Dysexecutive syndrome: causes, symptoms and treatment

The human body is a complex organism capable of performing numerous functions and processes.. Our nervous system governs the rest of the systems, allowing our survival both when it comes to keep our body functioning as when carrying out behaviors that allow us to adapt to the half.

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

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executive functions

We understand by executive functions to the set of higher order cognitive processes and abilities that allow us to integrate the information we receive from abroad, manage our behavior and ultimately adapt efficiently to the environment, in addition to helping to regulate our social behavior and the motivation. Aspects such as inhibition of behavior, abstract reasoning, the ability to make decisions or anticipate the consequences of our actions are included.

These intellectual capacities and processes are mainly controlled by the largest and most developed part of the cerebral cortex: the brain. frontal lobe. It is in this area, and especially in the area known as the prefrontal, where the areas involved in the proper functioning of executive functions are found.

The presence of lesions in this area will cause the existence of alterations in executive functions, which can have serious consequences for the functioning of the person in all areas of life.

dysexecutive syndrome

The so-called dysexecutive syndrome, formerly known as frontal syndrome, is a set of alterations of diverse types and severity that occur as a consequence of the existence of lesions in the frontal lobe and especially in the prefrontal area. As can be reflected by its current name, the main affectation occurs in the executive functions, that secondarily can cause alterations in other aspects such as communication or personality.

Symptoms can be highly variable. With regard to the main higher functions, there is usually a decrease in the ability to inhibit impulses, perseverance due to inability to change behavior and difficulties in general to adapt to changes in the environment. They become inflexible and tend to have difficulty planning, concentrating, organizing and rearranging information, and keeping things in memory. It is not uncommon for them to have obsessive thoughts and/or paranoid.

Another aspect that usually presents severe alterations in dysexecutive syndrome is personality. The subject has a tendency to be much more impulsive and irritable, to constantly vary his state of mind mood and even to be more aggressive and present difficulties in adjusting his behavior to the context. This is especially due to alterations of the orbitofrontal prefrontal, linked to social behavior.

Finally, directed behavior becomes much more complex, due to problems when performing sequenced actions and starting and ending actions. It is common for a certain level of apathy and apathy to appear that leaves the subject with little ability to plan and want to do something.

Subdivisions

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

1. dorsolateral syndrome

ANDThis syndrome is caused by lesions in the dorsolateral prefrontal cortex.. It is characterized by the presence of alterations in executive functions (it is the one that is most identified with the word dysexecutive) such such as memory problems, reasoning difficulties, decision making, planning and analysis, perseveration and lack of concentration. There are also problems in verbal fluency and even in movement. Finally, at the behavioral level they usually present distractibility, lack of motivation, apathy and depressive syndromes.

2. orbitofrontal syndrome

This subtype of dysexecutive syndrome is produced by lesions in the orbitofrontal. The most obvious symptoms have to do with impulse control, personality change, and difficulties managing social behavior. They are usually labile, aggressive and irritable, although they can also present dependency and ecosymptoms. They tend to explore the environment by touch. Moria may appear, or an empty happy mood 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 in the mesial circuit are apathy, lack of motivation, and akinetic mutism., in which he does not respond to environmental stimulation despite being able to if he wants to.

Affectation in different vital areas

Apart from the symptoms of the dysexecutive syndrome itself, this disorder usually causes the different domains and vital areas of the subject who suffers from it to suffer significantly. And it is that dysexecutive syndrome can mean the incapacitation of the patient in different aspects.

On a social level, it is likely that their high impulsiveness or passivity, and a possible increase in irritability can cause your environment to end up moving away little by little, leaving the subject isolated. Although they sometimes become more seductive (remember that inhibition is greatly reduced), it is not It's rare for them to have trouble making new companies that go beyond the skin and are meaningful to them. they. In addition, memory problems may arise that make it difficult to recognize loved ones.

The workplace can also suffer. It is not uncommon for them to lose their job for childish or irresponsible behavior, for not being able to plan and follow a course of action determined in advance or for not being able to adapt to changes. Nor is it strange that they depend on instructions from others to be able to perform their functions.

Problems can also appear in academics, with possible learning problems derived from injuries and difficulties in maintaining concentration.

Causes of the syndrome

The appearance of dysexecutive syndrome is due to the presence of alterations or lesions in the prefrontal area or its connections with the rest of the brain. These lesions can appear for different reasons, the following being an example.

1. Lacerations or external trauma

The experience of accidents, physical aggression or falls are some of the most obvious causes of this disorder. In fact, the most famous case of frontal or dysexecutive syndrome is Phineas Gage, a man who had a steel rod impaled through his skull in an explosion piercing the prefrontal in the process and that he ended up suffering from severe behavioral disturbances until the end of his days.

2. Brain tumors

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

3. stroke

Strokes and cerebral hemorrhages in the frontal or in its connections with the rest of the brain can cause dysexecutive syndrome, when the prefrontal neurons in charge of the functions are suffocated or drowned executives.

4. Dementias and neurodegenerative diseases

It is frequent that in patients with dementia the symptoms of dysexecutive syndrome can be observed. This is because the progressive neuronal death causes the prefrontal to stop working properly. In addition, in this case the symptoms tend to get worse as more and more neurons are destroyed. Diseases such as frontal dementia stand out.

Treatment

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

G.Generally, the treatment is about recovering, as much as possible, the lost abilities, alleviate the deficits generated by the injuries, enhance the preserved abilities and look for alternative ways that allow to compensate the possible deficits that they present. Stimulation is very important, which usually requires occupational therapy that allows mental exercise and recovery of functions. However, hyperstimulation could be counterproductive.

On the other hand, at the pharmacological level, different medications can be used to help overcome problems such as anxiety, possible paranoia and obsessiveness, apathy or depression.

Bibliographic references:

• Gomez, M. (2009). dysexecutive syndromes; clinical bases and evaluation.
• Goldberg, E. (2009). The executive brain: frontal lobes and the civilized mind. Criticism.
• Jarne, A. and Aliaga, A. (2010). Manual of forensic neuropsychology: from the clinic to the courts. Edit. Herder.
• Kandel, E.R.; Schwartz, J.H.; Jessell, T.M. (2001). Principles of Neuroscience. Madrid: MacGrawHill.