Eksekutiv svikt etter hjerneslag

Abstract

Background Executive function is a major control mechanism of the brain. 50-75% of stroke patients have executive dysfunction.

Aim To describe executive function and the executive dysfunction post stroke. Further to differentiate executive from other cognitive symptoms in stroke patients.

Method Literature searches in McMaster plus, Pubmed, and Cochrane library for articles on executive dysfunction and stroke.

Results Executive function is described by its subcomponents; planning, initiation, organization, problem solving, self-monitoring and error correction. It is closely linked to other cognitive functions such as working memory and psychomotoric speed. Impaired executive function is common in stroke patients and co-exists with other symptoms such as emotional instability and depression. It is correlated to lack of autonomy, and poor post-stroke survival. The anatomical substrate for executive function is the prefrontal cortex and a variety of subcortical pathways, mediated by dynamic and flexible networks. Diagnostic tools aim to screen for executive function by simple clinical tests. Treatment of executive dysfunction after stroke have multiple strategies; compensating, and partly restoring executive function.

Discussion Executive dysfunction after stroke is common, but it also occurs without a clear event. Perhaps executive dysfunction occurs as a continuum in cerebrovascular disease, with acute worsening when a stroke occurs. Lack of a set definition, and difficulty in finding reliable methods to measure executive dysfunction, are some of the major challenges of future research on the subject. Perhaps by combining the advances in brain pathophysiology and clinical studies can we begin to unravel the complexity of executive dysfunction.