Dysexecutive

Dysexecutive syndrome refers to a cluster of impairments in executive functions that arise from disruption to frontal lobe networks and their connections, particularly the frontostriatal circuits. It is a term used in neuropsychology and neurology to describe difficulties with higher-level control of behavior, not a single deficit. The syndrome can result from focal frontal lobe damage or diffuse brain injury and may accompany other cognitive or behavioral problems.

Causes and neuroanatomy vary but commonly include traumatic brain injury, stroke affecting frontal regions, tumors, and neurodegenerative diseases with frontal involvement such as frontotemporal dementia. Other contributors can include hydrocephalus, infections, metabolic disorders, or neurosurgical procedures. The underlying neural substrates often involve the dorsolateral prefrontal cortex and its connections with the basal ganglia, as well as orbitofrontal and medial frontal areas related to emotion, social behavior, and motivation.

Core symptoms encompass planning and organization, goal-directed behavior, problem solving, multitasking, and cognitive flexibility. Individuals may have difficulty initiating tasks, monitoring progress, and adapting strategies when problems arise. Deficits in working memory, inhibition, and error detection are common, along with changes in judgment, impulse control, and social behavior. Functional impact frequently appears in daily living activities, work, and social interactions.

Assessment typically includes targeted neuropsychological tests such as the Wisconsin Card Sorting Test, Stroop tasks, Trail Making Test Part B, and the Tower of London, along with rating scales like the Dysexecutive Questionnaire. Functional assessments of daily living complement cognitive testing.

Management focuses on rehabilitation and compensatory strategies. Interventions emphasize structured routines, external aids, explicit problem-solving training, memory and organization strategies, environmental modification, and caregiver education. Pharmacologic treatments are individualized and not universally effective. Prognosis varies with injury extent and location; some improvement occurs with rehabilitation, while significant deficits may persist.