Dysexecutive syndrome (DES) consists of a group of symptoms,[1] usually resulting from brain damage, that fall into cognitive, behavioural and emotional categories and tend to occur together.
The term was introduced by Alan Baddeley[2][3] to describe a common pattern of dysfunction in executive functions, such as planning, abstract thinking, flexibility and behavioural control.
Many of the symptoms can be seen as a direct result of impairment to the central executive component of working memory, which is responsible for attentional control and inhibition.
Impaired planning and reasoning affect the individual's ability to realistically assess and manage the problems of everyday living.
[6] Individuals with dementia, delirium or other severe psychiatric illnesses combined with DES often have disturbed sleep patterns.
Due to multiple impairments of cognitive functioning, there can be much more frustration when expressing certain feelings and understanding how to interpret everyday situations.
Individuals with DES may have higher levels of aggression or anger because they lack abilities that are related to behavioural control.
Utilization behaviour is thought to occur because an action is initiated when an object is seen, but patients with DES lack the central executive control to inhibit acting it out at inappropriate times.
[4] This is logical due to the similarities in executive disruptions that make everyday life difficult for those with schizophrenia and symptoms that form DES.
[2] The effects of DES symptoms on the executive functions and working memory, such as attentiveness, planning and remembering recently learned things, are some of the earliest indicators of Alzheimer's disease and dementia with Lewy bodies.
Studies have also indicated that chronic alcoholism (see Korsakoff's syndrome) can lead to a mild form of DES according to results of BADS.
[11] There is not one specific pattern of damage that leads to DES, as multiple affected brain structures and locations have led to the symptoms.
Assessment of patients with DES can be difficult because traditional tests generally focus on one specific problem for a short period of time.
People with DES can do fairly well on these tests because their problems are related to integrating individual skills into everyday tasks.
These tests assess executive functioning in more complex, real-life situations, which improves their ability to predict day-to-day difficulties of DES.
[2][13] Instructions are given to the participant to read 20 statements describing common problems of everyday life and to rate them according to their personal experience.
[15] Researchers suggest that a number of factors in the executive functioning need to be improved, including self-awareness, goal setting, planning, self-initiation, self-monitoring, self-inhibition, flexibility, and strategic behaviour.
One method for individuals to improve in these areas is to help them plan and carry out actions and intentions through a series of goals and sub-goals.
The final stage, named Initiation, Execution, and Regulation, requires patients to implement their goals in their everyday lives.
Because individuals with this syndrome have trouble integrating information into their actions it is often suggested that they have programmed reminders delivered to a cell phone or pager.
[11] This has led research to investigate the possibility that executive functioning is broken down into multiple processes that are spread throughout the frontal lobe.
[6] Further disagreement comes from the syndrome being based on Baddeley and Hitch's model of working memory and the central executive, which is a hypothetical construct.
The results show that some dysexecutive behaviours are part of everyday life, and the symptoms exist to varying degrees in everyone.
However, for the majority of the population such inattentiveness is manageable, whereas patients with DES experience it to such a degree that daily tasks become difficult.