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Executive functioning

What is executive functioning and how is it measured?

Executive functions are a group of cognitive processes including control, mental flexibility, planning, inhibition, decision-making, initiation, abstraction, self-monitoring and pursuit of goals. Executive functions are important in situations involving error correction and behaviour evaluation in response to environmental feedback

Executive functioning is most commonly measured using the Wisconsin Card Sorting Task (WCST). This task requires the ability to shift cognitive sets. Study participants are told to match stimulus cards containing varying coloured shapes, based first on colour, then quantity, then design. The participant is then given additional cards and asked to match each one without being told any matching rules, so participants usually match according to the previous rule. Feedback is provided as to whether their match was correct or incorrect, based on a new and undisclosed matching rule that changes during the task. Other common tasks assessing executive functioning include the Trail Making Test (TMT), which requires participants to connect, in order, letters and/or numbers as quickly as possible. Also, the Stroop Colour Word Test (SCWT), presents colour names printed in an ink congruent to the colour name (e.g. blue), or incongruent to the colour name (e.g. blue). Participants are asked to either read the word or name the ink colour. Any impairment in executive functioning can also reflect impairments in other cognitive functions such as processing speed, attention and memory.

What is the evidence regarding executive functioning in people with bipolar disorder?

Moderate to high quality evidence finds a medium-sized effect of poorer executive functioning in people with bipolar I or II disorder compared to controls. Poor executive functioning was associated with poor general functioning. There were no changes in performance on executive functioning tasks over time (~4-7 years), indicating a lack of relevant neurodegeneration.

High quality evidence finds a small effect of poorer executive functioning in people with bipolar disorder and a history of psychotic symptoms compared to people with bipolar disorder and no history of psychotic symptoms. There were also small effects of poorer executive functioning in people with bipolar I disorder compared to people with bipolar II disorder, and in overweight people with bipolar disorder compared to normal weight people with bipolar disorder

Moderate quality evidence found no differences in executive functioning between people with bipolar disorder and people with major depression.
High quality evidence finds a small effect of poorer performance on the Stroop test, but not the WCST, in young relatives of people with bipolar disorder compared to controls.

June 2020

Last updated at: 12:04 am, 27th June 2020
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