Executive Functioning Tutorial 2024 PDF

Executive Functioning PSYU3344 NEUROPSYCHOLOGY IN CLINICAL PRACTICE Tutorial Outline What is executive functioning? Neuropsychological assessment of executive functioning Conditions affecting executive functioning 2 PART...

Executive Functioning PSYU3344 NEUROPSYCHOLOGY IN CLINICAL PRACTICE Tutorial Outline What is executive functioning? Neuropsychological assessment of executive functioning Conditions affecting executive functioning 2 PART 1 What is executive functioning? What is executive functioning? DEFINITION “Executive functions are self-regulatory functions that organise, direct, and manage other cognitive abilities, emotional responses, and behaviour.” -Burgess and Alderman (2004) Complex set of processes that allow a person to plan and carry out goals, adapt to novel situations, and consider consequences of actions Higher-level cognitive skills 4 What is executive functioning? ASPECTS OF EXECUTIVE FUNCTIONING Inhibition Planning and organisation Cognitive flexibility Concept formation, reasoning, problem solving 5 What is executive functioning? EXECUTIVE FUNCTIONING AND THE FRONTAL LOBES Executive functions are often defined as those functions pertaining to the frontal lobes Most patients who have damage to the frontal lobes experience impairments in executive functioning Impairments in executive functioning are not specific to the frontal lobes Frontal lobe and executive function are not synonymous 6 What is executive functioning? FRONTAL LOBE SYNDROMES Dorsolateral Orbitofrontal Ventromedial Prefrontal Cortex Prefrontal Cortex Prefrontal Cortex Poor problem solving Disinhibition Apathy Poor organisation Impulsivity Emotional blunting Cognitive inflexibility Distractibility Impaired decision Apathy Emotional lability making Decreased emotional range 7 PART 2 Neuropsychological assessment of executive functioning Problems with neuropsychological assessment of executive functioning Neuropsychological assessment may not elicit impairments in executive functioning The structure of the assessment leaves little room for inappropriate behaviour Need to focus on the qualitative assessment findings Need to take into account informant reports of day-to-day functioning Tests also involve non-executive skills Concerns regarding ecological validity 9 Assessment of inhibition WHAT IS INHIBITION? The ability to withhold automatic responding and instead respond in a novel (or less automatic) manner Patients with poor inhibitory control may: Be impulsive Show little self-control Display inappropriate social behaviour 10 Assessment of inhibition STROOP TEST 11 Assessment of inhibition SENTENCE COMPLETION TEST 12 Assessment of planning & organisation WHAT IS PLANNING AND ORGANISATION? Identification of steps and elements needed to achieve a goal Involves conceptualising changes from present circumstances (i.e. looking ahead), dealing objectively with oneself in relation to the environment, conceiving alternatives, weighing up options, and making decisions Assessment includes formal testing plus observing the qualitative features of patients’ responses Patients with poor planning and organisation: Adopt a haphazard approach to tasks Do not think ahead Do not consider various options available 13 Assessment of planning & organisation CLOCK DRAWING 14 Assessment of planning & organisation REY COMPLEX FIGURE TEST 15 Assessment of planning & organisation KEY SEARCH TEST 16 Assessment of cognitive flexibility WHAT IS COGNITIVE FLEXIBILITY? Ability to switch between different ways of responding Adaptive responses to changing situational demands e.g. selecting a new strategy if the first one is not working Patients with poor cognitive flexibility may present with: Very rigid and concrete thinking Perseverative responding Difficulty understanding others’ points of view 17 Assessment of cognitive flexibility TRAIL MAKING TEST 18 Assessment of cognitive flexibility CLOCK DRAWING 19 Assessment of cognitive flexibility SORTING TASK 20 Assessment of concept formation, reasoning, & problem solving WHAT ARE REASONING, CONCEPT FORMATION, & PROBLEM SOLVING? Developing novel concepts and strategies to solve complex problems Using learned concepts and strategies to solve a problem Evaluating performance Considering alternative solutions Thinking in a logical manner Patients with impaired reasoning, concept formation, and problem solving may be unable to: Form categories Generate and implement strategies Correct errors Use feedback Generalise or apply general rules 21 Assessment of concept formation, reasoning, & problem solving SORTING TASK 22 Assessment of concept formation, reasoning, & problem solving SPATIAL ANTICIPATION TASK 23 Assessment of concept formation, reasoning, & problem solving VERBAL FLUENCY 24 Assessment of concept formation, reasoning, & problem solving REASONING BASED ON VERBAL INFORMATION 25 Assessment of concept formation, reasoning, & problem solving REASONING BASED ON NONVERBAL INFORMATION 26 Assessment of concept formation, reasoning, & problem solving TOWER TASK 27 PART 3 Conditions affecting executive functioning Traumatic Brain Injury Impairment in executive functioning is very common as the frontal lobes are particularly vulnerable to TBI due to their location and size Nature and severity of impairments depends on the exact location and severity of brain injury Phineas Gage https://www.youtube.com/watch?v=FCzLEd70n54 29 Frontotemporal Dementia Dementia characterised by early and progressive changes in personality, behaviour, and executive functioning Disinhibition Impulsivity Mental rigidity Perseveration Poor insight Loss of empathy Apathy Donna’s story: https://www.youtube.com/watch?v=AOBPNy7eQcY Schizophrenia Significant impairments in executive functioning compared to normal controls and psychiatric comparison groups Poor cognitive flexibility Impaired planning and organisation Poor insight Changing Minds – The Inside Story Thank you!