WHAT’S THE EXECUTIVE FUNCTION AND WHY IS SO IMPORTANT?
The set of mental skills that help you get things done is executive function. An area of the brain, the so called frontal lobe, is in charge of controlling these skills and is located in the top front part of the brain, right behind the forehead and continue its development through adolescence and into adult life. Many body functions are controlled by the frontal lobes, some of which are managing body movement (motor function), emotions, attention, motivation, and other thinking functions such as decision-making, judgment, abstract reasoning, planning and completing tasks, working memory (storing and using details to function), and meeting goals.
Executive function is a term used to describe the management of activities and derives from the business world. In other words, just as a manager decides, adjusts and supervises business activities, the frontal lobes are in charge of the body functions.
What enables us to plan, focus attention, remember instructions, carry out a set of tasks are those mental processes known as executive function. The brain acts just as an air traffic control system at a busy airport. With the help of executive function it filters distractions, prioritize tasks, set and achieve goals, and control impulses.
Executive function also enables the brain to organize, self-monitor and control behaviors and multiple other cognitive functions, and to perform goal-directed behavior. These high level thinking skills manage and direct lower levels of cognitive functioning.
What is interesting to notice is that although memory impaired people are often executively impaired, an individual may show no memory deficits but can be impaired as far as decision-making and executive functioning are concerned.
Executive function depends on three types of brain function: working memory, mental flexibility, and self-control. These functions are highly interrelated, and the successful application of executive function skills requires them to operate in coordination with each other.
- Working memorycontrols our ability to retain and manipulate distinct pieces of information over short periods of time.
- Mental flexibilityhelps us to maintain or shift attention in response to different commands or to apply different rules in different environments.
- Self-control enables us to set priorities and resist impulsive actions or responses.
Some people are born with weak executive function. Also, people with ADHD (attention deficit hyperactivity disorder), depression, or learning disabilities often have weaknesses in it. An injury to the front of the brain, where the frontal lobe is, can harm the individual’s ability to stay and concentrate on task. Problems may also be caused by Alzheimer’s disease or strokes.
It is no easy to identify problems since there is no single test to recognize executive dysfunction. Experts rely on different tests to measure specific skills. However, they can’t predict how well adults or children will perform in real life. Sometimes, watching them and trying different things are better ways to improve weak executive function. Some elder patients perform well on global tests of cognition; however, their behavior is disruptive not only to their lives but also to those of their families. What generates these behavior problems is not really understood, and thus, this kind of bad behavior is attributed to the personality of elder people.
Executive function can be divided into two groups:
- Organization – Gathering information and structuring it for evaluation, For example: attention, planning, sequencing, problem-solving, working memory, cognitive flexibility, abstract thinking, rule acquisition, selecting relevant sensory information
- Regulation – Assessing your surroundings and changing behavior in response to it. For example: initiation of action, self-control, emotional regulation, monitoring internal and external stimuli, initiating and inhibiting context-specific behavior, moral reasoning, decision-making.
Why is it important at the functional level?
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. In other words, executive functions handle planning and paying attention to important needs and actions of the body. It includes: controlling, starting, stopping, regulating, adjusting to change, planning when faced with new settings or situations, forming ideas, storing information in and accessing it from working memory, controlling emotions, and thinking abstractly. Also, it is a function that helps people manage their time, pay attention, switch focus, multi task, remember details and avoid saying or doing the wrong thing. For example, to pay a bill, executive function includes choosing:
♦ what to do (such as which bill to pay),
♦ how long to do a current step (find the checkbook or log into the web page for that bill),
♦ when to shift to the second step (such as fill in the details on the check or web page),
♦ when to shift to the next step (such as checking the figures and other details on the check or web page and then sign your name), and
♦ when to stop the completed task (such as put away the checkbook or close the web page) and then move on to a different activity.
Feedback about the quality of each completed step should lead to improvements at that step or fixing any errors before finishing the whole task. When executive function isn’t working as it should, people’s behavior is less controlled. This can affect the ability to:
- Work or go somewhere
- Do things independently
- Maintain relationships
ALTERATIONS IN THIS DIMENSION IN PATIENTS WITH ALZHEIMER’S DEMENTIA
Research has shown some decrease in executive function as people age. In the case of sudden injury to the frontal lobes such as in a stroke or a head injury from a fall, car accident, or sports injury, there may be sudden but not progressive loss of functions from this area of the brain. The frontal lobes are affected by Alzheimer’s disease, although it appears that early in the course of the illness there is a lot of frontal lobe activity which attempts to compensate for the damage. Persons diagnosed with Alzheimer’s disease frontal lobe damage often lose their ability to sequence a task because they can no longer prioritize each segment of an activity.
When there is slow progressive decline such as with Alzheimer’s disease, a frontal dementia, or a related progressive memory disorder, abilities may waver; some days the executive function may be better while other it may be worse. Slowly over time in a progressive dementia such as Alzheimer’s disease or frontal dementia, executive functions decline and a caregiver has to take over more of the related responsibilities. Brain cell changes that result in decline in executive function could interfere with memory, applying good judgment to choices, and paying attention long enough to a conversation to be able to respond appropriately.
A new study finds that after memory begins to decline, executive function is the next brain function to deteriorate in the progression from mild cognitive impairment, a pre-Alzheimer’s disease condition, to Alzheimer’s disease. It is hard to make a decision if you cannot remember the important elements that are needed to go into that decision.
In general, among the elderly, measures of general cognitive ability are not consistently related to the capacity for independent functioning. Impaired executive functioning is common in dementia, but also may be present in the context of an age-related decline in the speed and capacity of information processing and varying levels of general cognitive impairment. Τhere are sufficient data concerning the so-called executive functions of the brain and their impairment in both normal aging and various types of dementia, to support the hypothesis that many behavioral disturbances among demented older adults are a function of different degrees of loss of the capacity to engage in purposeful, goal-directed activity.
According to the results of another research, very mild AD patients differed significantly from controls on executive tasks (Self-Ordering task, Hukok Logical Matrices, Trail Making Test and verbal fluency test) that required concurrent manipulation of information, i.e., set shifting, self-monitoring, or sequencing tasks. Furthermore, the results show that impairment of executive function in very mild AD patients precedes the disturbance of sustained attention, language (oral comprehension, verbal abstraction and naming) and constructional abilities.
Some reports, however, are in contradiction with executive dysfunction in the early stage of the disease. They claimed that, executive function is relatively spared in the early stage of the disease. Executive impairment was related to the severity and duration of AD. Similarly, other authors claimed that executive deficits simply reflect a moderate or severe cognitive deterioration.
SERIOUS GAMES APPROPRIATE FOR THIS DIMENSION:
It is possible to use serious games to improve executive function or slow down its deterioration. Various scientific investigations reflect that certain activities like brain training game (Brain Age), popular puzzle game (Tetris) and board games help to improve the executive function. Apart from video games, some studies suggest that physical exercise can help improve executive functioning in people with dementia.
In the training materials of AD-GAMING we have selected some games that allow executive function to work: