Dysexecutive Syndrome: Causes, Symptoms And Treatment
The human body is a complex organism capable of carrying out numerous functions and processes. Our nervous system governs the rest of the systems, allowing our survival both when it comes to keeping our body functioning and when carrying out behaviors that allow us to adapt to the environment.
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 correctly due to a problem in the nervous connections that regulate them. One of the possible causes is the so-called dysexecutive syndrome.
We understand executive functions to be the set of higher-order cognitive processes and skills that allow us to integrate the information we receive from the outside, manage our behavior and ultimately adapt efficiently to the environment, in addition to helping to regulate our social behavior and motivation. Aspects such as behavioral inhibition, abstract reasoning, the ability to make decisions or foresee the consequences of our actions are included.
These intellectual abilities and processes are controlled mainly by the largest and most developed part of the cerebral cortex: the frontal lobe. It is in this area, and especially in the area known as prefrontal, where the areas involved in the proper functioning of executive functions are found.
The presence of injuries in this area will cause alterations in executive functions which can have serious consequences for the person’s functioning in all areas of life.
Dysexecutive syndrome
The so-called dysexecutive syndrome, previously known as frontal syndrome, is a set of alterations of diverse typology 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 executive functions, which can secondary cause alterations in other aspects such as communication or personality.
Symptoms can be very variable. With regard to the main higher functions, there is usually a decrease in the ability to inhibit impulses, perseverance due to the inability to change behavior and general difficulties in adapting to variations in the environment. They become inflexible and tend to have difficulty planning, concentrating, organizing and reorganizing information, and keeping things in memory. It is not uncommon for them to have obsessive and/or paranoid thoughts.
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 mood and even to be more aggressive and have difficulty 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, because problems appear 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 depending on the prefrontal region 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 most identified with the word dysexecutive) such as memory problems, reasoning difficulties, decision making, planning and analysis, perseveration and lack of concentration. There are also problems with verbal fluency and even movement. Finally, at a behavioral level they usually present distractibility, lack of motivation, apathy and depressive syndromes.
2. Orbitofrontal syndrome
This subtype of dysexecutive syndrome is caused by lesions in the orbitofrontal. The most obvious symptoms have to do with impulse control, personality change, and difficulties managing social behavior. They tend to be labile, aggressive and irritable, although they can also present dependence and ecosymptoms. They tend to explore the environment tactilely. Moria, or a state of empty, happy mood without internal or external stimulation to explain it, may appear. It is not uncommon for obsessive-compulsive symptoms to appear.
The most common symptoms of this lesion in the mesial circuit are apathy, demotivation and akinetic mutism in which it does not respond to environmental stimulation despite being able to do so if it wants to.
Affectation in different vital areas
Aside 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 lead to the patient’s incapacitation in different aspects.
At a social level, it is likely that their high impulsivity or passivity, and a possible increase in irritability, can cause their environment to end up gradually distancing themselves, leaving the subject isolated. Although they sometimes become more seductive (remember that inhibition is greatly reduced), it is not uncommon for them to have a hard time making new company that goes beyond the superficial and is meaningful to them. In addition, memory problems may arise that make it difficult to recognize your loved ones.
The workplace may also suffer. It is not uncommon for them to lose their job for displaying childish or irresponsible behavior, by not being able to plan and follow a course of action determined in advance or by not being able to adapt to changes. It is also not strange that they depend on other people’s instructions to be able to carry out their functions.
Problems may also appear academically, with possible learning problems derived from injuries and difficulties 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 injuries can appear for different reasons, an example being the following.
Experiencing accidents, physical attacks 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 whose skull was pierced by a steel bar in an explosion, perforating the prefrontal in the process and who ended up suffering from severe behavioral alterations until 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 capable of generating a dysexecutive syndrome by causing the brain to be compressed against the skull.
3. Stroke
Strokes and cerebral hemorrhages in the frontal cortex or in its connections with the rest of the brain can cause dysexecutive syndrome, by suffocating or suffocating the prefrontal neurons responsible for executive functions.
4. Dementia and neurodegenerative diseases
It is common that symptoms of dysexecutive syndrome can be observed in patients with dementia. This is because progressive neuronal death causes the prefrontal to stop functioning properly. Furthermore, 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 the different symptoms can be worked on from a multidisciplinary perspective.
g Generally, treatment is about recovering lost skills as much as possible, alleviate the deficits generated by injuries, enhance preserved skills and look for alternative ways to compensate for possible deficits they present. Stimulation is very important, which is why occupational therapy is usually required to allow mental exercise and recovery of functions. However, hyperstimulation could be counterproductive.
On the other hand, at a pharmacological level, different medications can be used to help overcome problems such as anxiety, possible paranoia and obsessiveness, apathy or depression.
