Dysexecutive Syndrome: Diagnostic Criteria and Validation Study
Dysexecutive Syndrome: Diagnostic Criteria and Validation Study
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DOI：
10.1002/ana.22117
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发表时间：
2010-12-01
影响因子：
11.2
通讯作者：
Meulemans, Thierry
中科院分区：
文献类型：
--
作者：
Godefroy, Olivier;Azouvi, Philippe;Meulemans, Thierry
目的：执行功能障碍是最常见的认知缺陷之一，但它们仍然定义不清，并受到异质性评估。为了解决这一主要问题，Groupe de Reflexion sur l 'Evaluation des Fonctions Executives（GREFEX）小组提出了行为和认知执行障碍综合征的标准，并设计了一套包括特定异性问卷和7项认知测试的电池。我们调查了患有各种疾病的患者中行为和认知执行障碍的频率以及这些障碍与自主性丧失的关联。方法：共有461名年龄在16至90岁之间的严重创伤性脑损伤、中风、轻度认知障碍、阿尔茨海默病、多发性硬化症、2003年9月至2006年6月，21个中心招募了20名帕金森病患者参加这项前瞻性队列研究。使用GREFEX电池检查行为和认知执行障碍。结果：60%的患者观察到执行障碍综合征，涉及行为和认知领域的26%和分离的34%。所有行为和认知执行障碍歧视（p = 0.001，所有）患者从控制。根据疾病，认知综合征的模式不同（p = 0.0001）。最后，行为（比值比[OR] 4.6; 95%置信区间[CI]，2。3-9.1; p = 0.0001）和认知（OR，3.36; 95% CI，1.7-6.6; p = 0.001）执行障碍综合征和简易精神状态检查评分（OR，0.79; 95% CI，0.68-0.91; p = 0.002）是自主性丧失的独立预测因素。这项研究提供了执行障碍综合征的标准，并表明行为和认知综合征都有助于丧失自主性。患者和疾病的特征各不相同，因此需要参照诊断标准对行为和认知障碍进行系统评估。神经网络2010;68：855-864
Objective: Disorders of executive functions are among the most frequent cognitive deficits, but they remain poorly defined and are subject to heterogeneous assessment. To address this major issue, the Groupe de Reflexion sur l'Evaluation des Fonctions Executives (GREFEX) group has proposed criteria for behavioral and cognitive dysexecutive syndromes and has designed a battery including a specific heteroquestionnaire and 7 cognitive tests. We investigated the frequency of behavioral and cognitive dysexecutive disorders in patients suffering from various diseases and the association or these disorders with loss of autonomy.Methods: A total of 461 patients aged between 16 and 90 years with severe traumatic brain injury, stroke, mild cognitive impairment, Alzheimer disease, multiple sclerosis, and Parkinson disease were recruited into this prospective cohort study by 21 centers between September 2003 and June 2006. Behavioral and cognitive dysexecutive disorders were examined using the GREFEX battery.Results: A dysexecutive syndrome was observed in 60% of patients, concerning both behavioral and cognitive domains in 26% and dissociated in 34%. All behavioral and cognitive dysexecutive disorders discriminated (p = 0.001, all) patients from controls. The pattern of cognitive syndrome differed (p = 0.0001) according to the disease. Finally, behavioral (odds ratio [OR] 4.6; 95% confidence interval [CI], 2. 3-9.1; p = 0.0001) and cognitive (OR, 3.36; 95% CI, 1.7-6.6; p = 0.001) dysexecutive syndromes and Mini Mental State Examination score (OR, 0.79; 95% CI, 0.68-0.91; p = 0.002) were independent predictors of loss of autonomy.Interpretation: This study provided criteria of dysexecutive syndrome and showed that both behavioral and cognitive syndromes contribute to loss of autonomy. Profiles vary across patients and diseases, and therefore systematic assessment of behavioral and cognitive disorders in reference to diagnostic criteria is needed. ANN NEUROL 2010;68:855-864