Zusammenfassung
Exekutive Kontrollfunktionen sind höhere kognitive Funktionen für komplexes zielgerichtetes Verhalten in Situationen, in denen Routinemechanismen nicht vorhanden oder nicht adäquat sind. Klinisch äußern sich exekutive Störungen außer in kognitiven Funktionen auch in Sozialverhalten und Antrieb. Exekutive Kontrollfunktionen basieren auf intakten Netzwerken zwischen präfrontalem Kortex und subkortikalen Strukturen, die in ihrer Funktion durch monoaminerge Neurotransmitter moduliert werden. Defizite exekutiver Kontrolle sind bei verschiedenen neuropsychiatrischen Erkrankungen beschrieben worden. Wir geben eine Übersicht über die Befunde mit einem Fokus auf extrapyramidale Bewegungsstörungen, Schizophrenie und affektive Störungen. Ein Schwerpunkt liegt dabei auf Gemeinsamkeiten zwischen diesen Erkrankungen hinsichtlich der Pathophysiologie fronto-subkortikaler Netzwerke. Aufgrund dieser Gemeinsamkeiten können Grundlinien pharmakologischer und rehabilitativer Strategien nosologieübergreifend auf die Behandlung exekutiver Defizite bei verschiedenen neuropsychiatrischen Krankheitsbildern angewendet werden. Wegen der hohen prognostischen Relevanz exekutiver Defizite sind kontrollierte Studien dieser Therapieverfahren dringend erforderlich.
Abstract
Executive control functions are higher cognitive functions for complex goal-oriented behavior in situations where routine mechanisms are not available or inappropriate. In clinical practice executive dysfunction presents with deficits in cognitive function as well as social behavior and drive. Executive control functions rely on intact networks involving prefrontal cortex and subcortical structures, which can be modulated by monoaminergic neurotransmitters. Deficits of executive control have been described in a variety of neuropsychiatric disorders. We present a review of the findings with a focus on movement disorders, schizophrenia and affective disorders. We emphasize similarities between these disorders regarding the pathophysiology of fronto-subcortical networks. Based on these similarities, principles of pharmacological and rehabilitative strategies can be applied to the treatment of executive deficits in a variety of neuropsychiatric disorders without being specific for one disease. Since executive dysfunction is highly relevant to prognosis, controlled trials of these treatments are urgently needed.
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PD Dr. med. Matthias Weisbrod
Psychiatrische Universitätsklinik
Voss-Strasse 4
69115 Heidelberg ·
Email: matthias_weisbrod@med.uni-heidelberg.de
