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Ecological Validity and Neuroanatomical Correlates of the NIH EXAMINER Executive Composite Score

Published online by Cambridge University Press:  14 June 2013

Katherine L. Possin*
Department of Neurology, University of California – San Francisco, San Francisco, California
Amanda K. LaMarre
Department of Neurology, University of California – San Francisco, San Francisco, California
Kristie A. Wood
Department of Neurology, University of California – San Francisco, San Francisco, California
Dan M. Mungas
Department of Neurology, University of California – Davis, Davis, California
Joel H. Kramer
Department of Neurology, University of California – San Francisco, San Francisco, California
Correspondence and reprint requests to: Katherine L. Possin, 675 Nelson Rising Lane, Ste 190, MC 1207, San Francisco, CA 94158. E-mail:


Executive functions refer to a constellation of higher-level cognitive abilities that enable goal-oriented behavior. The NIH EXAMINER battery was designed to assess executive functions comprehensively and efficiently. Performance can be summarized by a single score, the “Executive Composite,” which combines measures of inhibition, set-shifting, fluency, and working memory. We evaluated the ecological validity of the Executive Composite in a sample of 225 mixed neurological patients and controls using the Frontal Systems Behavior Scale (FrSBe), an informant-based measure of real-world executive behavior. In addition, we investigated the neuroanatomical correlates of the Executive Composite using voxel-based morphometry in a sample of 37 participants diagnosed with dementia, mild cognitive impairment, or as neurologically healthy. The Executive Composite accounted for 28% of the variance in Frontal Systems Behavior Scale scores beyond age. Even after including two widely used executive function tests (Trails B and Stroop) as covariates, the Executive Composite remained a significant predictor of real-world behavior. Anatomically, poorer scores on the Executive Composite were associated with smaller right and left dorsolateral prefrontal volumes, brain regions critical for good executive control. Taken together, these results suggest that the Executive Composite measures important aspects of executive function not captured by standard measures and reflects the integrity of frontal systems. (JINS, 2013, 19, 1–9)

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Copyright © The International Neuropsychological Society 2013 

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Ashburner, J. (2007). A fast diffeomorphic image registration algorithm. Neuroimage, 38(1), 95113.CrossRefGoogle ScholarPubMed
Ashburner, J., Friston, K.J. (2005). Unified segmentation. Neuroimage, 26(3), 839851.CrossRefGoogle ScholarPubMed
Basso, M.R., Shields, I.S., Lowery, N., Ghormley, C., Combs, D., Arnett, P.A., Johnson, J. (2008). Self-reported executive dysfunction, neuropsychological impairment, and functional outcomes in multiple sclerosis. Journal of Clinical and Experimental Neuropsychology, 30(8), 920930.CrossRefGoogle ScholarPubMed
Bates, E., Wilson, S.M., Saygin, A.P., Dick, F., Sereno, M.I., Knight, R.T., Dronkers, N.F. (2003). Voxel-based lesion-symptom mapping. Nature Neuroscience, 6(5), 448450.Google ScholarPubMed
Bondi, M.W., Jak, A.J., Delano-Wood, L., Jacobson, M.W., Delis, D.C., Salmon, D.P. (2008). Neuropsychological contributions to the early identification of Alzheimer's disease. Neuropsychology Review, 18(1), 7390.CrossRefGoogle ScholarPubMed
Boyle, P.A., Paul, R.H., Moser, D.J., Cohen, R.A. (2004). Executive impairments predict functional declines in vascular dementia. Clinical Neuropsychologist, 18(1), 7582.CrossRefGoogle ScholarPubMed
Brown, P.D., Buckner, J.C., O'Fallon, J.R., Iturria, N.L., Brown, C.A., O'Neill, B.P., Shaw, E.G. (2003). Effects of radiotherapy on cognitive function in patients with low-grade glioma measured by the folstein mini-mental state examination. Journal of Clinical Oncology, 21(13), 25192524.CrossRefGoogle ScholarPubMed
Caeyenberghs, K., Leemans, A., Leunissen, I., Gooijers, J., Michiels, K., Sunaert, S., Swinnen, S.P. (2012). Altered structural networks and executive deficits in traumatic brain injury patients. Brain Structure & Function. [Epub ahead of print]. Retrieved from ScholarPubMed
Cahn-Weiner, D.A., Farias, S.T., Julian, L., Harvey, D.J., Kramer, J.H., Reed, B.R., Chui, H. (2007). Cognitive and neuroimaging predictors of instrumental activities of daily living. Journal of the International Neuropsychological Society, 13(5), 747757.CrossRefGoogle ScholarPubMed
Champod, A.S., Petrides, M. (2010). Dissociation within the frontoparietal network in verbal working memory: A parametric functional magnetic resonance imaging study. Journal of Neuroscience, 30(10), 38493856.CrossRefGoogle ScholarPubMed
Chiaravalloti, N.D., DeLuca, J. (2003). Assessing the behavioral consequences of multiple sclerosis: An application of the Frontal Systems Behavior Scale (FrSBe). Cognitive and Behavioral Neurology, 16(1), 5467.CrossRefGoogle Scholar
Clark, L., Cools, R., Robbins, T.W. (2004). The neuropsychology of ventral prefrontal cortex: Decision-making and reversal learning. Brain and Cognition, 55(1), 4153.CrossRefGoogle ScholarPubMed
Coles, A.J., Twyman, C.L., Arnold, D.L., Cohen, J.A., Confavreux, C., Fox, E.J., Compston, D.A. (2012). Alemtuzumab for patients with relapsing multiple sclerosis after disease-modifying therapy: A randomised controlled phase 3 trial. Lancet, 380(9856), 18291839.CrossRefGoogle ScholarPubMed
Correa, D.D. (2010). Neurocognitive function in brain tumors. Current Neurology and Neuroscience Reports, 10(3), 232239.CrossRefGoogle ScholarPubMed
Cummings, J., Miller, B.L. (2007). Conceptual and clinical aspects of the frontal lobes. In B.L. Miller & J.L. Cummings (Eds.), The human frontal lobes (pp. 1224). New York: The Guilford Press.Google Scholar
Diamond, A. (2002). Normal development of prefrontal cortex from birth to young adulthood: Cognitive functions, anatomy, and biochemistry. In D.T. Stuss, & R.T. Knight (Eds.), Principles of frontal lobe function (pp. 466503). London, UK: Oxford University Press.CrossRefGoogle Scholar
Farias, S.T., Cahn-Weiner, D.A., Harvey, D.J., Reed, B.R., Mungas, D., Kramer, J.H., Chui, H. (2009). Longitudinal changes in memory and executive functioning are associated with longitudinal change in instrumental activities of daily living in older adults. Clinical Neuropsychologist, 23(3), 446461.CrossRefGoogle Scholar
Friston, K.J., Ashburner, J., Kiebel, S., Nichols, T., Penny, W. (2007). Statistical parametric mapping. London: Academic Press.CrossRefGoogle ScholarPubMed
Grace, J., Malloy, P.F. (2001). Frontal systems behavior scale (FrSBe): Professional manual. Lutz, FL: Psychological Assessment Resources.Google Scholar
Hayes, S., Donnellan, C., Stokes, E. (2012). Associations between executive function and physical function poststroke: A pilot study. Physiotherapy, 99(2), 165171.CrossRefGoogle ScholarPubMed
Hellmuth, J., Mirsky, J., Heuer, H.W., Matlin, A., Jafari, A., Garbutt, S., Boxer, A.L. (2012). Multicenter validation of a bedside antisaccade task as a measure of executive function. Neurology, 78(23), 18241831.CrossRefGoogle ScholarPubMed
Kramer, J.H., Jurik, J., Sha, S.J., Rankin, K.P., Rosen, H.J., Johnson, J.K., Miller, B.L. (2003). Distinctive neuropsychological patterns in frontotemporal dementia, semantic dementia, and Alzheimer disease. Cognitive and Behavioral Neurology, 16(4), 211218.CrossRefGoogle ScholarPubMed
Kramer, J.H., Mungas, D., Possin, K.L., Rankin, K.P., Boxer, A.L., Rosen, H.J., Windmeyer, M. (2013). NIH EXAMINER: Conceptualization and development of an executive function battery. Journal of the International Neuropsychological Society, 19(3), 000000.Google Scholar
Lane-Brown, A.T., Tate, R.L. (2009). Measuring apathy after traumatic brain injury: Psychometric properties of the Apathy Evaluation Scale and the Frontal Systems Behavior Scale. Brain Injury, 23(13–14), 9991007.CrossRefGoogle ScholarPubMed
Lezak, M.D., Howieson, D.B., Bigler, E.D., Tranel, D. (2012). Neuropsychological assessment (5th ed.). New York: Oxford University Press.Google ScholarPubMed
Little, D.M., Kraus, M.F., Joseph, J., Geary, E.K., Susmaras, T., Zhou, X.J., Gorelick, P.B. (2010). Thalamic integrity underlies executive dysfunction in traumatic brain injury. Neurology, 74(7), 558564.CrossRefGoogle ScholarPubMed
Litvan, I., Agid, Y., Calne, D., Campbell, G., Dubois, B., Duvoisin, R.C., Zee, D.S. (1996). Clinical research criteria for the diagnosis of progressive supranuclear palsy (Steele-Richardson-Olszewski syndrome): Report of the NINDS-SPSP international workshop. Neurology, 47(1), 19.CrossRefGoogle Scholar
Malloy, P., Grace, J. (2005). A review of rating scales for measuring behavior change due to frontal systems damage. Cognitive and Behavioral Neurology, 18(1), 1827.CrossRefGoogle ScholarPubMed
Malloy, P., Tremont, G., Grace, J., Frakey, L. (2007). The Frontal Systems Behavior Scale discriminates frontotemporal dementia from Alzheimer's disease. Alzheimer's & Dementia: the Journal of the Alzheimer's Association, 3(3), 200203.CrossRefGoogle ScholarPubMed
McDonald, B.C., Flashman, L.A., Saykin, A.J. (2002). Executive dysfunction following traumatic brain injury: Neural substrates and treatment strategies. Neurorehabilitation, 17(4), 333344.Google ScholarPubMed
McKhann, G.M., Knopman, D.S., Chertkow, H., Hyman, B.T., Jack, C.R. Jr., Kawas, C.H., Phelps, C.H. (2011). The diagnosis of dementia due to Alzheimer's disease: Recommendations from the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimer's & Dementia, 7(3), 263269.CrossRefGoogle Scholar
Muslimovic, D., Post, B., Speelman, J.D., Schmand, B. (2005). Cognitive profile of patients with newly diagnosed Parkinson disease. Neurology, 65(8), 12391245.CrossRefGoogle ScholarPubMed
Parmenter, B.A., Shucard, J.L., Shucard, D.W. (2007). Information processing deficits in multiple sclerosis: A matter of complexity. Journal of the International Neuropsychological Society, 13(3), 417423.CrossRefGoogle ScholarPubMed
Peinemann, A., Schuller, S., Pohl, C., Jahn, T., Weindl, A., Kassubek, J. (2005). Executive dysfunction in early stages of Huntington's disease is associated with striatal and insular atrophy: A neuropsychological and voxel-based morphometric study. Journal of the Neurological Sciences, 239(1), 1119.CrossRefGoogle ScholarPubMed
Polman, C.H., Reingold, S.C., Edan, G., Filippi, M., Hartung, H.P., Kappos, L., Wolinsky, J.S. (2005). Diagnostic criteria for multiple sclerosis: 2005 revisions to the “McDonald Criteria”. Annals of Neurology, 58(6), 840846.CrossRefGoogle ScholarPubMed
Possin, K.L., Feigenbaum, D., Rankin, K.P., Smith, G.E., Boxer, A.L., Wood, K., Kramer, J.H. (2013). Dissociable executive functions in behavioral variant frontotemporal and Alzheimer's dementias. Neurology, [Epub ahead of print]. Retrieved from CrossRefGoogle Scholar
Provost, J.S., Petrides, M., Monchi, O. (2010). Dissociating the role of the caudate nucleus and dorsolateral prefrontal cortex in the monitoring of events within human working memory. European Journal of Neuroscience, 32(5), 873880.CrossRefGoogle Scholar
Rabin, L.A., Barr, W.B., Burton, L.A. (2005). Assessment practices of clinical neuropsychologists in the United States and Canada: A survey of INS, NAN, and APA Division 40 members. Archives of Clinical Neuropsychology, 20(1), 3365.CrossRefGoogle ScholarPubMed
Rascovsky, K., Hodges, J.R., Knopman, D., Mendez, M.F., Kramer, J.H., Neuhaus, J., Miller, B.L. (2011). Sensitivity of revised diagnostic criteria for the behavioural variant of frontotemporal dementia. Brain, 134(Pt 9), 24562477.CrossRefGoogle ScholarPubMed
Reitan, R.M. (1955). The relation of the trail making test to organic brain damage. Journal of Consulting Psychology, 19(5), 393394.CrossRefGoogle ScholarPubMed
Robinson, H., Calamia, M., Glascher, J., Bruss, J., Tranel, D. (2013). Neuroanatomical correlates of executive functions: A neuropsychological approach using the EXAMINER battery. Journal of the International Neuropsychological Society, 19(3), 000000.Google Scholar
Rolls, E.T. (2004). The functions of the orbitofrontal cortex. Brain and Cognition, 55(1), 1129.CrossRefGoogle ScholarPubMed
Royall, D.R., Lauterbach, E.C., Cummings, J.L., Reeve, A., Rummans, T.A., Kaufer, D.I., Coffey, C.E. (2002). Executive control function: A review of its promise and challenges for clinical research. A report from the Committee on Research of the American Neuropsychiatric Association. Journal of Neuropsychiatry and Clinical Neurosciences, 14(4), 377405.CrossRefGoogle Scholar
Sachdev, P.S., Brodaty, H., Valenzuela, M.J., Lorentz, L., Looi, J.C., Wen, W., Zagami, A.S. (2004). The neuropsychological profile of vascular cognitive impairment in stroke and TIA patients. Neurology, 62(6), 912919.CrossRefGoogle ScholarPubMed
Salthouse, T.A. (2005). Relations between cognitive abilities and measures of executive functioning. Neuropsychology, 19(4), 532545.CrossRefGoogle ScholarPubMed
Schmahmann, J.D., Pandya, D.N. (2008). Disconnection syndromes of basal ganglia, thalamus, and cerebrocerebellar systems. Cortex, 44(8), 10371066.CrossRefGoogle ScholarPubMed
Seeley, W.W., Crawford, R., Rascovsky, K., Kramer, J.H., Weiner, M., Miller, B.L., Gorno-Tempini, M.L. (2008). Frontal paralimbic network atrophy in very mild behavioral variant frontotemporal dementia. Archives of Neurology, 65(2), 249255.CrossRefGoogle ScholarPubMed
Stoodley, C.J., Schmahmann, J.D. (2010). Evidence for topographic organization in the cerebellum of motor control versus cognitive and affective processing. Cortex, 46(7), 831844.CrossRefGoogle ScholarPubMed
Stuss, D.T., Levine, B. (2002). Adult clinical neuropsychology: Lessons from studies of the frontal lobes. Annual Review of Psychology, 53, 401433.CrossRefGoogle ScholarPubMed
Torralva, T., Kipps, C.M., Hodges, J.R., Clark, L., Bekinschtein, T., Roca, M., Manes, F. (2007). The relationship between affective decision-making and theory of mind in the frontal variant of fronto-temporal dementia. Neuropsychologia, 45(2), 342349.CrossRefGoogle ScholarPubMed
Van der Werf, Y.D., Scheltens, P., Lindeboom, J., Witter, M.P., Uylings, H.B., Jolles, J. (2003). Deficits of memory, executive functioning and attention following infarction in the thalamus; a study of 22 cases with localised lesions. Neuropsychologia, 41(10), 13301344.CrossRefGoogle ScholarPubMed
Velligan, D.I., Ritch, J.L., Sui, D., DiCocco, M., Huntzinger, C.D. (2002). Frontal Systems Behavior Scale in schizophrenia: Relationships with psychiatric symptomatology, cognition and adaptive function. Psychiatry Research, 113(3), 227236.CrossRefGoogle ScholarPubMed
Vercelletto, M., Boutoleau-Bretonniere, C., Volteau, C., Puel, M., Auriacombe, S., Sarazin, M., Lacomblez, L. (2011). Memantine in behavioral variant frontotemporal dementia: Negative results. Journal of Alzheimer's Disease, 23(4), 749759.Google ScholarPubMed
Whitwell, J.L., Duffy, J.R., Strand, E.A., Machulda, M.M., Senjem, M.L., Gunter, J.L., Josephs, K.A. (2012). Neuroimaging comparison of primary progressive apraxia of speech and progressive supranuclear palsy. European Journal of Neurology, 20(4), 629637.CrossRefGoogle ScholarPubMed
Willmott, C., Ponsford, J. (2009). Efficacy of methylphenidate in the rehabilitation of attention following traumatic brain injury: A randomised, crossover, double blind, placebo controlled inpatient trial. Journal of Neurology, Neurosurgery, and Psychiatry, 80(5), 552557.CrossRefGoogle ScholarPubMed
Wilson, S.M., Henry, M.L., Besbris, M., Ogar, J.M., Dronkers, N.F., Jarrold, W., Gorno-Tempini, M.L. (2010). Connected speech production in three variants of primary progressive aphasia. Brain, 133(Pt 7), 20692088.CrossRefGoogle ScholarPubMed
Winblad, B., Palmer, K., Kivipelto, M., Jelic, V., Fratiglioni, L., Wahlund, L.O., Petersen, R.C. (2004). Mild cognitive impairment--beyond controversies, towards a consensus: Feport of the International Working Group on Mild Cognitive Impairment. Journal of Internal Medicine, 256(3), 240246.CrossRefGoogle Scholar
Yin, X., Zhao, L., Xu, J., Evans, A.C., Fan, L., Ge, H., Liu, S. (2012). Anatomical substrates of the alerting, orienting and executive control components of attention: Focus on the posterior parietal lobe. PloS One, 7(11), e50590.CrossRefGoogle ScholarPubMed