講習会 Key words : Frontal Assessment Battery FAB Behavioural Assessment of the Dysexecutive Syndrome BADS Trail Making Test Stroop Test

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1 講習会 Key words : Frontal Assessment Battery FAB Behavioural Assessment of the Dysexecutive Syndrome BADS Trail Making Test Stroop TestWisconsin Card Sorting Test Tower of Hanoi I. 1 1 goal formation 2 planning 3 carrying out goal directed plans 4 effective performance : 2 : 3 : Japanese Journal of Cognitive Neuroscience

2 : II. 1 Frontal Assessment Battery FAB 2 FAB Go No go 6 2 Behavioural Assessment of the Dysexecutive Syndrome BADS 3 BADS III. 1 1 a 2 2 Trail Making Test A B 1 b B A Stroop test 24 Vol. 12 No

3 1 a : 1 b : Trail Making Test B : : 3psychomotor speed 1 2 : : 158 Japanese Journal of Cognitive Neuroscience

10 1 FAB Montreal Cognitive Assessment MoCA 4 http:// www.mocatest.

pdf FAB 9 MoCA 11 4recursive speculations Wisconsin Card Sorting Test WCST Tower of Hanoi WCST

4 10 1 FAB Montreal Cognitive Assessment MoCA Instructions Japanese_2009.pdf FAB 9 MoCA 11 4recursive speculations Wisconsin Card Sorting Test WCST Tower of Hanoi WCST 3 a 4 4 WCST a : Wisconsin Card Sorting Test WCST Wikepidia 3 b : Tower of Hanoi Wikepidia Tower of Hanoi 3 b Tower of Hanoi Vol. 12 No

5 IV. frontostriate projections dorsolateral prefrontal circuit 5 lateral orbitofrontal circuit anterior cingulate circuit motor circuit : oculomotor circuit : V. 1 : 59 : : CADASIL cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoenceph a lopathy CARASIL cerebral autosomal recessive arteriopathy with subcortical infarcts and leukoencephalopathy : : 2 : 1 HDS R / Japanese Journal of Cognitive Neuroscience

6 2 Clock drawing test CDT : a 3 Wechsler Adult Intelligence Scale Revised : IQ 95 IQ 100 : Rey : 31/ ±2.6 CDT 3 13/ ±4.6 : ±8.4 WCST : 0/6 : MRI T2 FLAIR SPECT ezis : Subcortical ischemic vascular dementia SIVD HDSR 26/30 non amnestic single domain MCI SIVD 2 : 68 : : : 4 Vol. 12 No

: head turning sign ; AD 1 HDS R : 100 7=97 7 3529 9352 3

7 : head turning sign ; AD 1 HDS R : 100 7= /30 2 CDT 4 b : 4 b 20 MRI SPECT : AD WCST 4 a : 1 clock drawing test 4 b : 2 clock drawing test Stroop test AD 8 AD 162 Japanese Journal of Cognitive Neuroscience

8 1 Lezak MD The problem of assessing executive functions. Int J Pshychol 17, Dubois B, Slachevsky A, Litvan I, Pillon B The FAB : a Frontal Assessment Battery at bedside. Neurology 55, Wilson BA, Alderman N, Burgess PW, Emslie H, Evans JJ Behavioural Assessment of the Dysexecutive Syndrome. Bury St Edmunds, England, Thames Valley Test Company. 4 Nasreddine ZS, Phillips NA, Bedirian V, Charbonneau S, Whitehead V, Collin I, Cummings JL, Chertkow H The Montreal Cognitive Assessment MoCA : A Brief Screening Tool For Mild Cognitive Impairment. J Am Geriatr Soc 53, Mega MS, Cummings JL Frontal subcortical circuits and neuropsychiatric disorders. J Neuropsychiatry Clin Neurosci 6, Nyatsanza S, Shetty T, Gregory C, Lough S, Dawson K, Hodges JR A study of stereotypic behaviours in Alzheimer's disease and frontal and temporal variant frontotemporal dementia. J Neurol Neurosurg Psychiatry 74, Zahn R, Moll J, Krueger F, Huey ED, Garrido G, Grafman J Social concepts are represented in the superior anterior temporal cortex. Proc Natl Acad Sci U S A 104, Binetti G, Magni E, Padovani A, Cappa SF, Bianchetti A, Trabucchi M Executive dysfunction in early Alzheimer's disease. J Neurol Neurosurg Psychiatry 60, Vol. 12 No

9 Some hints to understand executive function Toshiya Fukui Showa University Northern Yokohama Hospital Key words : Executive function, Goal formation, Planning, Goal directed, Effective performance, Fronto striate projections Executive function is defined as a brain function dedicated to sustain a proper mental set for the purpose of accomplishing a future goal, and comprises of four steps of 1 the goal formation, 2 planning, 3 goal directed actions and 4 effective performance [Lezak MD 1982]. More specifically, one has first to set a future goal with definite intention, secondly to consider and select most appropriate strategies that should be taken, thirdly to initiate and sustain constantly goal directed actions while adding appropriate amendments to the plans and methods, and finally to organize the most efficient strategies by reviewing the past progresses as well as estimating the extent of future courses still left before reaching the goal. Among various cognitive functions, executive function may be regarded as a higher order function that controls efficiency and purpose directed operations of other subordinate cognitive functions such as memory, language and visuospatial skills. Executive function may be assessed globally by short bedside tests represented by the Frontal Assessment Battery [Dubois B et al. 2000] and more complex and detailed test batteries such as the Behavioural Assessment of the Dysexecutive Syndrome [Wilson BA et al. 1996]. Further, executive function, when taken as a general umbrella term, may comprise of several associated brain functions, each of which represents specific aspect of executive function. Among these functions are 1 divided attention and a capacity to manage multiple and simultaneous tasks that may be tested by the Kana Hiroi phonemic letter picking up Test and the Trail Making Test, 2 capability for mental set shifting assessed by the Stroop Test, 3 psychomotor speed tapped by the semantic or phonemic word fluency test, and 4 abilities in recursive speculations that may be tested by the Wisconsin Card Sorting Test or Tower of Hanoi. Dysexecutive syndrome may be elicited by damage to the dorsolateral prefrontal cortex and/or its projection to the striatum, namely the dorsolateral prefrontal circuit, one of five functional neural circuits between the frontal lobes and the striata. Cognitively associated fronto striate circuits also include the lateral orbitofrontal circuit that is involved in inhibitory control of behaviors, and anterior cingulate circuit that is involved in maintenance of initiatives and interests in the outside milieu. Damage to the former may induce disinhibition and antisocial behaviors, and damage to the latter may cause inertia and apathy. Dysexecutive syndrome may be accompanied by other frontal symptoms such as behavioral and emotional impairment and these additional impairments may alternatively hamper executive function further. 164 Japanese Journal of Cognitive Neuroscience

Vol.0 No. 0 図 Montreal Cognitive AssessmentMoCA orientation visuospatial attention orientation 4 visuospatial executive MMSE MoCA language language me

Vol.0 No. 0 図 Montreal Cognitive AssessmentMoCA orientation visuospatial attention orientation 4 visuospatial executive MMSE MoCA language language me Parkinson 病の認知機能障害を MMSE と MoCA により評価した多施設共同研究 : 慶應 PD データベース Cognitive impairment in Parkinson s disease patients evaluated by the Montreal Cognitive Assessment and the Mini-Mental State Examination.