Executive cognitive dysfunction is typically the first area of cognitive impairment and these problems can precede the memory disturbances of dementia. People with executive cognitive dysfunction can have a normal MMSE score but still have severe functional limitations.
How Executive Functioning Is Affected by Dementia
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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.
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.
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, and will do so earlier in the disease process.
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 Executive Functioning Is 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.
Examples of Executive Dysfunction in Dementia
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.
Other examples of impaired executive functioning in dementia include poor judgment, disorganization, socially inappropriate behavior, difficulty making plans for an event later in the day, and an inability to understand how their behavior or choices affect those around them. Executive functioning impairments may make it seem like the person is behaving selfishly, especially if their memory is still quite intact.
Can You Improve Executive Functioning in Dementia?
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.
Other studies have demonstrated that certain diets, such as the MIND diet or the Mediterranean diet, have the potential to slow cognitive decline in those who have dementia, and this benefit may extend to executive functioning, as well as memory.
A Word From Verywell
An impairment in executive functioning can be frustrating at times, 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. Also, reminding yourself that this challenge is due to dementia and is not a deliberate choice can also help reduce your potential to respond emotionally instead of with a deep breath and patience.