Executive Functions Deficits After Severe Traumatic Brain Injury

Abstract

Behavioral changes were more frequent and severe than cognitive deficits, at least as assessed with traditional testing. The present results also suggest that a shortened battery may provide a rapid screening method with reasonable sensitivity to detect deficits of executive functions in patients with severe traumatic brain injury.

Theory of Mind Impairments Highlighted With an Ecological Performance-Based Test Indicate Behavioral Executive Deficits in Traumatic Brain Injury

“…In our study, disinterest and indifference, social behavior disorders, and irritability-aggressiveness were also very frequent behavioral changes reported by professionals and closest relatives as compared to pre-injury. Estimated rates for disinterest and indifference [49% in this study and 46.3% in the study by Azouvi et al (21)] or irritability-aggressiveness (47 vs. 42.6%) were close to those found by Azouvi et al (21). For social behavior disorders, the estimated rate was higher in our study (49 vs. 24.1%).…”

“…In line with this argument, Laillier et al (64) found that cognitive measures partially mediated the age effect on cognitive and affective ToM performances in healthy subjects using the MASC. In addition, dissociations between cognitive and behavioral assessments have been found in TBI with patients performing within the normal range on the cognitive battery while demonstrating significant behavioral changes (21). Such findings indicate that cognitive and behavioral dysexecutive syndromes may be dissociated (19) and support the hypothesis that behavioral disorders cannot always be explained by cognitive disorders.…”

“…In line with previous findings, and according to the BDSI, more than three quarters of the sample (79%) had dysexecutive behavioral disorders, which is consistent with past findings. In their study, Azouvi et al (21) found a prevalence of 81.5% of behavioral dysexecutive syndrome in a population of individuals with severe TBI, with a very similar distribution in the subdomains of BDSI. Indeed we also observed that reduction of activities, anticipation-planning-initiation disorders, and anosognosia-anosodiaphoria were the most frequent behavioral changes after TBI (frequency of impairment ≥50%).…”

“…Moderate to severe TBI also causes significant behavioral changes that may severely impact participation (19), return to work (20), quality of life (21), and caregiver burden (22). According to a recent review by Milders (23), the incidence of these changes is between 25 and 88% for persons with moderate to severe TBI, with higher prevalence rates associated with more severe TBI.…”

“…According to a recent review by Milders (23), the incidence of these changes is between 25 and 88% for persons with moderate to severe TBI, with higher prevalence rates associated with more severe TBI. These behavioral changes mainly include behavioral executive disorders (19) with, for example, hypoactivity, anticipation difficulty, euphoria, hyperactivity, environmental dependency, anosognosia, confabulation, and sexual conduct disorders [see, for example, (21,24) for a description of the characteristics of the behavioral dysexecutive syndrome in cohorts of patients with severe or moderate to severe TBI].…”