What Is Executive Functioning and How Is It Affected by Dementia?

Cooking Is a Skill that Requires Executive Functioning
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What Is Executive Functioning?

Executive functioning involves the ability to organize, plan and carry out a set of tasks in an efficient manner. It also includes the ability to self-monitor and control our behaviors and multiple other cognitive functions, and to perform goal-directed behavior. It can be described as high level thinking skills that control and direct lower levels of cognitive functioning.

Interestingly, although memory impairment often goes along with executive impairment, a person can show no memory problems but still be impaired in decision-making and executive functioning.

On a practical level, impairments in executive functioning have been associated with impairments in activities of daily living which include getting dressed, the ability to feed oneself, bathe oneself and more.

Executive functioning ability has been strongly connected to working memory ability.

How Is Executive Functioning Affected by Alzheimer's Disease?

In people with Alzheimer's disease, executive functioning is significantly impacted, and more so as the disease progresses. Some of the challenging behaviors that often accompany Alzheimer's and other types of dementia may be related to problems in executive functioning.

How Is Executive Functioning Affected by Other Types of Dementia?

One study involved 76 people with Alzheimer's disease and 46 people with vascular dementia and found similar levels of executive functioning impairments in both groups of people.

However, another study found that memory is typically more impaired earlier in Alzheimer's disease while executive functioning is usually more impaired in vascular dementia. 

When comparing the executive functioning in people with Alzheimer's disease to that of those with frontotemporal dementia, those with frontotemporal dementia will usually display a greater impairment in executive functioning.

Another study compared the executive functioning in people with frontotemporal dementia and Lewy body dementia and found similar levels of executive dysfunction in both disorders.

How Is Executive Functioning Assessed?

There are several tests that help assess executive functioning. They include the clock-drawing test, the Stroop test, the verbal fluency test, the Wisconsin card-sorting test and the executive interview, among others.

Coping with Executive Dysfunction

Be aware that multi-step processes such as cooking and driving carry the possibility of danger when executive functioning is impaired, so take precautions in those areas, whether that's disconnecting the stove or talking to your loved one about quitting driving.

Some studies suggest that physical exercise can help improve executive functioning in people with dementia. For example, one study found that people with Alzheimer's disease experienced less decline in their executive functioning when they had higher rates of physical activity.

An impairment in executive functioning has the potential to be frustrating both for the person experiencing it as well as for her loved ones, but if you're able to respond and interact positively, it will help both of you.

Sources:

Alzheimer's Association. Try This. Issue Number D3, Revised 2012. Brief Evaluation of Executive Dysfunction: An Essential Refinement in the Assessment of Cognitive Impairment. http://consultgerirn.org/uploads/File/trythis/try_this_d3.pdf

Applied Neuropsychology, 2007, Vol. 14, No. 3, 208–214. Relationship Between Executive Functioning and Activities of Daily Living in Patients With Relatively Mild Dementia. http://www.csun.edu/~ljr77544/PDFs/Razani%20et%20al.%20%282007%29.pdf

Archives of Gerontology and Geriatrics. 1995 Sep-Oct;21(2):167-77. Behavioral disturbance and impairment of executive functions among the elderly. http://www.ncbi.nlm.nih.gov/pubmed/15374212

International Journal of Geriatric Psychiatry.2010 Jun;25(6):562-8. Executive functioning in Alzheimer's disease and vascular dementia. http://www.ncbi.nlm.nih.gov/pubmed/19810010

Journal of the American Geriatric Society. 2005, 53:1577–1581. The Executive Interview as a Screening Test for Executive Dysfunction in Patients with Mild Dementia. http://gade.psy.ku.dk/pdf/2005Stokholm%20exit25.pdf?origin=publicationDetail

Journal of Clinical and Experimental Neuropsychology.2013;35(1):24-34. AD pathology and cerebral infarctions are associated with memory and executive functioning one and five years before death. http://www.ncbi.nlm.nih.gov/pubmed/23205616

Neurology. 2013 Jun 11;80(24):2174-5. Executive functions can help when deciding on the frontotemporal dementia diagnosis. http://www.ncbi.nlm.nih.gov/pubmed/23658381

Neuropsychology Development and Cognition. Section B, Aging, Neuropsychology and Cognition. 2016 Mar;23(2):234-52. The relationship between habitual physical activity status and executive function in individuals with Alzheimer's disease: a longitudinal, cross-lagged panel analysis.http://www.ncbi.nlm.nih.gov/pubmed/26330266

Neuropsychology. 2010. March 24(2); 222-243. The Relationship Between Working Memory Capacity and Executive Functioning: Evidence for a Common Executive Attention Construct. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2852635/

Neuropsychology. 2009 Nov;23(6):765-77.Executive functions in frontotemporal dementia and Lewy body dementia. http://www.ncbi.nlm.nih.gov/pubmed/19899835

University of California, San Francisco. Executive Functions. Accessed October 30, 2013. http://memory.ucsf.edu/ftd/overview/biology/executive/single

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