and Chanj~ （2009）.

The Relationship between Executive Functioning and Emotional Intelligence in Children with Autism Spectrum Disorder

Children with Autism Spectrum Disorder (ASD) demonstrate marked deficits in the ability to initiate, maintain and sustain meaningful social interaction. While the social-emotional deficits represent a core set of problems, persons with ASD also demonstrate significant problems in initiating, sustaining and maintaining appropriate goal directed behaviors. Emotional Intelligence (EI) is a construct that has been successfully applied to a range of skills that allow for the prediction of competent human social behavior. Executive Functions (EF) refer to constructs involving cognitive abilities necessary for initiating, sustaining and maintaining purposeful goal-oriented behavior. While both children and adults with ASD have previously shown to have atypical patterns of EF skills, little is known about EI in either children or adults with ASD. Moreover, there is no study examining the relationship between EI and EF that has been reported in individuals with ASD. The current study examined the relationship between EF and EI in children with ASD. Twenty children with ASD were compared to twenty neurotypical children on self-report and clinical assessments of EI and EF. Although the relationship between EF and EI was not statistically significant, results showed that children with ASD have deficits in interpersonal skills, intrapersonal skills and overall EI when compared to their neurotypical peers. These results suggest that EF and EI are relatively independent domains of development that show compromise in persons with ASD and each may be necessary to support typical socially directed behaviors.

Relationship between Cerebral Imaging and Executive Functions in Egyptian Elderly

This study aimed at assessing the relationship between executive functions and left sided hemiplegia due to non hemorrhagic supratentorial infarction in elderly Egyptians. It is considered a case control study which was conducted among 90 elderly participants, who were divided into two groups: a case group, 45 cases with cerebral infarctions of 6 months duration or more, and a control group who did not have previous cerebral infarctions. Both groups were selected from Ain shams University Hospital. Each participant was subjected to comprehensive geriatric assessment, executive functions assessment using, block design test, digit span, letter verbal fluency test, animal verbal fluency test and clock drawing test, and then a Computed Tomography (CT) brain was performed. It was found that cases were suffering from more functional impairment than controls, and have had significant lower scores in Mini Mental Status Examination (MMSE) (P < 0.01). Significant difference was found between both groups as regards performance of executive function tests (P < 0.05). Significant effect of Parietal lobe infarctions was found on Block Design Test, Digit Span Test, Animal Verbal Fluency and Clock Drawing Test (P value < 0.05). Conclusion: There was a significant difference between cases and controls as regards their performance in cognitive and executive function tests.

Optical neuroimaging of executive function impairments in food addiction

This study investigated the neural mechanisms located in the prefrontal cortex(PFC)involved in maintaining addictive-like eating behavior.Therefore,we aimed toll a gap in the existing literature and help clarify the food addiction(FA)cycle by inspecting the relationship between the executive control and psychopathology involved in the FA cycle.Twenty-three students recruited from the University of Macao participated in this study.We investigated a hemodynamic response captured by NIRS recordings,activated during n-back,set-shifting,and go/nogo paradigms.Moreover,we investigated the FA symptoms through the YFAS clinical inventory to better understand the relationship between hemodynamic response and clinical symptomatology in college students.First,the hemodynamicndings conrm that altered cognitive control in executive function performance appears to be linked to addictive-like eating behaviors,which in turn conrms a circuit similarity between FA and the substance abuse population(SUD)as reported in previous fMRI studies.Secondly,the psychologicalndings conrm the signicant association between the working memory decits and symptoms severity which suggest the role of self-control and regulation in limiting the storage resources as a potential trigger to develop overconsumption episodes in the FA cycle.Ourndings highlight how disrupted self-control and regulation of craving and negative a®ect induced by mental imagery might shape and overload the working memory storage as a potential trigger to develop binge eating episodes to maintain the FA cycle.In conclusion,the use of fNIRS in the context of eating disorders studies represents a valuable application,noninvasive,and patientfriendly tool,providing new insights into understanding the addiction cycle and treatment guidelines.

Factors affecting early decline of executive function after subthalamic nucleus stimulation in Parkinson’s disease

Subthalamic nucleus deep brain stimulation (STN DBS) is an effective treatment for medically refractory Parkinson’s disease (PD). However, a minority of patients develop cognitive problems, particularly a decline of executive function in the early period after STN DBS. Although this problem is usually transient, it may cause social maladjustment. We investigated factors affecting early decline of executive function after STN-DBS. Fifty-seven patients whose preoperative global cognitive screening was normal (MMSE score;28 or more) were enrolled in this study. Executive function was evaluated with the Trail-Making Test (TMT) preoperatively and 1-month after surgery. We considered a patient to have decline in executive function if the TMT (B-A) was prolonged more than 30 seconds after STN DBS. Among 57 patients, 25 patients were categorized as having decline of executive function. Univariate analysis revealed that high preoperative UPDRS III motor score in the medication-off period and a depressive state evaluated with BDI-II correlated significantly with decline in executive function. Multiple logistic regression analysis revealed that the only significant independent variable related to early decline of executive function was the preoperative BDI-II score. Postoperative factors such as active contact location or dopaminergic medication reduction had no relation with the decline of executive function. Even in cognitively well-selected patients, STN DBS causes early decline in executive function in a significant number of patients. Preoperative simple cognitive screening alone could not predict early decline in executive function. More detailed neuropsychological evaluation, including mood status, should be undertaken before surgery.