Executive functions: current concepts, clinical diagnosis, and future prospects

Executive functions play an important role, enabling individuals to engage in conscious, goal-oriented behavior and to plan actions and monitor their execution. This article summarizes current concepts regarding executive functions, potential approaches to their clinical diagnosis, and future development prospects. Moreover, the evolution of understanding and the conceptualization of the brain regulatory system are discussed. This article provides a comprehensive overview of the neurophysiological mechanisms underlying the executive functions. These mechanisms are driven by the activity of multiple, partially overlapping neural networks, along with specific intra-network nodes and connections that participate in basic data processing and play a pivotal role in the organization of neural networks. A review of cognitive models of executive functions have been presented, including a discussion of one of the most extensively cited models (Miyake’s model). The present article focuses on the current approaches to the investigation of executive functions and their underlying network models using graph theory-based mathematical methods.

The article discusses the qualitative and quantitative approaches to the diagnosis of executive dysfunction and the challenges associated with the neuropsychological assessment of such functions. Furthermore, a range of screening and conventional diagnostic tools for the assessment of executive dysfunction is hereby detailed. Relatively new approaches to the clinical diagnosis of executive functions using information and communication technologies (computerized neuropsychological tests with interactive graphics, virtual reality technologies, and serious games) have been reviewed. A significant focus is placed on virtual diagnostic tests that use gaming technologies, as these approaches can enhance the ecological validity and reliability of study findings.