Reiner 4 Neuroethics 65 Neuroscience has substantially advanced the understanding of how changes in brain biochemistry contribute to mechanisms of tolerance and physical dependence via exposure to addictive drugs. Promoting a brain disease concept is grounded in beneficent and utilitarian thinking: However such claims may yield unintended consequences by fostering discrimination commonly associated with pathology. Specifically, the language of neuroscience used to describe addiction may reduce attitudes such as blame and responsibility while inadvertently identifying addicted persons as neurobiological others.
Learning Objectives This is an advanced level course.
After completing this course, mental health professionals will be able to: Summarize the history of executive functioning EF. Describe the problems involved in the modern concept of EF.
Compare different conceptualizations of EF and outline their commonalities. State the problems associated with the tests used in the clinical assessment of EF. This course is divided into three sections: This course is adapted from several chapters in Dr. Barkley's latest book, Barkley, R.
It is also based in part on content from his latest manual, Barkley, R. These adaptations are done with permission of the publisher. The materials in this course are based on the most accurate information available to the author at the time of writing. The scientific literature on executive functioning grows daily, and new information may emerge that supersedes these course materials.
This course material will equip clinicians to have a basic understanding of the treatments for ADHD in children and adolescents. Section 1 - History of the Concept of EF The history of the concept of executive functioning EF appears to begin more than years ago in the s in the initial efforts by scientists to understand the functions of the frontal lobes generally and the prefrontal cortex specifically Luria, Indeed, its history predates the use of the very term EF by nearly years given that the term EF itself arose out of earlier efforts to understand the neuropsychological functions mediated by the frontal, and especially the prefrontal or premotor, regions of the brain.
Thus, there is an inherent conflating of the term EF with the functions of the prefrontal cortex PFC and vice versa that exists because of this history. Particular attention was paid to the PFC rather than the more obvious, pedestrian, non-executive functions of the primary, secondary, and tertiary motor programming zones of the larger frontal lobes to be found adjacent and more anterior to the sensory-motor strip.
It has also led to a slippage in the discourse on EF between two separate levels of analysis, one being the neuropsychological level involving thought cognitionemotion, and verbal or motor action behavior and the other being the neuro-anatomical level involving the localization of those functions of the former level to specific regions of the brain and their physiological activity Denckla, Moreover, the PFC may well engage in certain neuropsychological functions that would not be considered to fall under the umbrella of EF, such as simple or automatic sensory-motor activities, speech, and olfactory identification.
Early Discoveries Concerning the Functions of the Prefrontal Lobes Luria gives a fine account of the beginning history of the study of the functions of the frontal lobes on which I rely here to convey this historical period. From him we learn that Hughlings Jackson is said to have viewed the PFC as "the highest motor centres" being "the most complex and least organized centres.
According to LuriaBianchi voiced similar views independently of Jackson arguing that the frontal lobes contained the most complex forms of reflex activity organized hierarchically into a series of levels that "bring about the widest coordination of sensory and motor elements, utilize the product of the sensory zones to create mental syntheses, and play the same role in relation to the sensorimotor or kinesthetic zones that the latter play in relation to the subcortical nuclei.
This was the integrative function first attributed to the frontal lobes. It was based largely on animal ablation studies that resulted in a disorganized, fragmented, and unsubordinated character to the behavior of animals that had their PFC extirpated. This caused the animal to "cease to adapt itself to new conditions.
At this same time, others apparently attributed an inhibitory function over the lower divisions of the brain to the frontal lobes based on evidence that frontal ablations often led to a release of lower automatisms.
Noteworthy to Luria was the work of Bekhterev who, in his text, Fundamentals of Brain Function, observed that damaging the frontal lobes resulted in a disintegration of goal-directed behavior, which he saw as the principle function of the PFC.
Damage to the PFC specifically led to a loss of the individual's evaluation of their actions relative to their initial goals. It also led to difficulties correctly evaluating external impressions relative to those goals.
Hence, there was a decline in the purposive and deliberate choice of movements in accordance with such evaluations and goals p.
During the early s, Pavlov also was said to have noted the purposive nature of the PFC and the loss of "the integration of goal-directed movement" as a consequence of damage to this region see p.
By the s, Luria notes, "one of the essential results of destruction of the frontal lobes in animals is a disturbance of the preliminary.
Additional research by others at this time would also show that animals deprived of their PFC were "easily distracted by extraneous stimuli" p. Hence, the integration and execution of goal directed behavior, the inhibition of more automatic actions and reactions to extraneous stimuli distractibilitythe production of delayed reactions, the evaluation of one's goal-directed actions relative to the external environment — especially in novel circumstances — and the overall intentionality or purposive quality of behavior were all functions attributable to the PFC during the first years of the scientific study of its functions.
This makes it easy to understand just how such functions became bundled into the later conceptualization of EF when that specific term eventually arose to describe the neuropsychology of the PFC. Luria noted that published reports of humans suffering damage to various regions of the PFC would likewise have symptoms resembling those observed in animals whose PFC had been experimentally extirpated.
Among the first and most famous of such cases was that of Phineas Gage, the railroad foreman who suffered a penetrating head wound that destroyed a large portion of his PFC. This led to drastic alterations in his behavior, personality, and social conduct Harlow, Like Gage, patients with PFC damage studied in these early years demonstrated a lack of initiative or drive, a curtailing of their circle of interests, profound disturbances of goal-directed behavior, a loss of abstract or categorical behavior, and emotional changes, such as a proneness to irritation, emotional instability, and indifference toward their surroundings, often superimposed on depression.Michael Greger M.D.
FACLM. Michael Greger, M.D. FACLM, is a physician, New York Times bestselling author, and internationally recognized professional speaker on . Prior research suggests that, in addition to general cognitive abilities, executive functions and memory abilities are the two cognitive domains most consistently related to everyday functioning in the older adult population (e.g., Farias et al., ; Mariani et al., ; Rapp & Reischies, ).
Conducted systematic review of the potential adverse effects of caffeine consumption in healthy populations. • Included evaluation of cardiovascular, behavioral, reproductive & developmental, bone & calcium, and acute effects.
An international, peer reviewed, open access journal that focuses on the growing importance of patient preference and adherence throughout the therapeutic continuum. The journal is characterized by the rapid reporting of reviews, original research, modeling and clinical studies across all therapeutic areas.
Patient satisfaction, acceptability, quality of life, compliance, persistence and their. Social isolation, as evidenced by objective indicators such as having a small social network, 1 being unmarried, 2,3 participating in few activities with others, or some combination of these, 7,8 has been associated with increased risk of dementia and cognitive decline in several prospective studies.
In contrast, little is known about the association of dementia with emotional isolation. Cognitive dysfunction is defined as unusually poor mental function. This causes confusion, forgetfulness and difficulty concentrating.
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