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Profilowa analiza dysfunkcji wykonawczych w diagnostyce neuropsychologicznej osób po udarze mózgu

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Jodzio K., Biechowska D., Szurowska E., Gąsecki D.
Roczniki Psychologiczne
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2012
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vol. 15
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issue 3
83-100
PL
Dysfunkcje wykonawcze stanowią stosunkowo nową kategorę diagnostyczną, która obejmuje róźnorakie objawy dezorganizacji zachowania, takie jak utrata umiejętności planowania, inicjowania i kontrolowania podjętych działań. Jedną z najczęstszych przyczyn dysfunkcji wykonawczych jest udar mózgu. W badaniach wzięło udział 43 pacjentów, którzy rozwiązywali pięć zadań przeznaczonych do oceny ogólnej sprawności myślenia problemowego (Test Sortowania Kart z Wisconsin), przełączania uwagi (Test Łączenia Punktów, Test Kontrolowanego Kojarzenia Wyrazów – Fluencji Słownej), samokontroli hamującej reakcje konfliktowe (Test Interferencji Nazw i Kolorów – Stroopa, wystandaryzowane zadanie kontroli motorycznej). Pacjentów przydzielono do trzech podgrup różniących się lokalizację ogniska uszkodzenia mózgu. U wszystkich osób zawał ograniczał się jedynie do przednich, jedynie tylnych bądź jedynie podkorowych części mózgu (głównie prążkowia, wzgórza i / lub torebki wewnętrznej) według oceny topografii uszkodzeń wykrytych za pomocą TK i / lub MR. Zbadano również 25 osób zdrowych. Uzyskane wyniki wykazały, że: (a) zaburzenia wykonawcze po udarze mózgu były zróżnicowane pod względem nasilenia, jak i rodzaju; (b) zaburzona w stopniu najgłębszym okazała się zdolność hamowania automatycznych reakcji ruchowych; (c) pacjenci z uszkodzeniem płatów czołowych lub uszkodzeniem struktur podkorowych mózgu mieli więcej problemów z kontrolowaniem reakcji słownych i ruchowych niż pacjenci z uszkodzeniem części tylnej mózgu; (d) analiza profilowa (czyli analiza wzorca wyników całego badania) jest bardzo przydatna w diagnostyce intraindywidualnie heterogenicznych funkcji wykonawczych. Na przykład stwierdzono silny związek między stopniem dysharmonii wyników testowych a ogólnym nasileniem zaburzeń wykonawczych.
EN
Executive dysfunction (ExD) is a relatively common new diagnostic entity, which includes variety of symptoms of disorganized behavior, such as loss of ability to programming, initiating, and con-trolling ongoing actions. One of the most common origin of ExD is ischaemic stroke. Forty-three patients following unilateral hemispheric stroke were submitted to five tasks of executive functions, which is believed to measure an overall flexibility of problem solving (Wisconsin Card-Sorting Test), ability to switch of attention (Trail Making Test, Controlled Oral Word Association Test), and inhibitory control processes (Stroop Color-Word Test, go/no-go task). Subjects were divided into three anatomically-defined groups. The area of structural damage was limited entirely to the respec-tive frontal lobe, subcortical region (mostly striatum, thalamus, and/or internal capsule) or posterior (non-frontal) cortices. All brain lesions were verified by CT or MR scan. Also, 25 healthy subjects took part in the study. Results showed: (a) patients’ group manifested variety of ExD which were heterogeneous with respect to severity and character, (b) the most severe deficit was disinhibition of automatic response in go/no-go task, (c) the patients with frontal or subcortical lesions had more difficulties controlling (inhibiting) ongoing verbal and motor responses than the patients with posterior cerebral lesions, (d) utility of profile-based analysis (pattern analysis of test scores) was emphasized in diagnosis of intraindividual heterogeneity in executive functioning after stroke. For instance, a strong association was found between extent of intraindividual differences of test scores and the overall severity of ExD.
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Specyfika i dynamika czasowa objawów dysfunkcji wykonawczych po udarze mózgu w świetle badań longitudinalnych

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Jodzio K., Biechowska D., Gąsecki D., Szurowska E.
Polskie Forum Psychologiczne
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2012
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vol. XVII
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issue 2
276-289
EN
Cerebral stroke is the very common cause of executive dysfunctions, such as disinhibition and inability to switch of attention. The aim of this longitudinal study was to determine a clinical characteristic of executive dysfunctions in light of the neuropsychological examinations. Forty-four patients who had ischemic stroke were examined twice with a twelve-month interval. At each session executive functions were measured on the same patients. Executive functioning was measured by three popular tasks, i.e. an experimental version of the Stroop Color- Word Interference Test, Verbal Fluency Test, and Trail Making Test. Twenty-five healthy volunteers were examined once only to transform patients’ results of neuropsychological testing into standardized form. Executive impairment was found in 24 patients (i.e. 65% of the clinical group), who failed to complete at least one of the three tests. Patients manifested executive dysfunctions which were highly heterogeneous with respect to character, severity and their prevalence. Overall, there was clear evidence that executive functions showed substantial recovery. Timecourse of distinct executive dysfunctions was similar.
3
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Executive self-control in patients with arterial hypertension – cognitive and neuroimaging parameters measured with selected neuropsychological tests and fMRI

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Witkowska M. A., Naumczyk P., Jodzio K., Sabisz A., Graff B., Gąsecki D., Szurowska E., Narkiewicz K.
Polish Psychological Bulletin
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2019
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vol. 50
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issue 2
139-148
EN
Background: Arterial hypertension (HTN) ranks among the most widespread chronic illnesses that affect adults in industrialized societies. The main goal of this study was to describe the control (inhibition) processes among HTN patients, and to evaluate the dynamics of brain activity while the patients were engaged in tasks measuring the cognitive aspect of self-control. Participants and procedure: A set of neuropsychological tests (California Verbal Learning Test, Color Trails Test, The Trail Making Test, Controlled Oral Word Association Test), and a fMRI Stroop test (rapid event design) were administered to 40 persons (20 HTN patients and 20 controls). Groups were matched in terms of age, sex, education, smoking history, and waist-to-hip ratio. Results: As revealed by fMRI, the HTN patients demonstrate left-hemisphere asymmetry in inhibitory processes. Also around 90% of patients had problems when completing tasks which rely on verbal and graphomotor aspects of self-control. Conclusions: The results suggest that both cerebral hemispheres must interact correctly in order to provide successful executive control. The deficiencies in control and executive functioning, which were observed among the patients, prove that HTN negatively affects brain processes that control one’s cognitive activity
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