Executive Dysfunction and MCI

A diagnosis of Mild Cognitive Impairment (MCI) usually involves significant issues with a patient’s memory. However, this is not always the case. MCI can involve issues with other cognitive areas like language, visuospatial skills or executive functioning. Any of these “domains” of cognitive impairment can occur in addition to memory loss, or even without memory loss. Today we’ll focus on executive function.

So, What are Executive Functions?

They are the mental processes needed to execute purposeful, goal-directed behavior. They refer to things like paying attention, concentrating, planning, self-monitoring, and adapting when needed.

Executive function skills can affect daily life in many ways, but let’s focus on 3 key areas: Working Memory, Flexible Thinking, and Inhibition.

• Working Memory is different from short-term memory. In fact, we generally think of this term more as attention/concentration rather than “memory.” Working memory is about keeping track of information that is needed to work with. For example, remembering that you had spaghetti for dinner would be short-term memory. Keeping in mind that you have 5 minutes left on the timer for boiling your pasta, while chopping the onions and stirring the sauce, is working memory. People will also sometimes call the skill in this last example “multi-tasking.” Working memory or concentration is needed to make sense of anything that happens over time or in a particular order, such as following a story, working math in your head, or seeing task all the way through without getting distracted and moving on to something else.
• Flexible Thinking refers to the ability to adjust to changes in demands, priorities, plans, or opportunities. Think of being able to “roll with the punches” when things go wrong, take another perspective, and adapt in order to accomplish the goal. This is the opposite of being cognitively rigid. People who are weak in this area have difficulty changing course.
• Inhibition refers to being able to control (and stop) one’s attention, behavior, thoughts, and/or emotions. Examples of weak Inhibition skills include being distracted by background noise in the environment, blurting out the first thing that comes to mind even if it isn’t socially appropriate, impulsively thinking of the worst-case scenario when worried, or overreacting with anger. Inhibition is like a mental “brake pedal” that allows one time to think before acting.

Take a moment to take this self-quiz! It should give you an idea of how deficits in the three areas of EF can lead to practical problems in your daily life.

Executive Functioning Skills - Self-Quiz

For each statement below, please answer mostly Agree or mostly Disagree.

1. I have trouble getting started on tasks.
2. I find it hard to do things that aren’t interesting or fun.
3. I am easily distracted.
4. I am often late.
5. When in conversation, I often forget what I wanted to say.
6. I have difficulty understanding what I require before starting a new task.
7. I have trouble completing multiple step-tasks.
8. My personal space is usually messy and disorganized.
9. I lose or misplace things almost every day.
10. I become frustrated when things don’t go as planned and can quickly become angry.

(adapted from a similar quiz at www.additudemag.com)

The more “Agree” answers you have, the weaker your executive functioning skills are. If you “Disagree” with the statements, the less likely you have executive dysfunction. Regardless of the quiz score, in general, the executive function skills can decline with older age. So let’s discuss what one can do to improve/maintain one’s executive functioning.

Tips for improving Executive Functioning

• Take care of yourself. Poorer executive functioning is associated with stress, obesity, not getting enough sleep, and substance abuse.
• Consider computerized brain games. If you participated in our HABIT program, you were introduced to BrainHQ. Playing challenging games that involve fast processing speed, concentration, and switching between tasks can possibly improve executive function skills.
• Break down tasks into steps and sub-steps. Create “recipes” for complex tasks: Make a list of ingredients (e.g., the equipment, supplies, and labor), and list each step in the process. Estimate the time it would take to procure the things you need and complete each step. Then double that estimate and make a timeline.
• Take notes and keep a record of what you’ve done. This way if you stop, switch tasks, or get distracted, you’ll easily know where you left off.
• Speaking of distractions, keep them to a minimum in your working environment and when you are communicating with others when possible. Don’t have the TV or radio on, and don’t have important conversations in loud, noisy environments where there is a lot of other stuff going on.
• Don’t try to do effortful tasks when you’re tired. For example, if you’re a morning person, do the important/difficult stuff in the morning.
• When communicating with your loved ones, try not to shout from another room. Instead, try to talk when it’s possible to make eye contact with good lighting, and make a habit of paraphrasing what you think you heard. Avoid long drawn out explanations.

People often think MCI is only about memory loss, but the diagnosis can instead result from deficits in executive functioning and/or memory loss. If you have weak executive function skills, they can affect your ability to complete tasks and activities of daily living. To ensure that you are functioning at your optimal level, live a brain healthy lifestyle, break down complex tasks into smaller tasks, consider using something like a day planner to keep track of what you’re doing, and work and communicate in an environment free of distractions.