Executive Functions

Executive functions are a set of higher-order cognitive processes that monitor and regulate other systems in purposive and goal-directed behavior. The prefrontal cortex is the primary seat of executive functions, and the lateral, orbital, and medial aspects of the prefrontal cortex and their networks are associated with different subprocesses of executive functioning. Several neurological conditions affecting prefrontal networks, including cortical and subcortical circuits, may result in mild to severe executive impairment. The neuropsychological examination may help identify the nature of these impairments and provide a basis for increased self-awareness and a case formulation of assets and deficits to guide treatment and rehabilitation. Two approaches to managing executive impairment are presented. The first is concerned with improving or subsuming the function of the executive system by training metacognitive strategies that support executive attention and control in everyday life. The second is concerned with compensating for the impaired executive system by modulating the environment or establishing new behavioral routines using errorless learning.