Control functions of the frontal lobes. Modularity of the central-supervisory system?

More dissociations and interactions within central executive functioning: a comprehensive latent-variable analysis

The present study examined the separability of six executive functions (verbal storage-and-processing coordination, visuospatial storage-and-processing coordination, dual-task coordination, strategic retrieval, selective attention, and shifting) and their relationships, by means of confirmatory factor analysis. A set of tasks thought to primarily assess each target function was administered to 180 participants. The results demonstrated that five of the six functions initially considered were distinguishable albeit related constructs, with one of these functions combining inhibitory and strategic retrieval processes. The analyses failed to reveal a single dual-task coordination ability underlying performance on the dual-tasks. These findings provide further support for the fractionation of the central executive into several functions and also stress the need to approach executive functioning in terms of both dissociations within general functions and specific interactions between some of these functions.

Subcortical contributions to multitasking and response inhibition

The involvement of the prefrontal cortex in executive control has been well established. It is, however, as yet unclear whether the basal ganglia and the cerebellum as components of frontostriatal/frontocerebellar networks also contribute to the executive domains multitasking and response inhibition. To investigate this issue, groups of patients with selective vascular lesions of the basal ganglia (n=13) or the cerebellum (n=14) were compared with matched healthy control groups. Several paradigms assessing the ability to process concurrent visual and auditory input and to simultaneously perform verbal and manual responses as well as the inhibition of habitual or newly acquired response tendencies were administered. Basal ganglia patients showed marked response slowing during coordination of sensory input from different modalities and high error rates during the inhibition of overlearned responses. There was no clear evidence of a cerebellar involvement in multitasking or response suppression. Taken together, the findings provided evidence for a striatal involvement in both multitasking and response inhibition, emphasizing the functional implication of subcortical components in frontostriatal circuits.

The elusive nature of executive functions: a review of our current understanding

Executive functions include abilities of goal formation, planning, carrying out goal-directed plans, and effective performance. This article aims at reviewing some of the current knowledge surrounding executive functioning and presenting the contrasting views regarding this concept. The neural substrates of the executive system are examined as well as the evolution of executive functioning, from development to decline. There is clear evidence of the vulnerability of executive functions to the effects of age over lifespan. The first executive function to emerge in children is the ability to inhibit overlearned behavior and the last to appear is verbal fluency. Inhibition of irrelevant information seems to decline earlier than set shifting and verbal fluency during senescence. The sequential progression and decline of these functions has been paralleled with the anatomical changes of the frontal lobe and its connections with other brain areas. Generalization of the results presented here are limited due to methodological differences across studies. Analysis of these differences is presented and suggestions for future research are offered.

Domain-specific improvement of cognition on memantine in patients with Alzheimer's disease treated with rivastigmine

OBJECTIVE

Cholinergic therapy is used in mild-to-moderate Alzheimer's disease (AD) and antiglutamatergic therapy in moderate-to-severe AD. Global scales, as commonly used in clinical trials, blur specifics of disease progression and drug effects. The objective was to assess combination therapy of rivastigmine plus memantine by specific neuropsychological tests in patients with mild-to-moderate AD.

METHODS

12-week-short multicenter open-label pilot study. Ninety patients with mild-to-moderate AD already on stable medication with rivastigmine (3-6 mg b.i.d.) additionally received memantine for 12 weeks. Subscales of the Alzheimer's Disease Assessment Scale (ADAS-cog), the Mini-Mental State Examination (MMSE) and additional neuropsychological tests (e.g. span tasks, semantic fluency) were assessed.

RESULTS

The scores in the ADAS-cog memory subscale, the MMSE score, and digit span and semantic fluency significantly improved on combination therapy.

CONCLUSION

Memory improvement was correlated with ADAS-cog memory score at baseline and inversely with age at onset of treatment. The data suggest that improvement on combination therapy results from an improvement of attention/executive function with secondary memory improvement, which will need to be confirmed in a subsequent double-blind study on a larger number of patients.

Is there a dysexecutive syndrome?

The role of the frontal lobes has often been described as a 'paradox' or a 'riddle'. Ascribed to this region has been the loftiest of functions (e.g. executive; seat of wisdom); others contested that the frontal lobes played no special role. There has also been controversy about the unity or diversity of functions related to the frontal lobes. Based on the analysis of the effects of lesions of the frontal lobes, we propose that there are discrete categories of functions within the frontal lobes, of which 'executive' functioning is one. Within the executive category, the data do not support the concept of an undifferentiated central executive/supervisory system. The results are better explained as impairments in a collection of anatomically and functionally independent but interrelated attentional control processes. Evidence for three separate frontal attentional processes is presented. For each process, we present an operational description, the data supporting the distinctiveness of each process and the evidence for impairments of each process after lesions in specific frontal regions. These processes and their coarse frontal localizations are energization-superior medial, task setting-left lateral and monitoring-right lateral. The strength of the findings lies in replication: across different tasks; across different cognitive modalities (e.g. reaction time paradigms, memory); and across different patient groups. This convergence minimizes the possibility that any of the findings are limited to a specific task or to a specific set of patients. Although distinct, these processes are flexibly assembled in response to context, complexity and intention over real time into different networks within the frontal regions and between frontal and posterior regions.

Metabolic correlates of executive dysfunction

This study was designed to examine the correlations between resting-state brain glucose metabolism (CMRglc), as measured with Positron Emission Tomography and performance on executive function tasks in Alzheimer's disease (AD), while taking into account the severity of cognitive deterioration. We addressed this issue in 50 AD patients, classified as very mild (n = 22) and mild (n = 28) AD on the basis of an extensive neuropsychological battery. Thirteen healthy subjects were selected as controls for the neuropsychological measures. Statistical Parametric Mapping (SPM) was used to examine voxel-wise correlations between CMRglc and scores on selected cognitive tests of executive functions: the Stroop Test, the Trail Making Test, the Dual Task and the Phonemic Fluency, while correcting for age and global CMRglc. All analyses were done separately for the two AD subgroups. The very mild AD patients showed significant associations between Stroop and Trail Making Test scores and prefrontal regions metabolism, whereas the mild AD patients exhibited more widely distributed cognitive-metabolic correlations extending to the posterior brain regions. These data suggest that a large cortical network is implicated in executive dysfunction in AD, and that the pattern of cognitive-metabolic correlations varies according to disease severity.

Effects of age and mild cognitive impairment on direct and indirect access to arithmetic knowledge

The present study aimed at investigating age-related changes and mild cognitive impairment (MCI) related effects in simple arithmetic. To pursue this goal, MCI patients, healthy old adults and young adults performed three computerised tasks. The production (e.g., 3 x 4=?) and the verification task (3 x 4 12?) evaluated direct access to multiplication knowledge, the number-matching task (3 x 4 34?, 'do 3 x 4 and 34 have the same digits?') tested indirect access. In verification and number-matching, interference from related distractors (e.g., 3 x 4 followed by 16) relative to unrelated distractors (17) reflects access to stored fact representations as well as efficiency of inhibition processes. Results indicated that, compared to young adults, MCI and healthy old adults were slower in responding across tasks. In production and verification, analyses of individual latency regression slopes and intercepts suggested that these age effects were related to differences at peripheral processing stages (e.g., encoding) rather than at the central (arithmetic retrieval) stage. Differences between MCI and healthy elderly emerged only in the number-matching task. While in verification effects were comparable between groups, in number-matching MCI patients were more susceptible to interference from irrelevant information than healthy old participants. Overall, the present findings indicate that aging has a general effect on peripheral processing speed, but not on arithmetic memory retrieval. Parietal cortico-subcortical circuits mediating arithmetic fact retrieval (Dehaene, S., & Cohen, L. (1995). Towards an anatomical and functional model of number processing. Mathematical Cognition, 1, 83-120; Dehaene, S., & Cohen, L. (1997). Cerebral pathways for calculation: Double dissociation between rote verbal and quantitative knowledge of arithmetic. Cortex, 33, 219-250) thus seem to be preserved in normal aging and MCI. In contrast, MCI patients show enhanced interference in number-matching. This task-specific lack of inhibition may point to dysfunctional frontal cortico-subcortical networks in MCI.

Cerebellar involvement in executive control

The cerebellum has long been considered to be mainly involved in motor function. In the last 20 years, evidence from neuroimaging studies and from investigations of patients with cerebellar lesions has shown that the cerebellum plays a role in a range of cognitive functions. While cerebellar contributions have been shown for learning and memory, the cerebellum has also been linked to higher order cognitive control processes frequently referred to as executive functions. Although it is widely accepted that the cerebellum contributes to cognitive processing, the nature of cerebellar involvement is not well understood. The present paper focuses on the role of the cerebellum in executive processing, reviewing findings derived from neuroimaging studies or from studies investigating deficits related to cerebellar dysfunction. As executive functions cannot be considered as a unitary concept, special emphasis is put on cerebellar contributions to different aspects of executive control such as working memory, multitasking or inhibition. Referring to models derived from motor control, possible mechanisms of cerebellar involvement in executive processing are discussed. Finally, methodological problems in assessing executive deficits in general and in assessing the cerebellar contribution to executive processing in particular are addressed.

Inhibitory Control is Slowed in Patients with Right Superior Medial Frontal Damage

Inhibitory control is an essential part of behavior. Comprehensive knowledge of the neural underpinnings will shed light on complex behavior, its breakdown in neurological and psychological disorders, and current and future techniques for the pharmacological or structural remediation of disinhibition. This study investigated the neural mechanisms involved in rapid response inhibition. The stop signal task was used to estimate inhibitory speed in a group of neurologically normal control subjects and patients with discrete frontal lobe lesions. Task procedures were controlled to rule out probable confounds related to strategic changes in task effort. The findings indicate that the frontal lobes are necessary for inhibitory control and, furthermore, that the integrity of the right superior medial frontal region is key for rapid inhibitory control under conditions controlling for strategically slow responses, forcing reliance more on a rapid, “kill-switch” inhibitory system. These results are interpreted within an anatomical framework of corticospinal motor control.

Structure of four executive functioning tests in healthy older adults

The authors examined the factor structure of 4 indicators of executive functioning derived from 2 new (i.e., Hayling and Brixton) and 2 traditional (i.e., Stroop and Color Trails) tests. Data were from a cross-sectional sample of 55- to 85-year-old healthy adults (N=427) from the Victoria Longitudinal Study. Confirmatory factor analysis (LISREL 8.52) tested both a 2-factor model of Inhibition (Hayling, Stroop) and Shifting (Brixton, Color Trails) and a single-factor model. The 2-factor model did not fit the data because the covariance matrix of the factors was not positive definite. The single-factor model fit the data well, chi(2)(2, N=427)=0.32, p=.85, root-mean-square error of approximation (RMSEA)=.00, comparative fit index (CFI)=1.00, goodness-of-fit index (GFI)=1.00. Moreover, the single-factor structure of executive functioning was invariant (configural and metric) across gender, and invariant (configural with limited metric) across age. Structural relations showed that poorer executive functioning performance was related to older age and lower fluid intelligence, chi(2)(11, N=418)=23.04, p=.02, RMSEA=.05, CFI=.97, GFI=.98.

Neural plasticity in the ageing brain

The mechanisms involved in plasticity in the nervous system are thought to support cognition, and some of these processes are affected during normal ageing. Notably, cognitive functions that rely on the medial temporal lobe and prefrontal cortex, such as learning, memory and executive function, show considerable age-related decline. It is therefore not surprising that several neural mechanisms in these brain areas also seem to be particularly vulnerable during the ageing process. In this review, we discuss major advances in our understanding of age-related changes in the medial temporal lobe and prefrontal cortex and how these changes in functional plasticity contribute to behavioural impairments in the absence of significant pathology.

Screening for cognitive impairment: a triage for outpatient care

The current increase in aged individuals in number and proportion of the general population warrants dependable strategies to improve early detection of cognitive impairment. It was the goal of the present study to develop a triage for bedside testing and outpatient services. In a prospective clinical cohort study at the outpatient Memory Clinic, University of Ulm, Germany, 232 subjects were diagnosed with Alzheimer's disease [AD; NINCDS-ADRDA criteria; n = 66; age 65.9 +/- 7.3 years (mean +/- SD); Mini Mental State Examination (MMSE) score 23.4 +/- 4.1], mild cognitive impairment (MCI; criteria of Petersen et al.; n = 48; age 66.4 +/- 7.1 years; MMSE score 28.3 +/- 1.5), and major depressive disorder (DSM-IV criteria; n = 61; age 63.4 +/- 8.0 years; MMSE score 28.6 +/- 1.6). Diagnosis was secured with extensive neuropsychological, clinical, radiological, and laboratory investigations. Six brief screening tests including the Memory Impairment Screen (MIS), Letter Sorting Test (LST), Verbal Fluency (VF), and Clock Drawing Test (CDT) were assessed independently from the diagnostic procedure. We compared single items and composite scores. LST yielded a diagnostic accuracy of 0.81 and 0.62 for AD and MCI patients versus controls, respectively. With the MIS, diagnostic accuracy was 0.89 and 0.71, respectively. With a combination of LST, MIS, VF, and CDT, a sensitivity for AD and MCI patients of 1.00 and 0.83 was achieved. Thus, single-item screening (e.g. LST, VF) taking little more than 1 min and suitable for bedside testing or brief screening in the general practitioner's office yields diagnostic accuracy comparable to standard laboratory tests for other diseases. A composite of screening tests suitable for application in general outpatient care in neurological and psychiatric services reliably detects patients with AD and MCI.

Working memory, inhibition, and fluid intelligence as predictors of performance on Tower of Hanoi and London tasks

The contributions of working memory, inhibition, and fluid intelligence to performance on the Tower of Hanoi (TOH) and Tower of London (TOL) were examined in 85 undergraduate participants. All three factors accounted for significant variance on the TOH, but only fluid intelligence accounted for significant variance on the TOL. When the contribution of fluid intelligence was accounted for, working memory and inhibition continued to account for significant variance on the TOH. These findings support argument that fluid intelligence contributes to executive functioning, but also show that the executive processes elicited by tasks vary according to task structure.

Syndromes frontaux et dysexécutifs

Investigation of executive functions is an approach which began with the early description of behavioral disorders induced by frontal damage. The development of neuropsychology has led to the description of a large variety of cognitive disorders. This type of approach has generated a large number of tests which are still used in clinical practice. More recently, theoretical approaches have proposed an organization of executive processes and have documented the diversity of executive functions and related anatomy. These studies have deeply influenced the clinical approach, the assessment and the diagnosis of executive disorders. For clinical practice, these data favor specific assessment of certain key behavioral and cognitive deficits investigated with a battery of tests.

Cortico-subcortical contributions to executive control

The term "executive functions" refers to a range of cognitive processes, their common feature being the coordination of information processing and action control. Cortico-subcortical circuits which connect the prefrontal cortex (PFC), the basal ganglia and the cerebellum via the thalamus are believed to serve as neuroanatomical substrates of executive processing. This paper focuses on information processing related to executive functions by the PFC and related subcortical regions. Findings are mainly derived from neuropsychological investigations of brain-damaged patients but also from imaging studies in healthy subjects. There is evidence for subtle differences between these regions with respect to the cognitive mechanisms contributing to inhibition of habitual responses, task management/multitasking and set shifting, although the data base is sparse so far.

The role of brain oscillations as functional correlates of cognitive systems: a study of frontal inhibitory control in alcoholism

Event-related oscillations play a key role in understanding the brain dynamics and human information processing. In the present study, the Go/No-Go paradigm has been used to examine whether alcoholics have poor inhibitory control as compared to control subjects in terms of different oscillatory brain responses. The matching pursuit algorithm was used to decompose the event-related electroencephalogram into oscillations of different frequencies. It was found that alcoholics (n=58) showed significant reduction in delta (1.0-3.0 Hz) and theta (3.5-7.0 Hz) power during No-Go trials as compared to controls (n=29). This reduction was prominent at the frontal region. The decreased delta and theta power associated with No-Go processing perhaps suggests a deficient inhibitory control and information-processing mechanism. A neuro-cognitive model has been provided to explain the findings. It is suggested that the oscillatory correlates during cognitive processing can be an endophenotypic marker in alcoholism.

Neuropsychologic effects of frontal lobe epilepsy in children

Most published neuropsychologic studies on frontal lobe epilepsy have been performed on mixed groups of adults and adolescents with epilepsies of varying etiology. The cognitive profile of frontal lobe epilepsy in children has not been defined. The purpose of this study was to assess neuropsychologic performance in children with frontal lobe epilepsy. Intelligence and executive functions were examined in eight children (age 6 7/12 years to 13 11/12 years) with frontal lobe epilepsy. Performance was related to the focus side, seizure frequency, and age of epilepsy onset. Frontal lobe epilepsy was associated with a range of frontal dysfunctions, but IQ was generally spared. Left focus was associated with deficits in categorization, verbal long-term memory, and detailed visuospatial analysis. Frequent seizures correlated with attention difficulties and inability to inhibit impulsive responses. Children whose epilepsy appeared before age 6 years had reduced ability to change behavioral strategies. Frontal epileptic activity alone can cause selective frontal deficits, the severity and nature of which are related to side, seizure frequency, and age of epilepsy onset. These findings require confirmation on larger series of selected children.

Characterization of the neuronal changes in the medial prefrontal cortex during jaw movement and eyeblink Pavlovian conditioning in the rabbit

Medial prefrontal (mPFC) single-unit activity was assessed in defensive (eyeblink, EB) and appetitive (jaw movement, JM) Pavlovian conditioning in the rabbit. Concomitant heart rate (HR) changes were also assessed. In a first experiment robust JM conditioned responses (CRs) were observed to a tone-water (CS+) contingency but not to tone-alone (CS-), indicating discriminative JM conditioning. However, the CS-evoked accelerative HR response was not discriminative. Nevertheless, several single-unit discharge patterns were evoked by both tone-water and tone-alone, many of which were uniquely associated with either the CS+ or CS-. In a second experiment, Three separate stimuli, consisting of tone followed by periorbital shock (tone-shock), water (tone-water), and white noise not followed by shock or water, were presented in the same paradigm. Discrimination of conditioned JM, EB and HR changes were observed, i.e. each of these behavioral responses were uniquely associated with the relevant CS presentation. Conditioned bradycardia was evoked by tone-water during the first training session, which changed to tachycardia with further training. However, conditioned bradycardia was evoked by tone-shock throughout training. Different subpopulations of mPFC cells were activated by the tone-shock and tone-water contingencies, but a small group of cells were activated by both.

Anticipating incoming events: an impaired cognitive process in schizophrenia

Intentions are central to guiding actions to their completion because they generate expectations which precede the realization of a task. This ability to manage time was investigated by using a cognitive task which involves several highly integrated processes: sequential learning, explicit processing, and working memory. In this task, participants are required to explicitly learn a repeating color sequence before receiving an instruction to give an anticipatory motor response concerning the next element. Two types of sequences (temporal and spatial) and three experimental conditions were tested in both a group of normal participants and a group of schizophrenic patients. Schizophrenics were included because their condition is known to alter conscious executive function. Our results showed that schizophrenic patients have a strong deficit in performing anticipation tasks. Although they learned the sequences almost normally, their anticipatory ability was reduced in comparison to normal participants in all the tested conditions. These results expand the notion of a working memory deficit in schizophrenia and bear strong implications for understanding executive disorders observed in such patients.

The unity and diversity of executive functions and their contributions to complex "Frontal Lobe" tasks: a latent variable analysis

This individual differences study examined the separability of three often postulated executive functions-mental set shifting ("Shifting"), information updating and monitoring ("Updating"), and inhibition of prepotent responses ("Inhibition")-and their roles in complex "frontal lobe" or "executive" tasks. One hundred thirty-seven college students performed a set of relatively simple experimental tasks that are considered to predominantly tap each target executive function as well as a set of frequently used executive tasks: the Wisconsin Card Sorting Test (WCST), Tower of Hanoi (TOH), random number generation (RNG), operation span, and dual tasking. Confirmatory factor analysis indicated that the three target executive functions are moderately correlated with one another, but are clearly separable. Moreover, structural equation modeling suggested that the three functions contribute differentially to performance on complex executive tasks. Specifically, WCST performance was related most strongly to Shifting, TOH to Inhibition, RNG to Inhibition and Updating, and operation span to Updating. Dual task performance was not related to any of the three target functions. These results suggest that it is important to recognize both the unity and diversity of executive functions and that latent variable analysis is a useful approach to studying the organization and roles of executive functions.