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Guarino A, Favieri F, Boncompagni I, Agostini F, Cantone M, Casagrande M. Executive Functions in Alzheimer Disease: A Systematic Review. Front Aging Neurosci 2019; 10:437. [PMID: 30697157 PMCID: PMC6341024 DOI: 10.3389/fnagi.2018.00437] [Citation(s) in RCA: 116] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 12/20/2018] [Indexed: 12/14/2022] Open
Abstract
Alzheimer's disease is a severe irreversible syndrome, characterized by a slow and progressive cognitive decline that interferes with the standard instrumental and essential functions of daily life. Promptly identifying the impairment of particular cognitive functions could be a fundamental condition to limit, through preventive or therapeutic interventions, the functional damages found in this degenerative dementia. This study aims to analyse, through a systematic review of the studies, the sensitivity of four experimental paradigms (Wisconsin Card Sorting Test, Stroop Task, Go/No-Go Task, and Flanker Task) considered as golden standard instruments for executive functions assessment in elderly subjects affected by Alzheimer dementia. This review was carried out according to the PRISMA method. Forty-five studies comparing the executive performance of patients with Alzheimer's dementia (diagnosed according to different classification criteria for dementia) and healthy elderly patients both over the age of sixty, were selected. For the research, PubMed, PsycINFO, PsycArticles databases were used. The study highlighted the importance of using standard protocols to evaluate executive dysfunction in Alzheimer's disease. The Stroop task allows discriminating better between healthy and pathological aging.
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Affiliation(s)
- Angela Guarino
- Dipartimento di Psicologia, Università di Roma "Sapienza", Rome, Italy
| | - Francesca Favieri
- Dipartimento di Psicologia, Università di Roma "Sapienza", Rome, Italy
| | | | | | - Micaela Cantone
- Dipartimento di Psicologia, Università di Roma "Sapienza", Rome, Italy
| | - Maria Casagrande
- Dipartimento di Psicologia Dinamica e Clinica, Università di Roma "Sapienza", Rome, Italy
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Disproportionate Decline of Executive Functions in Early Mild Cognitive Impairment, Late Mild Cognitive Impairment, and Mild Alzheimer's Disease. Dement Neurocogn Disord 2016; 15:159-164. [PMID: 30906359 PMCID: PMC6428012 DOI: 10.12779/dnd.2016.15.4.159] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 12/19/2016] [Accepted: 12/19/2016] [Indexed: 01/14/2023] Open
Abstract
Background and Purpose Many literatures indicate that executive dysfunction exists in mild cognitive impairment (MCI) as well as Alzheimer’s disease (AD). However, there are few studies that found how early the deficits of the executive function (EF) exist in MCI. The present study investigated the presence of executive dysfunctions in the earliest stage of MCI, and the sub-domains of EF which are disproportionately impaired earlier than others. Methods The participants were 41 normal elderly (NE), 86 with amnestic multi-domain MCI, and 41 with mild AD. The MCI group was further sub-divided into two groups: Early MCI (EMCI, n=45) and late MCI (n=41), based on the Clinical Dementia Rating-Sum of Boxes. All participants were given neuropsychological tests to assess the sub-domains of EF, such as verbal fluency, psychomotor speed, inhibitory control, and mental set-shifting. Results Impairment of semantic fluency was observed in EMCI, with gradual worsening as cases approached mild AD. Phonemic fluency and psychomotor speed were also impaired at the early stage of MCI relative to the NE, but maintained at the same level up to mild AD. EMCI exhibited the same degree of performance with NE for inhibitory control and mental set-shifting; however, they progressively worsened from EMCI to mild AD. Conclusions These results suggest that impairments of EF exist even in the earliest stage of the MCI, with a disproportionate decline in the sub-domains of EF.
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Kuzmickienė J, Kaubrys G. Specific Features of Executive Dysfunction in Alzheimer-Type Mild Dementia Based on Computerized Cambridge Neuropsychological Test Automated Battery (CANTAB) Test Results. Med Sci Monit 2016; 22:3605-3613. [PMID: 27717954 PMCID: PMC5063414 DOI: 10.12659/msm.900992] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 09/07/2016] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The primary manifestation of Alzheimer's disease (AD) is decline in memory. Dysexecutive symptoms have tremendous impact on functional activities and quality of life. Data regarding frontal-executive dysfunction in mild AD are controversial. The aim of this study was to assess the presence and specific features of executive dysfunction in mild AD based on Cambridge Neuropsychological Test Automated Battery (CANTAB) results. MATERIAL AND METHODS Fifty newly diagnosed, treatment-naïve, mild, late-onset AD patients (MMSE ≥20, AD group) and 25 control subjects (CG group) were recruited in this prospective, cross-sectional study. The CANTAB tests CRT, SOC, PAL, SWM were used for in-depth cognitive assessment. Comparisons were performed using the t test or Mann-Whitney U test, as appropriate. Correlations were evaluated by Pearson r or Spearman R. Statistical significance was set at p<0.05. RESULTS AD and CG groups did not differ according to age, education, gender, or depression. Few differences were found between groups in the SOC test for performance measures: Mean moves (minimum 3 moves): AD (Rank Sum=2227), CG (Rank Sum=623), p<0.001. However, all SOC test time measures differed significantly between groups: SOC Mean subsequent thinking time (4 moves): AD (Rank Sum=2406), CG (Rank Sum=444), p<0.001. Correlations were weak between executive function (SOC) and episodic/working memory (PAL, SWM) (R=0.01-0.38) or attention/psychomotor speed (CRT) (R=0.02-0.37). CONCLUSIONS Frontal-executive functions are impaired in mild AD patients. Executive dysfunction is highly prominent in time measures, but minimal in performance measures. Executive disorders do not correlate with a decline in episodic and working memory or psychomotor speed in mild AD.
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Blanco Martín E, Ugarriza Serrano I, Elcoroaristizabal Martín X, Galdos Alcelay L, Molano Salazar A, Bereincua Gandarias R, Inglés Borda S, Uterga Valiente JM, Indakoetxea Juanbeltz MB, Moraza Lopez J, Barandiarán Amillano M, Fernández-Martínez M. Dysexecutive syndrome in amnesic mild cognitive impairment: a multicenter study. BMC Neurol 2016; 16:88. [PMID: 27260328 PMCID: PMC4893261 DOI: 10.1186/s12883-016-0607-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 05/21/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Executive functions (EF) in Alzheimer's disease (AD), classically related to the prefrontal cortex, have been forgotten in mild stages, given more importance to temporal lobe associated disorders, such as memory. The study of disexecutive syndrome (DS) has been relegated to advanced stages of the disease. Our goal is to demonstrate that EF are already present in amnesic mild cognitive impairment (aMCI). Furthermore, we are interested in knowing whether poor scores in EF tests are related to the progression to AD or another kind of dementia. METHODS We studied patients with aMCI (n = 81) and healthy controls (n = 142) from neurological departments of several centers of Basque Country with a cross-sectional design. Patients underwent a complete neuropsychological evaluation, neuroimaging testing APOE genotype and 3 year of prospective follow-up. RESULTS In the first visit, patients with aMCI showed more alterations in tests that evaluate EF such as Stroop, trail-making and categorical verbal fluency. More alterations were also found in NPI scale (P <0.05). Stroop and Trail-Making test were not associated with the future development of AD, but fluency (p = 0.01) and apathy (p = 0.031) did. No patient developed a different kind of dementia different from AD. CONCLUSIONS DS is a broad concept not confined to frontal lobes, and can be found in early stages of aMCI. DS impacts negatively on patient autonomy and may have prognostic value.
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Affiliation(s)
- E Blanco Martín
- Department of Neurology, Hospital Universitario Cruces, Barakaldo, Vizcaya, Spain. .,BioCruces Health Research Institute, Barakaldo, Vizcaya, Spain.
| | - I Ugarriza Serrano
- Department of Neurology, Hospital Universitario Cruces, Barakaldo, Vizcaya, Spain
| | | | | | - A Molano Salazar
- Department of Neurology, Hospital Universitario Cruces, Barakaldo, Vizcaya, Spain
| | | | - S Inglés Borda
- Hospital Universitario Álava, Vitoria-Gasteiz, Álava, Spain
| | - J M Uterga Valiente
- Department of Neurology, Hospital Universitario Basurto, Bilbao, Vizcaya, Spain
| | - M B Indakoetxea Juanbeltz
- Department of Neurology, Hospital Universitario Donostia, Donostia-San Sebastian, Guipúzcoa, Spain.,Biodonostia Health Research Institute, Donostia-San Sebastian, Guipúzcoa, Spain
| | - J Moraza Lopez
- Hospital Universitario Álava, Vitoria-Gasteiz, Álava, Spain
| | - M Barandiarán Amillano
- Department of Neurology, Hospital Universitario Donostia, Donostia-San Sebastian, Guipúzcoa, Spain.,Biodonostia Health Research Institute, Donostia-San Sebastian, Guipúzcoa, Spain
| | - M Fernández-Martínez
- Department of Neurology, Hospital Universitario Cruces, Barakaldo, Vizcaya, Spain.,BioCruces Health Research Institute, Barakaldo, Vizcaya, Spain
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