Encyclopedia of Clinical Neuropsychology

2018 Edition
| Editors: Jeffrey S. Kreutzer, John DeLuca, Bruce Caplan

Executive Interview

  • Donald R. RoyallEmail author
Reference work entry
DOI: https://doi.org/10.1007/978-3-319-57111-9_1891




The Executive Interview (EXIT25) (Royall et al. 1992) provides a brief, clinically based, bedside measure of executive control functions (ECF). EXIT25 scores have been used to identify the presence and severity of executive impairments and to predict problems in self-care, functional status, decision-making capacity, and problem behavior. The EXIT25 has been validated mainly in elderly persons but has also been used in a wide range of other populations, including medical patients, psychiatric patients, community samples, and as an outcome measure in clinical trials. It is available in many languages.

The EXIT25 is a compilation of 25 items that target motor, behavioral, and cognitive features associated with frontal systems dysfunction. Items include verbal and design fluency, an aural Trail Making task, repetition of anomalous sentences (e.g., “Mary fed a little lamb”), a Stroop-like interference task,...

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Further Reading

  1. Allen, S. C., Jain, M., Ragab, S., & Malik, N. (2003). Acquisition and short-term retention of inhaler techniques require intact executive function in elderly subjects. Age and Ageing, 32, 299–302.PubMedCrossRefPubMedCentralGoogle Scholar
  2. Altshuler, L., Tekell, J., Biswas, K., Kilbourne, A. M., Evans, D., Tang, D., & Bauer, M. S. (2007). Executive function and employment status among veterans with bipolar disorder. Psychiatric Services, 58, 1441–1447.PubMedCrossRefPubMedCentralGoogle Scholar
  3. Atkinson, H. H., Rosano, C., Simonsick, E. M., Williamson, J. D., Davis, C., Ambrosius, W. T., Rapp, S. R., Cesari, M., Newman, A. B., Harris, T. B., Rubin, S. M., Yaffe, K., Satterfield, S., Kritchevsky, S. B., & Health ABC study. (2007). Cognitive function, gait speed decline, and comorbidities: The health, aging and body composition study. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 62, 844–850.PubMedCrossRefPubMedCentralGoogle Scholar
  4. Auchus, A. P., Brashear, H. R., Salloway, S., Korczyn, A. D., De Deyn, P. P., Gassmann-Mayer, C., & GAL-INT-26 Study Group. (2007). Galantamine treatment of vascular dementia: A randomized trial. Neurology, 69, 448–458.PubMedCrossRefPubMedCentralGoogle Scholar
  5. Bauer, M., McBride, L., Shea, N., Gavin, C., & Fogel, B. (1994). Screening for executive cognitive dysfunction in bipolar disorder. Biological Psychiatry, 35, 636.CrossRefGoogle Scholar
  6. Boxer, A. L., Lipton, A. M., Womack, K., Merrilees, J., Neuhaus, J., Pavlic, D., Gandhi, A., Red, D., Martin-Cook, K., Svetlik, D., & Miller, B. L. (2009). An open-label study of memantine treatment in 3 subtypes of frontotemporal lobar degeneration. Alzheimer Disease and Associated Disorders, 23, 211–217.PubMedPubMedCentralCrossRefGoogle Scholar
  7. Burnett, J., Dyer, C. B., & Naik, A. D. (2009). Convergent validation of the Kohlman evaluation of living skills as a screening tool of older adults’ ability to live safely and independently in the community. Archives of Physical Medicine and Rehabilitation, 90, 1948–1952.PubMedPubMedCentralCrossRefGoogle Scholar
  8. Chan, S. M., Chiu, F. K., & Lam, C. W. (2006). Correlational study of the Chinese version of the executive interview (C-EXIT25) to other cognitive measures in a psychogeriatric population in Hong Kong Chinese. International Journal of Geriatric Psychiatry, 21, 535–541.PubMedCrossRefPubMedCentralGoogle Scholar
  9. DeCoteau, W. E., Selk, B., Stirling, G., Fentiman, P., Savage, C., & Landeryou, J. (2006). Dementia due to hypertensive microvascular disease of the brain often goes unrecognized because the patient is not tested, or the wrong tests are done. The Journal of Clinical Hypertension, 8(Suppl. A 5), 36.Google Scholar
  10. Dichgans, M., Markus, H. S., Salloway, S., Verkkoniemi, A., Moline, M., Wang, Q., Posner, H., & Chabriat, H. S. (2008). Donepezil in patients with subcortical vascular cognitive impairment: A randomised double-blind trial in CADASIL. Lancet Neurology, 7, 310–318.PubMedCrossRefPubMedCentralGoogle Scholar
  11. Dombrovski, A. Y., Butters, M. A., Reynolds, C. F., Houck, P. R., Clark, L., Mazumdar, S., & Szanto, K. (2008). Cognitive performance in suicidal depressed elderly: Preliminary report. The American Journal of Geriatric Psychiatry, 16, 109–115.PubMedPubMedCentralCrossRefGoogle Scholar
  12. Dreer, L. E., DeVivo, M. J., Novack, T. A., Krzywanski, S., & Marson, D. C. (2008). Cognitive predictors of medical decision-making capacity in traumatic brain injury. Rehabilitation Psychology, 53, 486–497.PubMedPubMedCentralCrossRefGoogle Scholar
  13. Fuller, C. D., Schillerstrom, J. E., Jones, W. E., 3rd, Boersma, M., Royall, D. R., & Fuss, M. (2008). Prospective evaluation of pretreatment executive cognitive impairment and depression in patients referred for radiotherapy. International Journal of Radiation Oncology, Biology, Physics, 72, 529–533.PubMedCrossRefPubMedCentralGoogle Scholar
  14. Gavett, B. E., Vudy, V., Jeffrey, M., John, S. E., Gurnani, A., & Adams, J. (2015). The δ latent dementia phenotype in the NACC UDS: Cross-validation and extension. Neuropsychologia, 29, 344–352.CrossRefGoogle Scholar
  15. Gildengers, A. G., Butters, M. A., Seligman, K., McShea, M., Miller, M. D., Mulsant, B. H., Kupfer, D. J., & Reynolds, C. F. (2004). Cognitive functioning in late-life bipolar disorder. American Journal of Psychiatry, 161, 736–738.PubMedCrossRefPubMedCentralGoogle Scholar
  16. Gujral, S., Dombrovski, A. Y., Butters, M., Clark, L., Reynolds, C. F., & Szanto, K. (2013). Impaired executive function in contemplated and attempted suicide in late life. American Journal of Geriatric Psychiatry, S1064-7481(13)00030-4.Google Scholar
  17. Gujral, S., Ogbagaber, S., Dombrovski, A. Y., Butters, M. A., Karp, J. F., & Szanto, K. (2016). Course of cognitive impairment following attempted suicide in older adults. International Journal of Geriatric Psychiatry, 31, 592–600.PubMedCrossRefPubMedCentralGoogle Scholar
  18. Hooten, W. M., & Lyketsos, C. G. (1998). Differentiating Alzheimer’s disease and frontotemporal dementia: Receiver operator characteristic curve analysis of four rating scales. Dementia and Geriatric Cognitive Disorders, 9, 164–174.PubMedCrossRefPubMedCentralGoogle Scholar
  19. Hughes, C. P., Berg, L., Danziger, W. L., Coben, L. A., & Martin, R. L. (1982). A new clinical scale for the staging of dementia. The British Journal of Psychiatry, 140, 566–572.PubMedCrossRefPubMedCentralGoogle Scholar
  20. Hwang, S. S., Lee, J. Y., Cho, S. J., et al. (2009). The model of the relationships among the predictors of quality of life in chronic stage of schizophrenia. Progress in Neuropsychopharmacology and Biological Psychiatry, 33, 1113–1118.CrossRefGoogle Scholar
  21. Jahn, D. R., Dressel, J. A., Gavett, B. E., & O’Bryant, S. E. (2015). An item response theory analysis of the executive interview and development of the EXIT8: A project FRONTIER study. Journal of Clinical and Experimental Neuropsychology, 37(3), 229–242.PubMedPubMedCentralCrossRefGoogle Scholar
  22. John, S. E., Gurnani, A. S., Bussell, C., Saurman, J. L., Griffin, J. W., & Gavett, B. E. (2016). The effectiveness and unique contribution of neuropsychological tests and the δ latent phenotype in the differential diagnosis of dementia in the uniform data set. Neuropsychologia, 30, 946–960.CrossRefGoogle Scholar
  23. Kennelly, S., Abdullah, L., Kenny, R. A., Mathura, V., Luis, C. A., Mouzon, B., Crawford, F., Mullan, M., & Lawlor, B. (2012). Apolipoprotein E genotype-specific short-term cognitive benefits of treatment with the antihypertensive nilvadipine in Alzheimer’s patients – An open-label trial. International Journal of Geriatric Psychiatry, 27, 415–422.PubMedPubMedCentralGoogle Scholar
  24. Kochunov, P., Robin, D. A., Royall, D. R., Coyle, T., Lancaster, J., Kochunov, V., Schlosser, A. E., & Fox, P. T. (2009). Can structural MRI indices of cerebral integrity track cognitive trends in executive control function during normal maturation and adulthood? Human Brain Mapping, 30, 2581–2594.PubMedPubMedCentralCrossRefGoogle Scholar
  25. Larson, E. B., & Heinemann, A. W. (2010). Rasch analysis of the executive interview (The EXIT-25) and introduction of an abridged version (The Quick Exit). Archives of Physical Medicine and Rehabilitation, 91, 389–394.PubMedCrossRefPubMedCentralGoogle Scholar
  26. Larson, E. B., Leahy, B., Duff, K. M., & Wilde, M. C. (2008). Assessing executive functions in traumatic brain injury: An exploratory study of the executive interview. Perceptual and Motor Skills, 106, 725–736.PubMedCrossRefPubMedCentralGoogle Scholar
  27. Lee, D.-W., Park, J. H., Kim, Y.-R., & Jung, H.-Y. (2011). MValidity of the Korean version of the executive interview (K-EXIT25). Journal of Korean Geriatric Psychiatry, 15, 76–79.Google Scholar
  28. Marin, R. S., Butters, M. A., Mulsant, B. H., Pollock, B. G., & Reynolds, C. F. (2003). Apathy and executive function in depressed elderly. Journal of Geriatric Psychiatry and Neurology, 16, 112–116.PubMedCrossRefPubMedCentralGoogle Scholar
  29. Martin, R. C., Okonkwo, O. C., Hill, J., et al. (2008). Medical decision-making capacity in cognitively impaired Parkinson’s disease patients without dementia. Movement Disorders, 23, 1867–1874.PubMedPubMedCentralCrossRefGoogle Scholar
  30. Matioli, N. M. P. S., & Caramelli, P. (2010). Limitations in differentiating vascular dementia from Alzheimer’s disease with brief cognitive tests. Arquivos de Neuro-Psiquiatria, 68, 185–188.PubMedCrossRefPubMedCentralGoogle Scholar
  31. Matsuoka, T., Kato, Y., Taniguchi, S., Ogawa, M., Fujimoto, H., Okamura, A., Shibata, K., Nakamura, K., Uchida, H., Nakaaki, S., Koumi, H., Mimura, M., Fukui, K., & Narumoto, J. (2014). Japanese versions of the executive interview (J-EXIT25) and the executive clock drawing task (J-CLOX) for older people. International Psychogeriatrics, 26, 1387–1397.PubMedCrossRefPubMedCentralGoogle Scholar
  32. McGuinness, B., Barrett, S. L., Craig, D., Lawson, J., & Passmore, A. P. (2010). Executive functioning in Alzheimer’s disease and vascular dementia. International Journal of Geriatric Psychiatry, 25, 562–568.PubMedPubMedCentralGoogle Scholar
  33. O’Bryant, S. E., Falkowski, F., Hobson, V., Johnson, L., Hall, J., Schrimsher, G. W., Win, O., Ngo, B., & Dentino, A. (2011). Executive functioning mediates the link between other neuropsychological domains and daily functioning: A project FRONTIER study. International Psychogeriatrics, 23, 107–113.PubMedCrossRefPubMedCentralGoogle Scholar
  34. O’Shaughnessy, J. A., Vukelja, S. J., Holmes, F. A., Savin, M., Jones, M., Royall, D., George, M., & Von Hoff, D. (2005). Feasibility of quantifying the effects of epoetin alfa therapy on cognitive function in women with breast cancer undergoing adjuvant or neoadjuvant chemotherapy. Clinical Breast Cancer, 5, 439–446.PubMedCrossRefPubMedCentralGoogle Scholar
  35. Osorio, R., García de Lózar, B., Ramos, I., & Agüera, L. (2009). Executive function in patients with late onset depression. Actas Españolas de Psiquiatría, 37, 196–199.PubMedPubMedCentralGoogle Scholar
  36. Pereira, F. S., Yassuda, M. S., Oliveira, A. M., & Forlenza, O. V. (2008). Executive dysfunction correlates with impaired functional status in older adults with varying degrees of cognitive impairment. International Psychogeriatrics, 20, 1104–1115.PubMedCrossRefPubMedCentralGoogle Scholar
  37. Ramos-Estébanez, C., Moral-Arce, I., Muñoz-Arrondo, R., González-Mandly, A., Matorras-Galán, P., González-Macias, J., & Hernández-Hernández, J. L. (2008). Vascular cognitive impairment: Prodromal stages of ischemic vascular dementia. Dementia and Geriatric Cognitive Disorders, 25, 451–460.PubMedCrossRefPubMedCentralGoogle Scholar
  38. Román, G. C., Salloway, S., Black, S. E., Royall, D. R., & DeCarli, C. (2010). A randomized, placebo-controlled clinical trial of donepezil in vascular dementia: Differential effects by hippocampal size. Stroke, 41(6), 1213–1221.PubMedPubMedCentralCrossRefGoogle Scholar
  39. Royall, D. R. (2000). Executive cognitive impairment: A novel perspective on dementia. Neuroepidemiology, 19, 293–299.PubMedCrossRefPubMedCentralGoogle Scholar
  40. Royall, D. R. (2002). Bedside assessment of vascular dementia. In S. Gauthier & T. Erkinjuntti (Eds.), Vascular cognitive impairment (pp. 307–322). London: Martin Dunitz Ltd.. Chapter 18.Google Scholar
  41. Royall, D. R., & Palmer, R. F. (2012). Getting past “g”: Testing a new model of dementing processes in non-demented persons. Journal of Neuropsychiatry & Clinical Neurosciences, 24, 37–46.CrossRefGoogle Scholar
  42. Royall, D. R., & Palmer, R. F. (2014). “Executive functions” cannot be distinguished from general intelligence: Two variations on a single theme within a symphony of latent variance. Frontiers in Behavioral Neuroscience, 8, 369.PubMedPubMedCentralCrossRefGoogle Scholar
  43. Royall, D. R., Mahurin, R. K., & Gray, K. F. (1992). Beside assessment of the executive cognitive impairment: The executive interview. Journal of the American Geriatrics Society, 40, 1221–1226.PubMedCrossRefPubMedCentralGoogle Scholar
  44. Royall, D. R., Mahurin, R. K., True, J., Anderson, B., Brock, P. I., Freeburger, L., & Miller, A. (1993). Executive impairment among the functionally dependent: Comparisons between schizophrenic and elderly subjects. American Journal of Psychiatry, 150, 1813–1819.PubMedCrossRefPubMedCentralGoogle Scholar
  45. Royall, D. R., Mahurin, R. K., & Cornell, J. C. (1994). Bedside assessment of frontal degeneration: Distinguishing Alzheimer’s disease from non-Alzheimer’s cortical dementia. Experimental Aging Research, 20, 95–103.PubMedCrossRefPubMedCentralGoogle Scholar
  46. Royall, D. R., Cabello, M., & Polk, M. J. (1998). Executive dyscontrol: An important factor affecting the level of care received by older retirees. Journal of the American Geriatrics Society, 46, 1519–1524.PubMedCrossRefPubMedCentralGoogle Scholar
  47. Royall, D. R., Rauch, R., Román, G. C., Cordes, J. A., & Polk, M. J. (2001). Frontal MRI findings associated with impairment on the executive interview (EXIT25). Experimental Aging Research, 27, 293–308.PubMedCrossRefPubMedCentralGoogle Scholar
  48. Royall, D. R., Lauterbach, E. C., Cummings, J. L., Reeve, A., Rummans, T. A., Kaufer, D. I., LaFrance, C. W., Coffey, C. E., & the Committee on Research of the American Neuropsychiatric Association. (2002). Executive control function: A review of its promise and challenges to clinical research. Journal of Neuropsychiatry and Clinical Neurosciences, 14, 377–405.PubMedCrossRefPubMedCentralGoogle Scholar
  49. Royall, D. R., Chiodo, L. K., & Polk, M. (2003). Executive dyscontrol in normal aging: Normative data, factor structure, and clinical correlates. In J. C. M. Brust & S. Fahn (Eds.), Current neurology and neuroscience reports (Vol. 3). Philadelphia: Current Science Inc. 6: 487–493.Google Scholar
  50. Royall, D. R., Chiodo, L. K., & Polk, M. J. (2005a). An empiric approach to level of care determinations: The importance of executive measures. Journal of Gerontology, 60A, 1059–1064.Google Scholar
  51. Royall, D. R., Palmer, R., Chiodo, L. K., & Polk, M. J. (2005b). Executive control mediates memory’s association with change in functional status: The freedom house study. Journal of the American Geriatrics Society, 53, 11–17.PubMedCrossRefGoogle Scholar
  52. Royall, D. R., Lauterbach, E. C., Kaufer, D. I., Malloy, P., Coburn, K. L., & Black, K. J. (2007). The cognitive correlates of functional status: A review from the Committee on Research of the American Neuropsychiatric Association. Journal of Neuropsychiatry and Clinical Neurosciences, 19, 249–265.PubMedCrossRefPubMedCentralGoogle Scholar
  53. Royall, D. R., Román, G. C., Cordes, J. A., Velez, A., Edwards, A., & Schillerstrom, J. S. (2009). Sertraline improves executive function in patients with vascular cognitive impairment. Journal of Neuropsychiatry and Clinical Neurosciences, 21, 445–454.PubMedCrossRefPubMedCentralGoogle Scholar
  54. Royall, D. R., Palmer, R. F., Matsuoka, T., Kato, Y., Taniguchi, S., Ogawa, M., Fujimoto, H., Okamura, A., Shibata, K., Nakamura, K., Nakaaki, S., Koumi, H., Mimura, M., Fukui, K., & Narumoto, J. (2016). Greater than the sum of its parts: δ can be constructed from item-level data. Journal of Alzheimer's Disease, 49, 571–579.PubMedCrossRefPubMedCentralGoogle Scholar
  55. Salazar, R., Velez, C. E., & Royall, D. R. (2014). Telephone screening for mild cognitive impairment in hispanics using the Alzheimer’s questionnaire. Experimental Aging Research, 40, 129–139.PubMedCrossRefPubMedCentralGoogle Scholar
  56. Schillerstrom, J. E., Deuter, M. S., Wyatt, R., Stern, S. L., & Royall, D. R. (2003). Prevalence of executive impairment in patients seen by a psychiatry consultation service. Psychosomatics, 44, 290–297.PubMedCrossRefPubMedCentralGoogle Scholar
  57. Schillerstrom, J. E., Horton, M. S., Schillerstrom, T. L., Joshi, K. G., Earthman, B. S., Velez, A. M., et al. (2005). Prevalence, course and risk factors for executive impairment in patients hospitalised on general medicine service. Psychosomatics, 46, 411–417.PubMedCrossRefPubMedCentralGoogle Scholar
  58. Schillerstrom, J. E., Rickenbacker, D., Joshi, K. G., & Royall, D. R. (2007). Executive function and capacity to consent to a noninvasive research protocol. The American Journal of Geriatric Psychiatry, 15, 159–162.PubMedCrossRefPubMedCentralGoogle Scholar
  59. Serrani Azcurra, D. J. (2013). Spanish translation and validation of an Executive Battery 25 (EB25) and its shortened version (ABE12) for executive dysfunction screening in dementia. Neurología, 28, 457–476.PubMedCrossRefPubMedCentralGoogle Scholar
  60. Spearman, C. (1904). General intelligence, objectively determined and measured. The American Journal of Psychology, 15, 201–293.CrossRefGoogle Scholar
  61. Stewart, J. T., Gonzalez-Perez, E., Zhu, Y., & Robinson, B. E. (1999). Cognitive predictors of resistiveness in dementia patients. The American Journal of Geriatric Psychiatry, 7, 259–263.PubMedCrossRefPubMedCentralGoogle Scholar
  62. Stokholm, J., Vogel, A., Gade, A., & Waldemar, G. (2005). The executive interview as a screening test for executive dysfunction in patients with mild dementia. Journal of the American Geriatrics Society, 53, 1577–1581.PubMedCrossRefPubMedCentralGoogle Scholar
  63. Tate, R. L. (2010). A compendium of tests, scales, and questionnaires: The practitioner’s guide to measuring outcomes after acquired brain impairment. Hove: Psychology Press.Google Scholar
  64. Thabit, H., Kennelly, S. M., Bhagarva, A., Ogunlewe, M., McCormack, P. M., McDermott, J. H., & Sreenan, S. (2009). Utilization of frontal assessment battery and executive interview 25 in assessing for dysexecutive syndrome and its association with diabetes self-care in elderly patients with type 2 diabetes mellitus. Diabetes Research and Clinical Practice, 86, 208–212.PubMedCrossRefPubMedCentralGoogle Scholar

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© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Deptartment of PsychiatryThe University of Texas Health Center at San AntonioSan AntonioUSA