Disexecutive syndrome: causes, symptoms and treatment

The human body is a complex organism capable of performing many functions and processes. Our nervous system governs the rest of the systems, enabling our survival both when it comes to keeping our bodies in working order and when it comes to performing behaviors that allow us to adapt to the environment. .

In the latter sense, higher order processes such as reasoning, decision making, or the ability to plan and predict outcomes are fundamental. However, sometimes these processes stop working due to a problem in the nerve connections that regulate them. One of the possible causes is the so-called dysexecutive syndrome.

    Executive functions

    By executive functions we mean the set of higher-order cognitive processes and skills that allow us to integrate the information we receive from the outside, to manage our behavior and, ultimately, to adapt effectively to it. environment, in addition to “ helping to regulate our social behavior and motivation. It includes aspects such as behavior inhibition, abstract reasoning, the ability to make decisions or predict the consequences of our actions.

    These intellectual capacities and processes are controlled primarily by the largest and most developed part of the cerebral cortex: the frontal lobe. It is in this area, and in particular in the so-called prefrontal one, that the spaces involved in the proper functioning of executive functions are located.

    The presence of injuries in this area will result in the existence of alterations in executive functions, Which can have serious consequences on the functioning of the person in all areas of life.

    Executive syndrome

    The so-called dysexecutive syndrome, formerly known as frontal syndrome, This is a set of alterations of various types and severity that occur as a result of the existence of injuries in the frontal lobe and in particular in the prefrontal region. As its current name may reflect, the primary affectation occurs in executive functions, which, in a secondary way, can cause alterations in other aspects such as communication or personality.

    Symptoms can be very variable. As for the main higher functions, it generally presents a reduced capacity to inhibit impulses, perseverance leads to an inability to change behavior and generally difficulties in adapting to variations in the environment. They become inflexible and tend to have difficulty planning, concentrating, organizing and rearranging information, and keeping things in mind. It is not uncommon for them to have obsessive and / or paranoid thoughts.

    Another aspect that usually exhibits severe alterations in dysexecutive syndrome is the personality. The subject tends to be much more impulsive and irritable, constantly changing his mood, and even more aggressive and having difficulty adapting his behavior to the context. This is notably due to alterations in the orbitofrontal prefrontal, linked to social behavior.

    To finish, directed behavior becomes much more complex, Because there are problems when performing sequenced actions and when starting and ending actions. It is common to develop a certain level of apathy and intimidation which leaves the subject unable to plan and want to do something.

    subdivisions

    Dysexual syndrome can be subdivided into three syndromes depending on the region of the prefrontal that has been injured and the type of symptoms that this injury causes.

    1. Dorsolateral syndrome

    Ethis syndrome is caused by damage to the dorsolateral cortex of the prefrontal cortex. It is characterized by the presence of alterations in executive functions (this is what is most identified with the word disexecutive) such as memory problems, difficulties in reasoning, decision-making, planning and analysis. , perseverance and lack of concentration. There are also problems with verbal fluency and even movement. Finally, at the behavioral level, they often present distractibility, a lack of motivation, apathy and depressive syndromes.

    2. Orbitofrontal syndrome

    This subtype of dysexecutive syndrome is caused by damage to the orbitofrontal region. The most obvious symptoms are related to impulse control, personality change, and difficulty managing social behavior. They are generally labile, aggressive and irritable, although they can also have addictions and ecosystems. They tend to explore the environment with tact. Moria may appear, or the empty mood of empty mood and without internal or external stimulation to explain it. It is not uncommon for obsessive-compulsive symptoms to appear.

    3. Frontal mesial syndrome

    The most common symptoms of this lesion of the mesial circuit are apathy, demotivation and kinetic mutism., In which he does not respond to environmental stimulation although he can if he wishes.

    Impairment in different vital areas

    In addition to the symptoms of dysexecutive syndrome itself, this disorder usually causes significant pain in various areas and vital areas of the subject. And this is it dysexecutive syndrome can lead to incapacity of the patient in different aspects.

    On the social level, it is likely that their strong impulsivity or passivity, and in a possible increase in irritability, can cause their environment to end up gradually receding, leaving the subject isolated. If they sometimes become more alluring (remember that inhibition is greatly reduced), it’s not uncommon for them to find new ventures that go beyond the superficial and make sense to them. In addition, memory problems can occur and make it difficult to recognize your loved ones.

    The work environment can also suffer. It is not uncommon for them to lose their jobs by exhibiting childish or irresponsible behavior, For not being able to plan and follow a predetermined course of action or for not being able to adapt to changes. It is also not uncommon for them to rely on outside instructions to carry out their tasks.

    Problems can arise for academics as well, and there are possible learning issues resulting from injuries and difficulty maintaining focus.

    Causes of the syndrome

    The onset of dysexecutive syndrome is due to the presence of alterations or injuries in the prefrontal area or its connections with the rest of the brain. These injuries can appear for different causes, for example the following.

    1. Lacerations or external trauma

    Experiences of accidents, physical assaults or falls are among the most obvious causes of this disorder. In fact, the most famous case of frontal or dysexecutive syndrome is Phineas Gage, a man whose steel bar pierced his skull in an explosion piercing the prefrontal in the process and who ended up undergoing severe behavioral alterations until at the end of his days.

    2. Brain tumors

    A brain tumor, whether it occurs in the frontal part or in another part of the brain, is able to generate dysexecutive syndrome by causing the brain to compress against the skull.

    3. Stroke

    Strokes and strokes in the frontal or in its connections to the rest of the brain can cause dysexecutive syndrome, suffocating or drowning the prefrontal neurons in charge of executive functions.

    4. Dementias and neurodegenerative diseases

    It is common for patients with dementia to have symptoms of dysexecutive syndrome. In fact, progressive neuronal death causes the prefrontal to stop functioning properly. Again, the symptoms tend to worsen as more and more neurons are destroyed. Diseases such as dementia front stand out.

    treatment

    Dysexecutive or frontal syndrome is a problem that can have different treatments depending on the type of phenomenon that causes it. It does not present a curative treatment, but the different symptoms can be worked on from a multidisciplinary perspective.

    gusually the treatment tries to recover as much of the lost capacity as possible, Mitigate the deficits generated by the injuries, strengthen the preserved capacities and seek alternative routes which allow to compensate the possible deficits which present to. Stimulation is very important, which usually requires occupational therapy to allow mental exercise and recovery of functions. However, hyperstimulation could be counterproductive.

    On the other hand, at the pharmacological level, they can use different drugs to help overcome problems such as possible anxiety, paranoia and obsession, apathy or depression.

    Bibliographical references:

    • Gómez, M. (2009). Disexecutive syndromes; clinical basis and evaluation.
    • Goldberg, I. (2009). The executive brain: frontal lobes and the civilized mind. Critical.
    • Jarne, A. and Aliaga, A. (2010). Manual of Forensic Neuropsychology: From Clinic to Courts .. Edit. Herder.
    • Kandel, ER; Schwartz, JH; Jessell, TM (2001). Principles of neuroscience. Madrird: MacGrawHill.

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