Dysfunkcje wykonawcze u chorych z uszkodzeniem mózgu Artykuł przeglądowy
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Opublikowane:
gru 31, 2012
Słowa kluczowe:
dysfunkcje wykonawcze, uszkodzenie mózgu
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Abstrakt
Funkcje wykonawcze są wiązane przede wszystkim z inicjowaniem, programowaniem i kontrolowaniem celowego zachowania człowieka. Stanowią najwyższy poziom jego hierarchicznej organizacji. Mimo powszechnego używania terminu system wykonawczy (executive system) jego elementy, a także kliniczne wskaźniki nie zostały jasno sprecyzowane. Zwykle włącza się do nich funkcje napędowo-regulacyjne, nadzorcze funkcje poznawcze oraz tzw. metapoznawcze. Uznaje się, że okolice przedczołowe czynnościowo ściśle współpracujące ze strukturami podkorowymi (ciałem prążkowanym, gałką bladą, wzgórzem) (frontal-subcortical circuits) odgrywają zasadniczą rolę w regulowaniu funkcji wykonawczych, jednak ich zaburzenia są obserwowane również przy innej lokalizacji uszkodzenia mózgu. Można to wyjaśnić nakładaniem się w obrazie klinicznym zaburzeń z różnych poziomów regulacji zachowania. W artykule omawiane są zagadnienia związane z oceną kliniczną i terapią dysfunkcji wykonawczych.
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Numer
Dział
Artykuły
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Bibliografia
1. Royall P., Lauterbach E.C., Cummings J.L., Reeve A., Rummans T.A., Kaufer D.I.: Executive control function: A review of its promise and challenge for clinical research. J. Neuropsychiatry Clin. Neurosci. 2002; 14: 377-405.
2. Cummings J.L., Miller B.L.: Conceptual and Clinical Aspects of the Frontal Lobes. W: The Human Frontal Lobes. Miller B.L., Cummings J.L. (red.). The Guilford Press, New York 2007: 12-43.
3. Godefroy O., Stuss D.: Dysexecutive syndromes. W: The behavioral and cognitive neurology of stroke. Godefroy O., Bogousslavsky J. (red.). Cambridge University Press, New York 2007: 369-406.
4. Ardila A.: On the evolutionary origins of executive functions. Brain Cogn. 2008; 68: 92-99.
5. Shannon C.R., Thomas-Duckwitz C.: Executive functioning. W: Encyclopedia of Clinical Neuropsychology. Vol. 2. Kreutzer J.S., DeLuca J., Caplan B. (red.). Springer, New York 2011: 991-997.
6. Stuss D.: New Approaches to Prefrontal Lobe Testing. W: The Human Frontal Lobes. Miller B., Cummings J.L. (red.). The Guilford Press, New York 2007: 292-305.
7. Ardila A., Surloff C.: Dysexecutive syndromes. Medlink Neurology. Arbor Publishing Co., San Diego 2008.
8. Jurado M.B., Roselli M.: The elusive nature of executive functions: a review of our current understanding. Neuropsychol. Rev. 2007; 17: 213-233.
9. Kramer J.H., Krueger C.E., Sinha L.: Executive Abilities: Methods and Instruments for Neurobehavioral Evaluation and research. W: Encyclopedia of Clinical Neuropsychology. Vol. 2. Kreutzer J.S., DeLuca J., Caplan B. (red.). Springer, New York 2011: 987-997.
10. Duncan J., Emslie H., Williams P., Johnson R., Freer C.: Intelligence and the frontal lobes: The organization of goal-directed behavior. Cognit. Psychol. 1996; 30: 257-303.
11. Kimberg D., D’Esposito M., Farah M.: Cognitive functions in the prefrontal cortex – working memory and executive control. Curr. Direct. Psychol. Sci. 1997; 6: 185-192.
12. De Frias C., Dixon R., Strauss E.: Structure of tour executive functioning test in healthy older adults. Neuropsychology 2006; 20: 206-214.
13. Baddeley A.: Exploring the central executive. Quarterly J. Exp. Psychol. 1996; 49A: 5-28.
14. Stuss D.T., Alexander M.: Executive functions and the frontal lobes: A conceptual view. Psychol. Research 2000; 63: 289-298.
15. Miyake A., Friedman N., Emerson M., Witzki A., Howerter A.: The unity and diversity of executive functions and their contribution to complex „frontal lobe” tasks: A latent variable analysis. Cognit. Psychol. 2000; 41: 49-100.
16. Gazzaley A., D’Esposito M.: Unifying Prefrontal Cortex Function. Executive Control, Neural Networks, and Top-down Modulation. W: The Human Frontal Lobes. Miller B., Cummings J.L. (red.). The Guilford Press, New York 2007: 187-206.
17. Kaufmann L., Koppelstaetter F., Delazer M., Siedentopf C., Rhomberg P., Golaszewski S., Felber S., Ischebeck A.: Neural correlates of distance and congruity effects in a numerical Stroop task: An event-related fMRI study. Neuroimage 2005; 15: 888-898.
18. Lie C., Specht K., Marshall J., Fink G.: Using fMRI to decompose the neural processes underlying the Wisconsin Card Sorting Test. Neuroimage 2006; 15: 1038-1049.
19. Wagner G., Kock K., Reichenbach J., Sauer H., Schlosser R.: The special involvement of the rostrolateral prefrontal cortex in planning abilities: An event-related fMRI study with the Tower of London paradigm. Neuropsychologia 2006; 44: 2337-2347.
20. Hirshorn E.A., Thompson-Schill S.L.: Role of the left inferior frontal gyrus in covert word retrieval: neural correlates of switching during verbal fluency. Neuropsychologia 2006; 44: 2547-2557.
21. Stuss D.T., Alexander M.P., Floden D., Binns M.A., Levine B., McIntosh A.R.: Fractionation and localization of distinct frontal lobe processes: Evidence from focal lesions in humans. W: Principles of frontal lobe function. Stuss D.T., Knight R.T. (red.). Oxford University Press, New York 2002: 392-407.
22. Collette T., van der Linden M., Laureys S., Delfiore G., Degueldre C., Luxen A.: Exploring the unity and diversity of the neural substrates of executive functioning. Hum. Brain Mapp. 2005; 25: 409-423.
23. Lewis S.J., Dove A., Robbins T., Barker R.A., Owen A.M.: Striatal contribution to working memory. A functional magnetic resonance imaging study in humans. Eur. J. Neurosci. 2004; 19: 755-760.
24. Kassubeck J., Juengling F.D., Ecker D., Landwehrmeyer G.B.: Thalamic atrophy in Huntington’s disease co-varies with cognitive performance. A morphometric MRI analysis. Cereb. Cortex 2005; 15: 846-853.
25. Baddeley A.: Working memory. Oxford University Press, Oxford 1986.
26. Marin R.S.: Apathy: concept, syndrome, neural mechanisms, and treatment. Semin. Clin. Neuropsychiatry 1996; 1(4): 304-314.
27. Laplane D., Dubois B.: Auto-Activation deficit: a basal ganglia related syndrome. Mov. Dis. 2001; 16(5): 810-814.
28. Rao S.M., Leo G.J., Bernardin L., Unverzagt F.: Cognitive dysfunction in multiple sclerosis. Frequency, patterns and prediction. Neurology 1991; 41: 685-691.
29. Nebel K., Wiese H., Seyfarth J., Gizewski E.R., Stude P., Diener H.C., Limmroth V.: Activity of attention related structures in multiple sclerosis. Brain Res. 2007; 1151: 150-160.
30. Rovaris M., Filippi M., Falautano M., Minicucci L., Rocca M.A., Martinelli V., Comi G.: Relation between MR abnormalities and patterns of cognitive impairment in multiple sclerosis. Neurology 1998; 50: 1601-1608.
31. Foong J., Rozewicz L., Quaghebeur G., Davie C.A., Kartsounis L.D., Thompson A.J., Miller D.H., Ron A.: Executive function in multiple sclerosis. The role of frontal lobe pathology. Brain 1997; 120: 15-26.
32. Sperling R.A., Guttmann C.R., Hohol M.J., Warfield S.K., Jakab M., Parente M., Diamond E.L., Daffner K.R., Olek M.J., Orav E.J., Kikinis R., Jolesz F.A., Weiner H.: Regional magnetic resonance imaging lesion burden and cognitive function in multiple sclerosis: a longitudinal study. Arch. Neurol. 2001; 58: 115-121.
33. Ranjeva J.P., Audoin B., Au Duong M.V., Ibarrola D., Confort-Gouny S., Malikova I., Suolier E., Viout P., Ali-Cherif A., Pelletier J., Cozzone P.: Local tissue damage assessed with statistical mapping analysis of brain magnetization transfer ratio: relationship with functional status of patients in the earliest stage of multiple sclerosis. Am. J. Neuroradiol. 2005; 26: 119-112.
34. Piras M.R., Magnano I., Canu E.D., Paulus K.S., Satta W.M., Soddu A., Conti M., Achene A., Solinas G., Aiello I.: Longitudinal study of cognitive dysfunction in multiple sclerosis: neuropsychological, neuroradiological, and neurophysiological findings. J. Neurol. Neurosurg. Psychiatry 2003; 74: 878-885.
35. Nelson F., Datta S., Garcia N., Rozario N.L., Perez F., Cutter G., Narayana P.A., Wolinsky J.S.: Intracortical lesions by 3T magnetic resonance imaging and correlation with cognitive impairment in multiple sclerosis. Mult. Scler. 2011; 11: 1122-1129.
36. Huijbregts S.C., Kalkers N.F., de Sonneville L.M., de Groot V., Polman C.H.: Differences in cognitive impairment of relapsing remitting, secondary, and primary progressive MS. Neurology 2004; 63: 335-339.
37. Golden C.J.: Stroop color and word test: A manual for clinical and experimental uses. Stoelting, Chicago 1978.
38. Jaworowska A.: Test Sortowania Kart z Wisconsin. Pracownia Testów Psychologicznych PTP, Warszawa 2002.
39. Reitan R.M.: The relation of the Trail Making Test to organic brain damage. J. Consult. Psychol. 1955; 19: 393-394.
40. Benton A.L., Hamsher K.: Multiligual aphasia examination. AJA, Iowa City 1989.
41. Shallice T.: Specific impairment of planning. Philos. Trans. R. Soc. Lond. B. Biol. Sci. 1982; 298: 199-209.
42. Wilson B.A., Alderman N., Burgess P., Emslie H., Evans J.J.: The Behavioural Assessment of the Dysexecutive Syndrome. Thames Valley Test Company, Flempton, UK 1996.
43. Gioia G., Isquith P., Guy S., Kenworthy L.: Behavior rating inventory of executive functions. Psychological Assessment Resources, Lutz, FL 2000.
44. Downes J., Evenden J., Morris R., Oven A., Robbins T., Roberts A., Sahakian B.: Cambridge Neuropsychological Test Automated Battery: CANTABeclipse, version 3. Cambridge Cognition Limited, Cambridge 2006.
45. Delis D., Kaplan E., Kramer N.: Delis–Kaplan executive function system. Psychological Assessment Resources, Odessa, FL 2001.
46. Grace J., Malloy P.F.: Frontal system behavioral scale. Psychological Assessment Resources, Odessa, FL 2002.
47. Jodzio K.: Neuropsychologia intencjonalnego działania. Koncepcje funkcji wykonawczych. Wydawnictwo Naukowe SCHOLAR, Warszawa 2008: 242-289.
48. Ballard C., Stephens S., Kenny R.A., Kalaria R., Tovee M., O’Brien J.: Profile of neuropsychological deficits in older stroke survivors without dementia. Dement. Geriatr. Cogn. Disord. 2003; 16: 52-6.
49. Cicerone K., Levin H., Malec J., Stuss D., Whyte J.: Cognitive Rehabilitation Interventions for Executive Function: Moving from Bench to Bedside in Patients with Traumatic Brain Injury. J. Cog. Neurosci. 2006; 18(7): 1212-1222.
50. Levine B., Robertson I.H., Clare L., Carter G., Hong J., Wilson B.A., Duncan J., Stuss D.T.: Rehabilitation of executive functioning: An experimental-clinical validation of goal management training. J. Inter. Neuropsychol. Soc. 2000; 6: 299-312.
51. Fasotti L., Kovacs F., Eling P.A., Brouver W.H.: Time pressure management as a compensatory strategy training after closed head injury. Neuropsychol. Rehabil. 2000; 10: 47-55.
52. Ownsworth T.L., McFarland K., Young R.M.: Self-awareness and psychosocial functioning following acquired brain injury: An evaluation of a group support programme. Neuropsychol. Rehabil. 2000; 10: 465-484.
53. Gordon W.A., Cantor J., Ashman T., Brawn M.: Treatment of post-TBI executive dysfunction: application of theory to clinical practice. J. Head Trauma Rehabil. 2006; 21: 156-67.
54. Cicerone K.D., Dahlberg C., Malec J.F., Langenbahn D.M., Felicetti T., Kneipp S., Ellmo W. et al.: Evidence-based cognitive rehabilitation: updated review of the literature from 1998 through 2002. Arch. Phys. Med. Rehabil. 2005; 86: 1681-92.
55. Chung C.S.Y., Pollock A., Campbell T., Durward B.R., Hagen S.: Cognitive rehabilitation for executive dysfunction in patients with stroke or other adult non-progressive acquired brain damage. Cochrane Database of Systematic Reviews 2010, 3: CD008391.
2. Cummings J.L., Miller B.L.: Conceptual and Clinical Aspects of the Frontal Lobes. W: The Human Frontal Lobes. Miller B.L., Cummings J.L. (red.). The Guilford Press, New York 2007: 12-43.
3. Godefroy O., Stuss D.: Dysexecutive syndromes. W: The behavioral and cognitive neurology of stroke. Godefroy O., Bogousslavsky J. (red.). Cambridge University Press, New York 2007: 369-406.
4. Ardila A.: On the evolutionary origins of executive functions. Brain Cogn. 2008; 68: 92-99.
5. Shannon C.R., Thomas-Duckwitz C.: Executive functioning. W: Encyclopedia of Clinical Neuropsychology. Vol. 2. Kreutzer J.S., DeLuca J., Caplan B. (red.). Springer, New York 2011: 991-997.
6. Stuss D.: New Approaches to Prefrontal Lobe Testing. W: The Human Frontal Lobes. Miller B., Cummings J.L. (red.). The Guilford Press, New York 2007: 292-305.
7. Ardila A., Surloff C.: Dysexecutive syndromes. Medlink Neurology. Arbor Publishing Co., San Diego 2008.
8. Jurado M.B., Roselli M.: The elusive nature of executive functions: a review of our current understanding. Neuropsychol. Rev. 2007; 17: 213-233.
9. Kramer J.H., Krueger C.E., Sinha L.: Executive Abilities: Methods and Instruments for Neurobehavioral Evaluation and research. W: Encyclopedia of Clinical Neuropsychology. Vol. 2. Kreutzer J.S., DeLuca J., Caplan B. (red.). Springer, New York 2011: 987-997.
10. Duncan J., Emslie H., Williams P., Johnson R., Freer C.: Intelligence and the frontal lobes: The organization of goal-directed behavior. Cognit. Psychol. 1996; 30: 257-303.
11. Kimberg D., D’Esposito M., Farah M.: Cognitive functions in the prefrontal cortex – working memory and executive control. Curr. Direct. Psychol. Sci. 1997; 6: 185-192.
12. De Frias C., Dixon R., Strauss E.: Structure of tour executive functioning test in healthy older adults. Neuropsychology 2006; 20: 206-214.
13. Baddeley A.: Exploring the central executive. Quarterly J. Exp. Psychol. 1996; 49A: 5-28.
14. Stuss D.T., Alexander M.: Executive functions and the frontal lobes: A conceptual view. Psychol. Research 2000; 63: 289-298.
15. Miyake A., Friedman N., Emerson M., Witzki A., Howerter A.: The unity and diversity of executive functions and their contribution to complex „frontal lobe” tasks: A latent variable analysis. Cognit. Psychol. 2000; 41: 49-100.
16. Gazzaley A., D’Esposito M.: Unifying Prefrontal Cortex Function. Executive Control, Neural Networks, and Top-down Modulation. W: The Human Frontal Lobes. Miller B., Cummings J.L. (red.). The Guilford Press, New York 2007: 187-206.
17. Kaufmann L., Koppelstaetter F., Delazer M., Siedentopf C., Rhomberg P., Golaszewski S., Felber S., Ischebeck A.: Neural correlates of distance and congruity effects in a numerical Stroop task: An event-related fMRI study. Neuroimage 2005; 15: 888-898.
18. Lie C., Specht K., Marshall J., Fink G.: Using fMRI to decompose the neural processes underlying the Wisconsin Card Sorting Test. Neuroimage 2006; 15: 1038-1049.
19. Wagner G., Kock K., Reichenbach J., Sauer H., Schlosser R.: The special involvement of the rostrolateral prefrontal cortex in planning abilities: An event-related fMRI study with the Tower of London paradigm. Neuropsychologia 2006; 44: 2337-2347.
20. Hirshorn E.A., Thompson-Schill S.L.: Role of the left inferior frontal gyrus in covert word retrieval: neural correlates of switching during verbal fluency. Neuropsychologia 2006; 44: 2547-2557.
21. Stuss D.T., Alexander M.P., Floden D., Binns M.A., Levine B., McIntosh A.R.: Fractionation and localization of distinct frontal lobe processes: Evidence from focal lesions in humans. W: Principles of frontal lobe function. Stuss D.T., Knight R.T. (red.). Oxford University Press, New York 2002: 392-407.
22. Collette T., van der Linden M., Laureys S., Delfiore G., Degueldre C., Luxen A.: Exploring the unity and diversity of the neural substrates of executive functioning. Hum. Brain Mapp. 2005; 25: 409-423.
23. Lewis S.J., Dove A., Robbins T., Barker R.A., Owen A.M.: Striatal contribution to working memory. A functional magnetic resonance imaging study in humans. Eur. J. Neurosci. 2004; 19: 755-760.
24. Kassubeck J., Juengling F.D., Ecker D., Landwehrmeyer G.B.: Thalamic atrophy in Huntington’s disease co-varies with cognitive performance. A morphometric MRI analysis. Cereb. Cortex 2005; 15: 846-853.
25. Baddeley A.: Working memory. Oxford University Press, Oxford 1986.
26. Marin R.S.: Apathy: concept, syndrome, neural mechanisms, and treatment. Semin. Clin. Neuropsychiatry 1996; 1(4): 304-314.
27. Laplane D., Dubois B.: Auto-Activation deficit: a basal ganglia related syndrome. Mov. Dis. 2001; 16(5): 810-814.
28. Rao S.M., Leo G.J., Bernardin L., Unverzagt F.: Cognitive dysfunction in multiple sclerosis. Frequency, patterns and prediction. Neurology 1991; 41: 685-691.
29. Nebel K., Wiese H., Seyfarth J., Gizewski E.R., Stude P., Diener H.C., Limmroth V.: Activity of attention related structures in multiple sclerosis. Brain Res. 2007; 1151: 150-160.
30. Rovaris M., Filippi M., Falautano M., Minicucci L., Rocca M.A., Martinelli V., Comi G.: Relation between MR abnormalities and patterns of cognitive impairment in multiple sclerosis. Neurology 1998; 50: 1601-1608.
31. Foong J., Rozewicz L., Quaghebeur G., Davie C.A., Kartsounis L.D., Thompson A.J., Miller D.H., Ron A.: Executive function in multiple sclerosis. The role of frontal lobe pathology. Brain 1997; 120: 15-26.
32. Sperling R.A., Guttmann C.R., Hohol M.J., Warfield S.K., Jakab M., Parente M., Diamond E.L., Daffner K.R., Olek M.J., Orav E.J., Kikinis R., Jolesz F.A., Weiner H.: Regional magnetic resonance imaging lesion burden and cognitive function in multiple sclerosis: a longitudinal study. Arch. Neurol. 2001; 58: 115-121.
33. Ranjeva J.P., Audoin B., Au Duong M.V., Ibarrola D., Confort-Gouny S., Malikova I., Suolier E., Viout P., Ali-Cherif A., Pelletier J., Cozzone P.: Local tissue damage assessed with statistical mapping analysis of brain magnetization transfer ratio: relationship with functional status of patients in the earliest stage of multiple sclerosis. Am. J. Neuroradiol. 2005; 26: 119-112.
34. Piras M.R., Magnano I., Canu E.D., Paulus K.S., Satta W.M., Soddu A., Conti M., Achene A., Solinas G., Aiello I.: Longitudinal study of cognitive dysfunction in multiple sclerosis: neuropsychological, neuroradiological, and neurophysiological findings. J. Neurol. Neurosurg. Psychiatry 2003; 74: 878-885.
35. Nelson F., Datta S., Garcia N., Rozario N.L., Perez F., Cutter G., Narayana P.A., Wolinsky J.S.: Intracortical lesions by 3T magnetic resonance imaging and correlation with cognitive impairment in multiple sclerosis. Mult. Scler. 2011; 11: 1122-1129.
36. Huijbregts S.C., Kalkers N.F., de Sonneville L.M., de Groot V., Polman C.H.: Differences in cognitive impairment of relapsing remitting, secondary, and primary progressive MS. Neurology 2004; 63: 335-339.
37. Golden C.J.: Stroop color and word test: A manual for clinical and experimental uses. Stoelting, Chicago 1978.
38. Jaworowska A.: Test Sortowania Kart z Wisconsin. Pracownia Testów Psychologicznych PTP, Warszawa 2002.
39. Reitan R.M.: The relation of the Trail Making Test to organic brain damage. J. Consult. Psychol. 1955; 19: 393-394.
40. Benton A.L., Hamsher K.: Multiligual aphasia examination. AJA, Iowa City 1989.
41. Shallice T.: Specific impairment of planning. Philos. Trans. R. Soc. Lond. B. Biol. Sci. 1982; 298: 199-209.
42. Wilson B.A., Alderman N., Burgess P., Emslie H., Evans J.J.: The Behavioural Assessment of the Dysexecutive Syndrome. Thames Valley Test Company, Flempton, UK 1996.
43. Gioia G., Isquith P., Guy S., Kenworthy L.: Behavior rating inventory of executive functions. Psychological Assessment Resources, Lutz, FL 2000.
44. Downes J., Evenden J., Morris R., Oven A., Robbins T., Roberts A., Sahakian B.: Cambridge Neuropsychological Test Automated Battery: CANTABeclipse, version 3. Cambridge Cognition Limited, Cambridge 2006.
45. Delis D., Kaplan E., Kramer N.: Delis–Kaplan executive function system. Psychological Assessment Resources, Odessa, FL 2001.
46. Grace J., Malloy P.F.: Frontal system behavioral scale. Psychological Assessment Resources, Odessa, FL 2002.
47. Jodzio K.: Neuropsychologia intencjonalnego działania. Koncepcje funkcji wykonawczych. Wydawnictwo Naukowe SCHOLAR, Warszawa 2008: 242-289.
48. Ballard C., Stephens S., Kenny R.A., Kalaria R., Tovee M., O’Brien J.: Profile of neuropsychological deficits in older stroke survivors without dementia. Dement. Geriatr. Cogn. Disord. 2003; 16: 52-6.
49. Cicerone K., Levin H., Malec J., Stuss D., Whyte J.: Cognitive Rehabilitation Interventions for Executive Function: Moving from Bench to Bedside in Patients with Traumatic Brain Injury. J. Cog. Neurosci. 2006; 18(7): 1212-1222.
50. Levine B., Robertson I.H., Clare L., Carter G., Hong J., Wilson B.A., Duncan J., Stuss D.T.: Rehabilitation of executive functioning: An experimental-clinical validation of goal management training. J. Inter. Neuropsychol. Soc. 2000; 6: 299-312.
51. Fasotti L., Kovacs F., Eling P.A., Brouver W.H.: Time pressure management as a compensatory strategy training after closed head injury. Neuropsychol. Rehabil. 2000; 10: 47-55.
52. Ownsworth T.L., McFarland K., Young R.M.: Self-awareness and psychosocial functioning following acquired brain injury: An evaluation of a group support programme. Neuropsychol. Rehabil. 2000; 10: 465-484.
53. Gordon W.A., Cantor J., Ashman T., Brawn M.: Treatment of post-TBI executive dysfunction: application of theory to clinical practice. J. Head Trauma Rehabil. 2006; 21: 156-67.
54. Cicerone K.D., Dahlberg C., Malec J.F., Langenbahn D.M., Felicetti T., Kneipp S., Ellmo W. et al.: Evidence-based cognitive rehabilitation: updated review of the literature from 1998 through 2002. Arch. Phys. Med. Rehabil. 2005; 86: 1681-92.
55. Chung C.S.Y., Pollock A., Campbell T., Durward B.R., Hagen S.: Cognitive rehabilitation for executive dysfunction in patients with stroke or other adult non-progressive acquired brain damage. Cochrane Database of Systematic Reviews 2010, 3: CD008391.