07.12.18 Deficits in Executive Function in Alzheimer’s and Related Dementia

Thursday, July 12, 2018 – I haven’t written about my dementia lately nor have I shared information about dementia that I’ve found in my reading.  Mostly because I haven’t been able to absorb much lately and putting the information out there just wasn’t happening.
All dementias are different so what is commonly thought to be what memory loss looks like can be very different from individual to individual.  I have new learning deficiency, short term (recent) memory deficiency and others including Executive Function deficiency. If I can help others understand that there is no one way that people lose their memory that would be a big accomplishment.
This article below is about one of the aspects of frontotemporal dementia which is one of the aspects that affects me a lot, Executive Function. When I saw the article from Alzheimer’s Reading Room in my email I thought I really should share this.
From the article:
Executive function is an umbrella term for cognitive processes that regulate, control, and manage other cognitive processes. These processes include planning, working memory, attention, problem solving, verbal reasoning, inhibition, mental flexibility, task switching, and initiation and monitoring of actions.

Executive Function is something I’ve been dealing with a lot the last two years. My deficiency in this area became very apparent to us when we were on the road last year.  Making plans during our travel has always been my responsibility.  I have always been an organizer and planner and I loved doing that.

When my brain was working at its best I could see the overall goal (the big picture), determine all the steps that needed to be taken to achieve that goal and on down to all of the details.  I was very good at that so now that I can no longer do any part of that well on most days, I just don’t like it.

The planning for our travels became very difficult because of my growing loss of Executive Function.  Having to compare two or more RV parks in various locations and remember what I found from each was impossible for me.  The parks we’d stay at depending on several factors (price, how far we would travel in a day, how close they were to what we wanted to see and on and on) Remembering what step I just did or read or found out (or I should say NOT remembering what I just did) made moving forward with the next decision something I couldn’t do without being frustrated.

We realized after a few months that if I couldn’t do this any more we couldn’t travel.  Roy could not be responsible for the driving, setting us up and taking it down at a park, all of the planning, driving us in our truck to and from places and just a lot more things.  He helped me with the planning as much as he could.  I wrote down each thing I did to try to remember.  While that helped it made everything much harder, taking some of the joy out of our travels.

For me to write today’s blog post and organize it properly my Executive Function had to be doing pretty good.  It is at the moment and I grabbed today’s good time to put this together!

Deficits in Executive Function in Alzheimer’s and Related Dementia

Brain Executive FunctionBy Carole Larkin, Alzheimer’s Reading Room

Shall we ponder some of the issues regarding slowly losing executive functions in Alzheimer’s and related diseases today?

First, let’s define what executive function is.

An article by Leilani Doty, PhD, the Director of the University of Florida Cognitive and Memory Disorder Clinics tells us that executive functions generally take place in our frontal lobes, right behind our forehead.

These functions include our ability to plan things, to solve problems, to organize things in our heads, to develop the initiative to start something, to make an appropriate decision, to consider consequences of our choices, to form an idea, to prioritize things, to be able to control your own emotions and to be able to think abstractly.

Additionally executive functions include:

  1. the ability to use working memory (to hold the item in your head long enough to use it or apply it to something else),
  2. the ability to pay attention to something without getting distracted,
  3. the ability to focus in on important details, to work towards a goal (plan), to adjust to changes (shift gears midstream)
  4. and, to know when to stop an action or task that has been completed.

These things are what place us above other animals; in other words what make us human.

Dr. Doty breaks it down into 4 main steps:

  1. Start: Think about the problem and what needs to be done. Think of a way to solve the problem. Consider resources, past experience, new possibilities, values, deadlines, etc.
  2. Maintain: Start acting on the first step and continue until that step is done.
  3. Switch: Do each step and move on to the next step in order to complete the task or solve the problem.
  4. Stop: Evaluate the outcome. Is the end result good, is it adequate, is it finished, or is more action needed? When done, then stop.

And here are some finer brain actions within the main steps of executive function:

  1. Forming ideas to do an action.
  2. Starting an action.
  3. Maintaining an action until the step is finished (knowing when a step is done).
  4. Switching behaviors to do the next step needed.
  5. Regulating, controlling and adjusting body actions to deal with changes and new information along the way.
  6. Planning a tactic down the road to deal with a new issue or new direction.
  7. Holding details in working memory.
  8. Controlling emotions.
  9. Thinking abstractly.

Knowing when the whole task is finished, stopping that task, and moving onto a different task or activity.

Follow this link to see the full article: http://alzonline.phhp.ufl.edu/en/reading/ExecutiveFxLatest.pdf.

Note from Rosalyn: I ask that my family and close friends read the full article above.  Please do it for me.  It explains more than just what Executive Function does, it says how it affects someone with dementia and I think will explain a lot about how I am different now than I use to be.  Please read this. 

Back to the article: Phew! That’s a lot of things that executive function controls.

Dementia Caregiver Information (and anyone else who is around the patient a lot)

Now imagine the neurons in that part of the brain beginning to die. Think of it as if there is a light bulb representing that part of the brain and it begins flickering; sometimes on strongly, sometimes on weakly, sometimes not on at all. Well that’s how it is for years and years in Alzheimer’s and other related dementias.

How do you (the caregiver) know when the person’s executive function is OK, kinda not OK, or definitely not OK, because it’s always fluctuating? The answer is: you don’t know.

You couldn’t possibly know. Because, of course, you are not inside their heads watching the neurons fire, or not fire. So here you’ve come face to face with the true evil which is Alzheimer’s or another dementia.

You are the caregiver. The one with the whole brain (theoretically). At any given moment, you are responsible for their safety and their continued existence on this planet. Yet, they deserve to be self-reliant and independent as any other adult would be. They know it and you know it.

What to do? What to say? Stressed out much, are you at this moment?

So now, I think we are talking about talking risks here, folks. We do it with them all day, every day. We don’t want to, but we’re forced to. They force us to because many times they are not even aware that the light of logic and reason is weak or has gone out. Oh and by the way, self awareness is another executive function.

To think about taking a calculated risk by trying to control the environment or the circumstances in which this action (or non action) takes place, as much as possible. By tipping the scale on the side of safety as much as you can, you are taking a calculated risk as opposed to an uncalculated risk. It takes courage, I know, in the face of the anger and other nasty emotions that you will faced with, from the person with the disease.

But at least try.

Alzheimer's Reading RoomCarole Larkin MA, CMC, CAEd, DCP, QDCS, EICS is an expert in Alzheimer’s and related Dementias care.  She also is a Certified Geriatric Care Manager who specializes in helping families with Alzheimer’s and related dementias issues. Her company, ThirdAge Services LLC, is located in Dallas, TX, and her website is www.thirdageservices.com.

Original content the Alzheimer’s Reading Room

The Alzheimer’s Reading Room is the publisher of high quality expert content and news for the Alzheimer’s and dementia community.

Ya’ll come back now, ya’ hear!

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