FUNCIONES EJECUTIVAS FFEE :

Mantener objetivos, inhibir lo irrelevante, hacer seguimiento

de resultados, detectar errores, ajustar conducta día a día
Relación con cuidar de uno mismo, adaptarse al entorno y
mantener un rol social adecuado
Amplia evidencia relaciona FFEE con ajuste psicosocial y con
capacidades concretas: éxito reincorporación laboral después
de una lesión, estabilidad relaciones, realizar determinados
contratos legales, administrar finanzas, consentir tratamientos
médicos o conducir Tirapu, .
Peores FFEE se relaciona con más estrés
Apatía, Desinhibición y Disfunción Ejecutiva
Frontal Systems Behavior Scale (FrSBe)

La p n acione e ob ienen en cada e cala

Cada fo ma F SBe iene na P n aci n To al
p n acione en be cala e miden cond c a de
ba e cond c a ac al.

El cambio cond c al e inde a po compa aci n de la

p n acione T de lo e l ado de la cond c a del
pacien e an e aho a.

Autoinforme e informe de familiar

(la dife encia e a como p n aci n de
elf-a a ene , G afman 2017)

F al S e Beha i Scale F SBe

Ja e G ace PhD a d Pa l F Mall PhD
 Executive Function and Psychosocial Quality of Life in
School Age Children with Congenital Heart Disease. Sanz et
al. J Pediatr. ; : -
Executive dysfunction is a strong predictor of psychosocial
quality of life at school age

Executive functioning but not IQ or illness severity predicts

occupational status in bipolar disorder. Drakopoulos et al. Int
J Bipolar Disord. ; :
Executive functioning was a more powerful predictor of
occupational status in bipolar disorder patients than IQ and
other clinical factors, including illness severity.
 Scores on executive function and working memory attention
domains correlated with self, but not family reported executive
dysfunction.
While agreement between self-rated and family-rated total
FrSBe scores was significant in all groups, our results showed that
self-ratings were of higher predictive utility for executive
functioning compared with family ratings.

Further, at years post-TBI, patients show greater awareness of

deficits compared with family who rate consistently closer to the
normal functioning range

PlosInjury
One. 2013,
at - Volyears,
8, I 10.now
Self versus Famil
years Ratingsand
or older, of the Frontal
more S stems
than Behaviour
years post
Scale and Measured E ecutive Functions: Ad
injury O c C d d
T a a c Brain Injur . Barrett, McLellan, McKinla .
INSIGHT ANOSOGNOSIA a areness :
Anosognosia pacientes lesionales. Lesión frontal.
Córtex prefrontal FFEE.
Implicación clínica y funcional: mal pronóstico, baja adherencia
terapéutica, funcionamiento psicosocial pobre.
who are unaware of deficits are more likely to have
problems finding employment, maintaining relationships,
and have vocational and other social problems Barret et
al.,
INSIGHT ANOSOGNOSIA a areness :
Self-awareness of peer-rated social attributes in children with
traumatic brain injury.
children with severe TBI,
children with complicated mild moderate TBI
children with orthopedic injury.
Self-ratings of classroom social behavior did not differ between
injury groups severe, moderate orthopedic .
Self- and peer ratings generally agreed, although children with
severe TBI rated themselves as less rejected/victimized than
did their peers.
Higher EF predicted better self- and peer ratings, which in turn
predicted better adjustment.
Wolfe et al. (2015). J Pediatr Ps chol ;40(3):272-84
Executive functions and theory of mind as predictors of social
adjustment in childhood traumatic brain injury

children with severe TBI,

children with complicated mild moderate TBI
children with orthopedic injury.

The impact of TBI on children s social adjustment

is likely mediated by its effects on executive
function and theory of mind.

Robinson et al. (2014) J Neurotrauma; 31(22):1835-42.

The mentalizing network and theory of mind mediate
adjustment after childhood traumatic brain injury.

Children at greatest
risk of poor adjustment
after TBI could be
identified based in part
on a
ca b a
a d
a ca
c and thereb
more effectivel
allocate limited
intervention resources

Hoskinson et al. (2020) Soc Cogn Affect Neurosci

Relationship between social cognition and fatigue,
depressive symptoms, and anxiety in multiple sclerosis.

The results indicated that worse performance in both

facial affect recognition and ToM were associated with
higher rates of psychosocial fatigue, depressive
symptoms, and anxiety levels; furthermore, these
relationships were not explained by participants cognitive
ability

Genova et al. (2019) J Neurops chol

 Traumatismo craneoencefálico TCE :
estudios. - riesgo presentar trastornos de conducta. Años
después de la lesión
Cambios de personalidad - a los años : labilidad,
agresividad, desinhibición por lesión frontal, TCE grave
Factores:
Del niño: estatus premórbido, edad complicada
De la lesión: gravedad
De la familia: estatus socioeconómico, estilo educativo parental, relación
emocional
Persisten y pueden empeorar. Moderadas por familia.
 Compared with the TD group, the TBI sample showed greater
rates of social and behavioral impairments.
Significant predictors six months post-injury included pre-
injury functional status, injury severity, and restrictions to
social participation as indicated by clinicians in the acute
stage, highlighting the importance of both pre-and-post-
injury factors in the prediction of outcome.
The need to assess social and behavioral function in order to
intervene in areas including social participation re-
integration and behavior externalizing difficulties for
children at risk.
Journal of Neurotrauma 32:109 115 (2015) Social and Behavioral Outcomes: Pre-
Injur to Si Months follo ing Childhood Traumatic Brain Injur . Catroppa et al.
Psychosocial and Executive Function Recovery
Trajectories One Year after Pediatric Traumatic Brain
Injury: The Influence of Age and Injury Severity.

Children with mild and complicated mild TBI had a decreasing

anxiety trajectory
Children with severe TBI had increasing symptoms
The youngest children had increasing symptoms over time

Peer relationships and prosocial behaviors were not significantly

affected by TBI but were associated with family environment

K a a . (2018) J N a a;35(2):286-296
TCE: increase the likelihood of social difficulties

younger age at insult,

pathology to frontal regions and the corpus
callosum,
and social disadvantage and family dysfunction

Journal of Neurotrauma. Ma 2012, Vol. 29, No. 7: 1277-1291

S ca F c in Children and Adolescents after Traumatic Brain Injur : A
S stematic Revie 1989 2011. Rosema, Cro e, and Anderson
TCE y estilo de crianza:
Estilo crianza funcionamiento familiar comportamiento
TCE. Crianza autoritaria-dificultades ejecutivas , m
post
Menos recursos familiares predicen déficits FFEE
Entorno social familiar importante sobre todo después TCE
moderado
Relación positiva, disciplina consistente, apoyo a conductas
autónomas: mejor control impulsos, memoria de trabajo y
estrategias autoregulatorias
 TCE y estilo de crianza: follow-up
In a prospective longitudinal cohort study, children
with early TBI were rated as having higher levels of
functional impairments than those with orthopedic injury,
with boys having higher levels of impairment than girls.
Functional impairments in children with TBI were more
pronounced among children from families with higher
levels of authoritarian or permissive parenting
or with fewer home resources.
JAMA Pediatr. 2016;170(4):343-349. Social
Environmental Moderators of Long-term Functional
Outcomes of Earl Childhood Brain Injur . Wade,
Zhang, Yeates, Stancin, Ta lor
JAMA Pediatr. 2016;170(4):343-349. Social Environmental Moderators
of Long-term Functional Outcomes of Earl Childhood Brain Injur .
Wade, Zhang, Yeates, Stancin, Ta lor
JAMA Pediatr. 2016;170(4):343-349. Social Environmental Moderators of Long-term Functional Outcomes
of Earl Childhood Brain Injur . Wade, Zhang, Yeates, Stancin, Ta lor
TCE y estilo de crianza: Parenting styles as a predictor of long-
term psychosocial outcomes after traumatic brain injury TBI in
early childhood.
The groups differed significantly on behavioral adjustment, social
competence, and executive functioning
Late but not early parenting styles predicted outcomes in all
groups: more permissive parenting predicted worse outcomes in
all domains
more authoritative parenting predicted better social competence
and executive functioning.
Severe traumatic brain injury interacted with parenting style for
several outcomes,
Ineffective parenting exacerbating the negative sequelae.
Schorr et al. (2019). Disabil Rehabil. Apr 21:1-7.
TDAH:
Crianza de los hijos de adultos con TDAH
La mitad de los adultos con TDAH tienen un hijo con TDAH
Del - de los niños con TDAH tienen un progenitor con
TDAH
Comportamiento padres desarrollo mantenimiento TDAH
Problemas para: supervisar los hijos de forma continuada,
recordar actividades de los niños, mantener rutinas, mantener
una disciplina consistente, inhibir impulsos
TDAH:
Tres categorías de disfunción afectan la crianza:
disfunción cognitiva: procesos cognitivos memoria de trabajo,
planificación y control inhibitorio
déficit autoregulación monitorización detectar errores o regulación
conducta emoción
motivacionales respuesta incentivos, demora .
TDAH impacta en la crianza. Falta estudiar relación genética
crianza y hacer estudios longitudinales.
Programas específicos, coach, tutor
Clin Psychol Rev. Jun; : - .
Parenting in adults with attention-deficit/hyperactivity
disorder ADHD .
Johnston C, Mash EJ, Miller N, Ninowski JE. REVISIÓ
Fathers with Childhood ADHD, Parenting, and Their Young
Children s Behavior: Offspring of the Pittsburgh ADHD
Longitudinal Study PALS .
ADHD offspring had elevated ADHD symptoms and behavior
dysregulation.
ADHD fathers reported lower supportive responses to their
child’s negative emotions than comparison fathers
ADHD offspring were distinguishable as early as age
earlier diagnosis and intervention may be feasible for this at risk
population.
Future research should investigate the acceptability and efficacy
of parent training for fathers with ADHD.

Joseph et al. (2019). Child Ps chiatr Hum Dev;50(1):35-44.

TCE leve, factores:

(1) preinjur personal factors

(2) injur -related personal factors
(3) postinjur personal factors
(4) occupational factors
(5) environmental factors

Systematic Review of Return to Work After Mild Traumatic Brain Injury: Results of the
International Collaboration on Mild Traumatic Brain Injury Prognosis.
Cancelliere et al. Archives of Physical Medicine and Rehabilitation ; Suppl :S -
 preinjury personal factors: age, sex, marital status, race,
educational level, and psychological status;
injury-related personal factors: injury severity, type mechanism of
injury CT scan results, concurrent symptoms eg, nausea, vomiting,
pain , acute impairments and patterns of recovery, and length of
hospital stay;
postinjury personal factors: physical status, neuropsychological
and general cognitive status, psychosocial status eg, depression,
anxiety, posttraumatic stress , functional abilities at admission and
discharge , and self-reported status eg, subjective complaints ;
occupational factors: pre and postinjury occupational
category complexity;
environmental factors: economic factors, workplace supports, and
social and instrumental supports.
What is a return to work following traumatic brain
injury? Analysis of work outcomes months post TBI.
. returned to work in the months post-injury,
only . people with brain injury made a complete
RTW.
People with higher functional ability, anxiety, and health-
related QoL were most likely to achieve a complete RTW.
Most returned to the same job and employer, worked fewer
hours than pre-injury, experienced substantial loss in
income, were less satisfied

Watkin et al. (2020). Brain Inj;34(1):68-77.

Table . Cognitive sensory functions needed for driving.
Visual information selection
Visual perception including contrast and darkness vision
Visual attention
Visuospatial skills
Divided and sustained attention
Executive functions planning, anticipation, adaption to
new situations
Speed of processing
Episodic, semantic, procedural, and prospective memory
Pharmacops chiatr 2017; 50: 197 202
D P b Ed a dC I a d
Haussmann, Buthut, Doni
El número de conductores mayores de años ha aumentado
actualmente cerca del de dicha edad, y aumentará en los
próximos años, sobre todo los mayores de años
Dejar de conducir va unido a depresión, soledad, aislamiento
social, con reducción drástica de actividades y relaciones sociales y
necesidad de adaptarse a una movilidad reducida
La normativa española prohíbe la conducción a personas con
delirium o demencia reglamento de , artículo . En la
práctica diaria no suele ser tarea fácil el cese de la conducción
Hasta un de pacientes con demencia renuevan anualmente
su carné de conducir y más del de los pacientes con demencia
siguen conduciendo
Revista española de gerontología ,
 i dementia may compromise the complex task of driving
ii defining onset and severity of dementia is problematic
iii symptom progression impacts on driving skills
iv assessment of fitness to drive remains subjective
v some drivers are reluctant to accept negative
assessment outcomes
vi the search for effective strategies to enhance
acceptance of driver retirement continues.

Journal of Advanced Nursing 2015. An integrative revie : understanding

driving retirement decisions for individuals living ith a dementia
Andre , Tra nor & Iverson
Institucionalización:
Sobrecarga incrementa con el deterioro cognitivo
Deterioro cognitivo, conducta del paciente, aislamiento social,
recursos disponibles son factores influyentes
Grado de familiaridad, tipo de relación premórbida, contexto
cultural, sexo
Psicoeducación disminuye la sobrecarga
Ansiedad y depresión de cuidadores correlaciona con horas de
atención, cantidad de tiempo libre fuera de casa
Anosognosia:
De los déficits de memoria o de los trastornos de conducta
produce más carga del cuidador que el deterioro cognitivo o
funcional
Conducta:
Problemas de comportamiento de sistemas frontales apatía,
disfunción ejecutiva y desinhibición Frontal Systems Behavior
Scale FrSBe predictores de carga. Controlado por depresión
del cuidador y gravedad de la demencia
Análisis de subescalas: desinhibición y disfunción ejecutiva
predictores de carga.
Enabling and supportive environments: What does good
psychological care involve?
Challenging ageist attitudes and reducing the stigma of
dementia, and promoting social inclusion and involvement in
valued roles and activities.
Helping families, carers and care staff understand that behaviour
that challenges communicates an unmet need.
Training staff in the use of psychosocial approaches to meet the
person s needs.
Advising on environmental adaptations to promote
independence and reduce risk
Ps chological dimensions of dementia: Putting the person at the centre of care
British Ps chological Societ Dementia Advisor Group. The British Ps chological
Societ 2016
Key components of interventions for carers
Emotional and psychological support encompassing emotional
support, counselling or psychotherapy, and development of stress
management and self-care strategies.
Information including developing knowledge about dementia
and the support services available, and understanding the
behaviour of the person with dementia.
Skills training focusing on, for example, how to communicate
effectively with the person with dementia, how to respond to
distress, how to engage a person who has become inactive or
withdrawn, and how to support meaningful activity and occupation.
Increasing social support for some carers, involving the wider
family or otherwise strengthening networks of social support is an
important consideration.