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Am J Psychiatry 1993; 150:1813-1819
Copyright © 1993 by American Psychiatric Association
Executive impairment among the functionally dependent: comparisons between schizophrenic and elderly subjects
DR Royall, RK Mahurin, JE True, B Anderson, IP Brock 3d, L Freeburger and A Miller
Department of Psychiatry, University of Texas Health Science Center at San Antonio 78284-7792.
OBJECTIVE: Executive deficits have traditionally been associated with
frontal lobe brain damage. They are relevant to a variety of disabling
mental conditions, including schizophrenia and Alzheimer's disease. To
measure these deficits, the authors developed the Executive Interview, a
25-item, 15-minute interview. It has been validated among elderly subjects
across a wide range of functional impairment. METHODS: Forty young,
chronically ill schizophrenic residents of a state mental health facility
and 104 elderly residents, representing three levels of care, of a
comprehensive retirement community were tested with the Executive Interview
and the Mini-Mental State. RESULTS: When age, gender, education, and number
of prescribed medications were controlled, cognitive impairment on the
Executive Interview and Mini-Mental State rose with level of care. The
Executive Interview alone discriminated between subjects at each level of
care, and it was more sensitive to cognitive impairment than the
Mini-Mental State. Executive Interview scores correlated the strongest with
level of care. Mini-Mental State scores, number of prescribed medications,
and age also correlated significantly. Schizophrenic patients showed as
much executive impairment on the Executive Interview as elderly subjects at
the same level of care despite significant differences in age, sex, and
neuroleptic use. Executive Interview and Mini-Mental State scores were
highly correlated among the elderly but less so among the schizophrenic
patients. Cross-group differences were also found in the pattern of failure
on selected Executive Interview items despite similar total Executive
Interview scores. CONCLUSIONS: Increasing executive dyscontrol is
associated with the need for increasing levels of care and supervision.
This finding is neither age nor disease specific. Cross-group differences
on selected Executive Interview items suggest the existence of
disease-specific patterns of failure. Their recognition could prove useful
in the identification of anatomically or pathophysiologically distinct
subgroups among patients with executive dyscontrol.
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