© Aktualn Neurol 2015, 15 (1), p.

11–17
DOI: 10.15557/AN.2015.0002

Anna Rajtar-Zembaty1, Dorota Przewoźnik1, Bogusława Bober-Płonka2,3, Received: 26.03.2015

Accepted: 14.04.2015
Anna Starowicz-Filip1, Jakub Rajtar-Zembaty4, Ryszard Nowak3, Ryszard Przewłocki2,5 Published: 30.04.2015

Application of the Trail Making Test in the assessment of cognitive flexibility

in patients with speech disorders after ischaemic cerebral stroke
Zastosowanie Testu Łączenia Punktów do oceny elastyczności poznawczej u chorych
z zaburzeniami mowy po udarze mózgu
1
Department of Psychiatry, Jagiellonian University Medical College
2
Department of Neuroscience and Neuropsychology, Institute of Applied Psychology, Jagiellonian University
3
Department of Neurology and Cerebral Strokes, Ludwik Rydygier Specialist Hospital
4
University School of Physical Education in Krakow
5
Department of Molecular Neuropharmacology, Institute of Pharmacology
Correspondence: Anna Rajtar-Zembaty, Katedra Psychiatrii Wydziału Lekarskiego Uniwersytetu Jagiellońskiego, ul. Mikołaja Kopernika 21 A, 31-501 Kraków, e-mail: [email protected]

The main aim of this study was to evaluate the level of cognitive flexibility in patients with speech disorders after ischaemic
Abstract cerebral stroke. The study was conducted in a group of 43 patients (18 women and 25 men) who had experienced cerebral
ischaemic stroke. The patients under study were divided into groups based on the type of speech disorders, i.e.: aphasia, lack
of speech disorders and dysarthria. A Mini-Mental State Examination (MMSE) and a Clock Drawing Test (CDT) were
applied for the general evaluation of the efficiency of cognitive functions. Cognitive flexibility – a component of executive
functions, was evaluated with the use of a Trail Making Test (TMT). The results obtained prove that patients with aphasia
show the lowest level of cognitive flexibility. Disorders of executive functions can be related to the dysfunction of the
prefrontal cortex which has been damaged as a result of ischaemic cerebral stroke. Presumably, there are common functional
neuroanatomical circuits for both language skills and components of executive functions. In the case of damage to the
structures that are of key importance for both skills, language and executive dysfunctions can therefore occur in parallel.
The presence of executive dysfunctions in patients with aphasia can additionally impede the functioning of the patient, and
also negatively influence the process of rehabilitation the aim of which is to improve the efficiency of communication.

Key words: aphasia, executive functions, cognitive flexibility, stroke, dysarthria

Nadrzędnym celem pracy było określenie poziomu elastyczności poznawczej za pomocą Testu Łączenia Punktów (Trail
Streszczenie Making Test, TMT) u chorych z zaburzeniami mowy po udarze mózgu. Badaniem objęto 43 chorych (18 kobiet oraz
25 mężczyzn) z niedokrwiennym udarem mózgu. Badanych przydzielono do trzech grup w zależności od rodzaju zaburzenia
mowy: chorych z afazją, brakiem afazji i dyzartrią. Do oceny ogólnej sprawności funkcji poznawczych zastosowano Krótką
Skalę Oceny Stanu Psychicznego (Mini-Mental State Examination, MMSE) oraz Test Rysowania Zegara (Clock Drawing Test,
CDT). Elastyczność poznawcza była badana przy użyciu Testu Łączenia Punktów. Uzyskane wyniki wykazały, że chorzy
z afazją wykazują najniższy poziom elastyczności poznawczej. Zaburzenia elastyczności poznawczej mogą być związane
z dysfunkcją kory przedczołowej, która uległa uszkodzeniu w wyniku niedokrwiennego udaru mózgu. Przypuszczalnie dla
umiejętności językowych i komponentów funkcji wykonawczych istnieją wspólne neuroanatomiczne obwody funkcjonalne.
Stąd w przypadku uszkodzenia kluczowych dla obu zdolności struktur dysfunkcje językowe i wykonawcze mogą występować
paralelnie. Współwystępowanie deficytów poznawczych u chorych z afazją może dodatkowo utrudniać funkcjonowanie
chorego, a także mieć negatywny wpływ na proces rehabilitacji sprawności porozumiewania się.

Słowa kluczowe: afazja, funkcje wykonawcze, elastyczność poznawcza, udar mózgu, dyzartria

11
© Medical Communications Sp. z o.o. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives
License (CC BY-NC-ND). Reproduction is permitted for personal, educational, non-commercial use, provided that the original article is in whole, unmodified, and properly cited.
 Anna Rajtar-Zembaty, Dorota Przewoźnik, Bogusława Bober-Płonka, Anna Starowicz-Filip, Jakub Rajtar-Zembaty, Ryszard Nowak, Ryszard Przewłocki

INTRODUCTION follows: total aphasia – 32%, amnestic aphasia – 25%, Wer-

A
nicke’s aphasia – 16%, Broca’s aphasia – 12%, transcortical
Trail Making Test (TMT) derives from Halstead– sensory aphasia – 7%, conduction aphasia – 5% and trans-
Reitan Neuropsychological Battery. TMT is used cortical motor aphasia – 2% (Pedersen et al., 2004). In apha-
for the measurement of the skills of visual and spa- sia, depending on the location of damage, changes consist
tial search, operative memory and executive functions in in the loss or impairment of creating and/or understanding
the scope of prolonged concentration and smooth alternat- spoken and written language. Recent theoretical consider-
ing attention between two tasks performed simultaneous- ations and study results suggest that the deterioration of ex-
ly (cognitive flexibility). Cognitive flexibility is one of the ecutive functions is a frequent neuropsychological deficit in
components of executive functions, next to initiating and patients with aphasia (Purdy, 2002). What is more, the stud-
planning activities (Friedman and Miyake, 2000). Execu- ies involving healthy individuals confirm that the efficiency
tive functions are involved in situations in which automat- of executive functions is correlated with the speed of nam-
ic behaviour in response to an external impulse is replaced ing objects (Shao et al., 2012), verbal fluency (Constantini-
by a planned behaviour and by one that is related to the ex- dou et al., 2012) and the ability to make sentences (Engel-
tinction or delay of a reaction (Norman and Shallice, 2000). hardt et al., 2013).
In the literature on the subject, there is no consensus as to Other speech disorders, namely dysarthrias, are also fre-
the issue of identifying neuronal structures responsible for quently related to the damage within the subcortical struc-
cognitive processes related to executive functions (Jodzio, tures of the brain. Dysarthria is defined as impaired abili-
2008). Executive skills require activity and coordination be- ty to produce articulated speech sounds as a result of the
tween scattered areas of the brain, which is indispensable disruption of neural mechanisms for creating and modu-
in order to achieve such a wide scope of mental activities lating: volume, shape and resonance of voice. Patients with
(Rajtar et al., 2014). Executive functions are mainly associ- dysarthria, in contrast to patients with aphasia, understand
ated with the neuronal activity within the frontal lobes, and speech and have no difficulty in formulating speech, al-
specifically within the dorsolateral prefrontal cortex (Alva- though pronunciation itself is impaired.
rez and Emory, 2006; Stuss and Alexander, 2000; Zakzanis In the literature on the subject there are very few studies on
et al., 2005). However, more and more researchers stress the executive functions in patients with dysarthria. Research-
interaction of numerous brain structures in regulating ex- ers such as Sterling et al. (2010), having assessed executive
ecutive functions, both those localised in the frontal lobes functions in patients with dysarthria, pointed out that the
and the subcortical structures (Niendam et al., 2012). Re- deterioration of their results was exclusively related to the
cent empirical data indicate that one of the most frequent slower work pace which resulted from the general slowness
causes of executive dysfunctions is cerebral stroke involv- of movement in this group of patients. In the light of the
ing the areas of the frontal lobes of the brain and subcorti- above findings, attention was drawn to the non-homoge-
cal structures which project into this cortex (Jodzio et al., nous nature of the symptoms of executive dysfunctions and
2012). The frequency of occurrence of executive function an attempt was made to separate the key component – cog-
disorders in patients after stroke ranges from 10 to 63%, nitive flexibility. The purpose of the study was to compare
depending on the scope of methods applied (Grau-Oliva- cognitive flexibility in patients with speech disorders (apha-
res et al., 2007; Nys et al., 2005; Pohjasvaara et al., 2002; Su sia and dysarthria) after cerebral stroke, which are the con-
et al., 2007; Zinn et al., 2007). Moreover, attention has to sequences of ischaemic lesions located in various brain
be drawn to the fact that in the recent years, researchers regions.
are more and more interested in the issues of the coexis-
tence of non-linguistic cognitive and behavioural dysfunc- MATERIAL AND METHOD
tions in patients with speech disorders after ischaemic cere-
bral stroke (Seniów et al., 2009). In neuropsychology, it has The study included 43 patients (18 women and 25 men)
been pointed out for a long time that damage to the pre- with diagnosed ischaemic cerebral stroke, hospitalised at
frontal areas results in the disintegration of complex cogni- the Department of Neurology and Cerebral Strokes with
tive (executive as well as linguistic), volitional, motivation- a Subdivision for Cerebral Strokes in Ludwik Rydygier Spe-
al and emotional functions. In the case of a blood supply cialist Hospital in Krakow. The study included demograph-
pathology within the forebrain, the coexistence of focal ic data, such as: sex, age and level of education, as well as
cognitive disorders and acquired speech disorders, such as clinical data taking into account the ischaemic lesion loca-
aphasia and dysarthria, is quite frequent. Despite varied ae- tion, type of speech disorder and the time that has passed
tiopathogeneses, cerebral stroke is the most frequent cause since the occurrence of the vascular accident. The inclu-
of aphasia which is believed to affect over a half of patients sion criterion was ischaemic cerebral stroke. The exclusion
after stroke (Pąchalska, 2011). The frequency of occurrence criteria were: poor nonverbal communication skills, coex-
of post-cerebral aphasia is estimated at 21–38% (Ryglewicz istence of other diseases and disorders that can affect the
and Milewska, 2004). The prevalence of various types of variables studied, i.e. consciousness disturbances, psycho-
aphasia as a consequence of the first cerebral stroke is as sis, dementia diagnosed before stroke, alcoholic disease,
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DOI: 10.15557/AN.2015.0002 AKTUALN NEUROL 2015, 15 (1), p. 11–17
 Application of the Trail Making Test in the assessment of cognitive flexibility in patients with speech disorders after ischaemic cerebral stroke

post-traumatic cognitive deficits, post-stroke movement (expressed in seconds) for each part, A and B, was also
(e.g. paresis handedness) or visual perceptron deficits (e.g. taken into account.
amblyopia, alexia, agnosia) making it impossible to carry
out neuropsychological tests. Statistical analysis
In a cross-sectional study, a group of patients was exam-
ined at one point in time to compare the level of cognitive The calculations in this study were made with the use
function efficiency in patients with various speech disor- a STATISTICA v 9.0 PL package. The comparisons between
ders. The study was carried out over a period of 12 months. the groups were made using a single-factor analysis of vari-
Patients were recruited for the study according to the or- ance, as more than two groups were compared. In order
der of admission to hospital. Patients with a clinical diag- to establish statistically significant differences between the
nosis of ischaemic stroke and who met the criteria were in- groups, multiple comparisons of the average results were
cluded in the study. The presence and location of a defect made according to Tukey method. The variables at a nom-
was confirmed in computed tomography (CT) recommend- inal scale were described by the multiplicity and the corre-
ed by a radiologist. Patients were divided into three groups sponding percentage. All statistical hypotheses were verified
according to the type of speech disorder: a) patients with at the significance level of α = 0.05.
aphasia, b) patients without disorders of speech, and c) pa- In order to select the type of measurement, an analysis of
tients with dysarthria. An experienced clinical neuropsy- the variables under study was carried out, which proved
chologist, neurologist and a speech therapist confirmed the that the hypothesis of normal distribution has to be partly
diagnosis of a speech disorder. This study included patients rejected. Due to the fact that the variance analysis is “re-
with non-fluent forms of aphasia: motor (Broca’s) aphasia sistant” to the breaking of the assumption concerning nor-
and transcortical motor aphasia, which are usually the con- mal distribution and that in the study, small groups were
sequences of damage to the frontal lobe. The research was compared in terms of variables, which in theory have the
carried out as part of research project Demeter, with the normal distribution, and that the assumption concerning
approval of the Ethics Committee at the local Chamber of homogeneity of variance was met, parametric tests were
Krakow – No. 12/KBL/2010 of 26 January 2011. applied for all the variables compared.
For the assessment of the general efficiency of cognitive
functions, the following were applied: a Mini-Mental State Descriptive statistics
Examination (MMSE) and Clock Drawing Test. A Trail
Making Test (TMT) was used to assess psychomotor skills The group under study consisted of persons aged 42 to 87,
(part A) as well as working memory and cognitive flexi- with average age M = 66. The study included more men
bility (part B). TMT consists of two parts assessed sepa- (58%) than women (42%). The most numerous group con-
rately (A and B). In part A, there are 25 circles numbered sisted of persons with secondary education (40%) and vo-
from 1 to 25 in a white sheet of paper while in part B there cational education (30%). The average time of examination
are 25 circles marked with numbers from 1 to 13 and with was 3.5 days after stroke (from 1 to 7 days). In almost a half
letters from A to L. In part A, the task of the subject is to of the cases, stroke affected the left hemisphere. Aphasia
connect the dots with a solid line in numerical order as was noted in 42% of the persons examined and dysarthria –
fast as possible. In part B, the subject has to, as fast as pos- in 26%. In every third person no speech disorders occurred.
sible, connect with a solid line the digits with the subse- Motor aphasia (Broca’s aphasia) was diagnosed in 61% of
quent letters of the alphabet in the following alternating the patients, and transcortical motor aphasia – in 39% of the
order: 1 – A – 2 – B – 3 – C – 4 – D etc. In the assessment patients. Frontal lobe damage was noted in 42% of the per-
of the test results, the time (in seconds) needed to com- sons examined, subcortical structure damage – in 33% of
plete the task and the number of mistakes made (Reitan, the patients, and in every fourth person the damage to the
1955) are assessed. A result of part B is a sensitive indica- cortex of the posterior part of the cerebral hemispheres was
tor of a dysfunction within cognitive flexibility – a compo- found. A radiologist confirmed the location of the damage
nent of executive functions (Kortte et al., 2002; Lee at al., in a CT scan, while a neurologist and a clinical psychologist
2014; Salthouse, 2011). Furthermore, some authors suggest confirmed speech disorders. The clinical and demographic
that the B/A ratio should be taken into account in order to data are compiled in Tab. 1.
reflect the efficiency of executive functions more precise-
ly. In their opinions, the psychomotor component, mea- RESULTS
sured in part A of the TMT, is then eliminated (O’Rourke
et al., 2011). Therefore, the longer the time needed to com- According to the data presented in Tab. 2, it appears that
plete part B in comparison to that in part A (and, at the the groups with different types of speech disorders did not
same time, the higher the B/A ratio), the worse the re- differ in respect of age and a day after stroke. Similarly, no
sult of cognitive flexibility testing. The study included the differences were found between the examined persons with
score of components A and B, the B/A ratio and the num- various speech disorders with respect to cognitive efficiency
ber of mistakes in Part B. Moreover, the execution time measured with the use of screening methods of assessment
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AKTUALN NEUROL 2015, 15 (1), p. 11–17 DOI: 10.15557/AN.2015.0002
 Anna Rajtar-Zembaty, Dorota Przewoźnik, Bogusława Bober-Płonka, Anna Starowicz-Filip, Jakub Rajtar-Zembaty, Ryszard Nowak, Ryszard Przewłocki

(MMSE, Clock Drawing Test) (Tab. 3). In the analysed sub- average time in part B to the average time in part A was
groups of patients, no differences were observed in the av- different in the groups with different speech disorder types
erage time of completing the Trail Making Test, both in part (p < 0.001). Multiple comparisons with the use of Tukey
A and B, and in the number of mistakes made. The only dif- method proved that the persons with aphasia demonstrat-
ferences observed between the examined persons with dif- ed a lower level of flexibility in comparison to the persons
ferent types of speech disorders concerned part B to part without aphasia (p = 0.003) and in comparison to the per-
A ratio in the Trail Making Test (Tab. 4). The ratio of the sons with dysarthria (p = 0.002).

Group with aphasia Group with no aphasia Group with dysarthria

(n = 18) (n = 14) (n = 11)
Variable Category
M (SD) M (SD) M (SD)
N (%) N (%) N (%)
gap gap gap
65.9 (10) 66.6 (13) 63.6 (10)
Age 48–86 44–87 42–79
Higher 2 (11.1) 2 (14.3) -
Vocational 6 (33.3) 3 (21.4) 4 (36.4)
Education level Secondary 8 (44.4) 6 (42.8) 3 (27.3)
Primary 1 (5.5) 2 (14.3) 1 (9.1)
Technical 1 (5.5) 1 (7.1) 3 (27.3)
4.2 (2) 3.2 (2) 3.1 (2)
Number of days after stroke 1–7 1–7 1–7
Left 14 (77.8) 1 (7.1) 6 (54.5)
Hemisphere Right - 11 (78.6) 4 (36.4)
Bi-hemispheric 4 (22.2) 2 (14.3) 1 (9.1)
KP 11 (61.1) 4 (28.6) 4 (36.4)
Location KT 4 (22.2) 4 (28.6) 2 (18.2)
of the damage
SP 3 (16.7) 6 (42.8) 5 (45.4)
Source: author’s own material based on the test results obtained.
N – multiplicity, % – percentage of the whole, M – average, SD – standard deviation.
KP – persons with the damage to the frontal cerebral lobes; KT – persons with the damage to the cortex of the posterior parts of the cerebral hemispheres; SP – persons with
the damage to the subcortical structures of the brain.
Tab. 1. Characteristics of the group under study divided into subgroups based on the type of speech disorders

Aphasia No aphasia Dysarthria Effect strength

Test F(2.40) p
(n = 18) (n = 11) (n = 14) (h2)
Age 65.9 (9.63) 66.4 (12.65) 63,64 (10.14) 0.25 0.01 0.776
Day 3.6 (1.97) 4.27 (2.19) 3.21 (1.31) 1.89 0.09 0.165
Source: author’s own material based on the test results obtained.
Tab. 2. Comparison of the group divided into subgroups according to the type of speech disorders with respect to age and a day after stroke

Aphasia No aphasia Dysarthria Effect Strength

Test F(2.40) p
(n = 18) (n = 14) (n = 11) (h2)
MMSE 23.78 (5.05) 26.57 (3.98) 24.82 (5.55) 1.30 0.06 0.283
Clock Test 7.83 (1.92) 8.79 (1.63) 7.09 (2.51) 2.27 0.10 0.116
Source: author’s own material based on the test results obtained.
MMSE – Mini-Mental State Examination; Clock Test – Clock Drawing Test.
Tab. 3. Level of efficiency of cognitive functions in patients after cerebral stroke divided into subgroups according to the type of speech disorders
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DOI: 10.15557/AN.2015.0002 AKTUALN NEUROL 2015, 15 (1), p. 11–17
 Application of the Trail Making Test in the assessment of cognitive flexibility in patients with speech disorders after ischaemic cerebral stroke

Aphasia No aphasia Dysarthria Effect strength

Test F(2.40) p
(n = 18) (n = 14) (n = 11) (h2)

TMT (A) 75.39 (27.9) 70.57 (34.3) 101.2 (49.8) 2.46 0.11 0.098

TMT (B) 313.7 (130.6) 219.7 (140.0) 276.5 (144.6) 1.85 0.08 0.171

TMT (B/A) 4.29 (1.47) 2.91 (0.82) 2.70 (0.54) 9.52 0.32 <0.001

TMT-number of mistakes 4.89 (4.57) 4.64 (5.77) 5.00 (4.63) 0.02 0.00 0.983

Source: author’s own material based on the test results obtained.

TMT – Trail Making Test; TMT A – average time of completion (s); TMT B – average time of completion (s); B/A ratio of average time (s) from part A to part B of the TMT.
Tab. 4. Level of the efficiency of executive functions in patients after cerebral stroke divided into subgroups according to the type of speech
disorders

DISCUSSION application of functional neuroimaging in healthy adults

proved that performing part B of the TMT is related to
The purpose of this study was to compare the skill of cog- the greater activity of the frontal lobe within the left dor-
nitive flexibility as a component of executive functions solateral prefrontal cortex compared to part A of this test
in patients with speech disorders after cerebral stroke. (Zakzanis et al., 2005). Similarly, patients with focal cere-
The verification of the significance of the differences be- bral damage located in the frontal lobes perform part B
tween the groups in the test assessing the level of cogni- with significantly worse results in comparison to part A.
tive flexibility proved that the persons with aphasia found What is more, it was proven that significantly worse per-
it more difficult to solve part B compared to part A of the formance of the test is observed in patients with dorsolat-
Trail Making Test (TMT). Motor aphasia and transcorti- eral prefrontal cortex damage in comparison to patients
cal motor aphasia are most frequently the consequences with damage to the orbitomedial prefrontal cortex (Stuss
of the damage to the lower areas of the left frontal part of et al., 2001). As some authors argue, the ratio of the time
the brain. This allows one to presume that the noticeable needed to complete part B to the time needed to finish
relation between cognitive flexibility dysfunctions and part A (B/A) enables one to assess the efficiency of cogni-
the occurrence of motor aphasia disorders results from tive functions more precisely, as the disruptive influence
the functional and anatomical interdependence of the two of the psychomotor component measured in part A of the
types of disorders. The most significant result of the tests test is eliminated (O’Rourke et al., 2011). This dependence
was that the patients with aphasia demonstrated a signif- was also observed in this study when comparing the aver-
icantly lower level of flexibility, i.e. the ability to switch age time in both tests and the ratio of part B to part A in
from one task or mental state to another carried out or oc- the groups examined. The patients with dysarthria spent
curring simultaneously. The relation between the disor- more time performing both part B and part A of the test,
ders in the scope of cognitive flexibility and aphasia was al- and therefore no significant differences were observed af-
ready noted by Purdy (2002). She pointed out that patients ter taking into account the part B to part A ratio. Poor-
with aphasia performed tasks involving cognitive flexibil- er results in both parts can be related to a slower pace of
ity less efficiently. Such conclusions were drawn after tak- work resulting from general psychomotor impairment in
ing into account the precision and effectiveness of perfor- patients with dysarthria. Sterling et al. (2010) drew similar
mance rather than the pace of work. However, the author conclusions after comparing the results obtained in a wide
did not undertake to characterise the group under study range of neuropsychological tests in patients with dysar-
either in respect of the type of aphasia or the location of thria and in the control group. The authors observed that
brain damage. The TMT selected in this study is current- poorer results in executive tests (inter alia, in both parts of
ly a frequently used method for the assessment of the ef- the TMT) are found when the time of completion, which
ficiency of cognitive flexibility in persons after cerebral is longer in the group of patients with general motor re-
stroke. It is believed that part A of this test is to a larger tardation, is taken into consideration in the assessment.
extent used for the assessment of psychomotor skills while Dysarthria generally occurs as a result of damage to the
part B is used for the assessment of working memory and motor area of the cortex, pyramidal and extrapyramidal
the skill of alternating attention between tasks being per- tracts, medulla oblongata or cerebellum, and not as a re-
formed, i.e. cognitive flexibility. Due to the fact that exec- sult of damage to the lower parts of the frontal cortex, as
utive functions to a large extent depend on the activity of in the case of patients with aphasia. Therefore, psychomo-
the frontal lobes, part B of the test is more sensitive in de- tor retardation can result from damage to the subcortical
tecting damage just within these lobes. Studies with the structures and cortical-subcortical tracts. This observation
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AKTUALN NEUROL 2015, 15 (1), p. 11–17 DOI: 10.15557/AN.2015.0002
 Anna Rajtar-Zembaty, Dorota Przewoźnik, Bogusława Bober-Płonka, Anna Starowicz-Filip, Jakub Rajtar-Zembaty, Ryszard Nowak, Ryszard Przewłocki

can be useful in diagnosing executive dysfunctions in pa- the average results of both tests, conducted in patients af-
tients with a pathology within the subcortical structures ter stroke, did not differ in a significant way between the
of the brain. groups with different speech disorders.
Beside cognitive flexibility, another key component of ex- In the light of the studies carried out and the conclusions
ecutive functions is the control of extinction. The loss of formulated by other authors, executive dysfunctions char-
inhibition is manifested in the form of unsuppressed and acterised by specific symptoms of behavioural disorganisa-
disorganised reactions. The lack of flexible suppression of tion are undoubtedly a frequently occurring neuropsycho-
impulsive reactions makes reactions and the course of men- logical deficit in persons after cerebral stroke. The clinical
tal processes rigid, causing perseveration in behaviour. Be- manifestation of focal cognitive behavioural syndromes in
havioural symptoms, such as hyperactivity, increased sus- the acute phase of the illness after focal, non-progressive
ceptibility to distraction, impulsiveness, perseveration and brain damage, primarily depends on the location of the
stereotypic reactions, were presented by Godefroy (2003). damage. Despite the fact that there is no consensus as to
The inhibition assessment is also performed with the use the manner of defining “executive” functions, which are fre-
of the TMT, the performance of which requires efficien- quently incorrectly defined as “frontal” functions, cognitive
cy of various cognitive modalities. That is why this test dysfunctions are most frequently the consequences of dam-
is a very sensitive tool for detecting mental rigidity men- aging the frontal lobes (Stuss and Alexander, 2000). Patients
tioned above. If the problem with inhibition causes diffi- with motor aphasia and transcortical motor aphasia find
culties in suppressing reactions, and hence retardation and it difficult to perform tasks involving cognitive flexibility.
tendencies to perseveration, the deficits in cognitive flex- These actions are undoubtedly connected with speech gen-
ibility can impede accepting, maintaining and changing eration processes. In the light of the above considerations,
the mental attitude in the course of performing equivalent effective communication depends on the integrity of exec-
tasks. Other studies also indicate the relation between inhi- utive functions. Despite numerous clinical data as well as
bition and linguistic functions. Deficits in storing semantic the results obtained in this study concerning the co-occur-
information in short-term memory can be related to a dis- rence of executive dysfunctions and aphasia, there are still
order in inhibition. It is believed that the weakening of the no explicit conclusions that would explain anatomical and
ability to extinct insignificant utterances impede the search functional correlates of these disorders. It is possible that
for and selection of appropriate responses, which results future studies, combining the paradigm of linguistic com-
in the deterioration of speech fluency (Martin and Allen, munication and cognitive neuropsychology, will broaden
2008). Almaghyuli et al. (2012) also stress the role of ex- the knowledge of the cerebral mechanisms of the most com-
ecutive functions in the processes of controlling semantic plicated cognitive functions in human beings.
processing. They observed that patients with aphasia show
deficits in suppressing false associations, that is why their Conflict of interest
performance in a task consisting in providing synonyms of The authors do not report any financial or personal links with other per-
words that are more common is poorer than doing so with sons or organizations, which might affect negatively the content of this
words that occur more rarely. The authors explain this phe- publication or claim authorship rights to this publication.
nomenon claiming that executive functions are to a great-
er degree involved in choosing synonyms for the words that
occur more frequently, which is related to the selective con-
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Neuroscience R&D Technologies Conference

3–4 December 2015
Barcelona, Spain

In the last financial year, massive investments have come back in both drug development as well as non-invasive
therapies like neuromodulation and deep brain stimulation. Advances in modern brain imaging, neuroinformatics
and animal models have been discussed at length but how can they be applied to screen and validate compounds,
devices and other treatments at an early developmental stage?

MnM Conferences is organising the Neuroscience R&D Technologies Conference on 3rd & 4th December
in Barcelona, Spain to help answer the important questions in neuroscience research.
For more info please email [email protected]

Website:
http://www.mnmconferences.com/neuroscience-r-and-d-technologies-conference.html
Contact:
[email protected]
17
AKTUALN NEUROL 2015, 15 (1), p. 11–17 DOI: 10.15557/AN.2015.0002