Executive functions in dementia and how to preserve them?

The term executive functions of the brain includes a range of cognitive abilities, which control and regulate other abilities and behaviors of a person. They control and regulate cognitive processes including working memory, reasoning, problem solving, and planning and its execution. Basically, the executive functions regulate and co-ordinate three types of brain functions as follows -

Working memory – It is the ability to retain and process distinct pieces of information over short periods of time.

Mental flexibility – It is the ability to sustain or shift attentions in response to different demands and handle them in different settings.

Self-control – It is the ability to set priorities and resist impulsive actions or responses.

Good executive functions are crucial for the learning and development of positive behavior. They assist us filter distractions, prioritize tasks, set and achieve goals, and control impulses. They let us make healthy choices for us and our families. It is significant to note that the skills for the development of good executive functions can be learned with some efforts.

The executive functions involve the areas of the brain that include prefrontal cortex, basal ganglia, thalamus and hippocampus. The frontal lobes are the last areas of the brain to develop fully. This area of the brain, which is evolutionarily late to appear, is much larger in human beings than in our closest non-human primate relatives. The frontal lobes typically account for about 40% of the human brain.

The damage to the most forward areas of the frontal lobes, located just above the eyes, as well as the cortical and sub-cortical structures that connect to the frontal lobes is associated with deficits of executive functions. Similarly, damage to the thalamus and hippocampus also causes deficits of the execution functions.

Deficits of executive functions –

The deficits associated with executive functions causes the following changes in a person –

• It causes socially inappropriate behavior.
• It causes an inability to apply consequences from past actions.
• It causes difficulty with abstract concepts.
• It causes difficulty in planning and initiation.
• It causes difficulty with verbal fluency.
• It causes an inability to multitask.
• It causes difficulty processing, storing, and/or retrieving information.
• It causes loss of fine motor skills like grabbing something with your thumb and forefinger more than gross motor skills like running and jumping.
• It makes one moody and emotionally labile.
• It creates a lack of concern toward people and animals.
• It causes a loss of interest in activities.
• It causes unawareness that their behavior is a problem.
• It produces an antisocial behavior without an inhibition.
• It causes trouble planning for the future.

Executive function in dementia –

A growing number of studies have shown that there is a deterioration of executive functions in patients with dementia. The frontal lobes are affected by Alzheimer's disease - the most common type of dementia.Alzheimer's disease
A neurological disease that affects memory and behaviour. It is characterized by beta-amyloid plaques and neurofibrillary tangles in the brain. There is no known cause but genetics and lifestyle are thought to play a role. Early in the course of the illness, there is a lot of frontal lobe activity, which attempts to compensate for the damage. In addition, the memory Memory
The ability to process information that requires attention, storage, and retrieval. loss that characterizes Alzheimer's disease can also affect executive function. Frontal lobe impairment classically is a late sign Sign
In medicine a sign is what a physician finds by examining a patient. For example, a patient with the symptom of pain might have signs of a fast heart rate, a pale face, a clammy touch and tenderness. of Alzheimer's disease.

Preserving executive functions in dementia -

The strategies to treat Alzheimer's disease and other dementia need not just focus on countering the disease process, but also on its prevention. By adopting the following healthy lifestyle habits elderly people can prevent or delay the onset of dementia.

• Healthy diet – By eating low fat high fiber diet including plenty of fresh fruits and vegetables, and whole grains, one can reduce the risks of some types of dementia. One should limit the amount of salt in diet to no more than 6 grams per day to control blood pressure and limit the amount of foods high in saturated fat to keep in check the cholesterol level. These changes will also reduce the risk of some types of dementia.
• Healthy body weight – Being overweight or obese can increase the risk of getting some kinds of dementia by increasing the blood pressure. The risk increases in proportion to the increase in body weight.
• Do exercise regularly – For the majority of people, a minimum of 150 minutes (2 hours and 30 minutes) of moderate-intensity aerobic activity each week, such as cycling or fast walking, is recommended. Inclusion of weight training of minimum of two days a week in the exercise schedule will further reduce the risk of dementia.
• Limit alcohol intake - Drinking excessive amounts of alcohol will cause blood pressure to rise, as well as the level of cholesterol in the blood. So, one should stick to the recommended daily limit for alcohol consumption of three to four units of alcohol a day for men, and two to three units a day for women. A unit of alcohol is equal to about half a pint of normal-strength lager, a small glass of wine or a pub measure (25ml) of spirits.
• Stop smoking - Smoking can cause the arteries to narrow, which can lead to a rise in the blood pressure. And, therefore, it increases the risk of developing dementia.
• Have good sleep – Cultivating good sleep habits reduces the risk or delays the development of dementia since it has been found that there exist a direct relationship between insomnia and development of dementia in old age. In old age, sleep disruption is a common problem and, therefore, it is of paramount importance for old people to cultivate good sleep hygiene.
• Learn a new language – It has been found that speaking more than one language leads to a better development of the areas of the brain which handle executive functions. So, it helps us protect from the onset of dementia. A study done by the researchers at Nizam’s Institute of Medical Sciences in Hyderabad, India has concluded that bilingualism delays the onset of dementia independent of education and immigration status. So, it is never too late to learn a new language, especially in old age to prevent or delay dementia.
• Enjoy music – The studies have revealed that music positively affects quality of life in patients of dementia. Music can shift mood, manage stress-induced agitation, stimulate positive interactions, facilitate cognitive function, and coordinate motor movements.
• Learn new skills – Learning new skills like dancing, singing, writing, cooking etc. also influence areas associated with executive functions in a positive manner. If you already know these skills, pay more attention in order to develop them further and try to become expert in them. This will reduce the risk of developing dementia.
• Teach others- Teaching others will reinforce what you are teaching them. Translating the material or writing it in your style that you read will strengthen and clarify what you are reading.
• Repeat the material read – By repeating the material that has been read after a gap of two to three days, one will strengthen the knowledge of the material so read. This is called the spacing effect by the cognitive researchers. This is how one can strengthen the roots of what has been learned.
• Solve quizzes – Solving different quizzes will also positively affect the executive functions of the brain. Making quizzes of the materials read or the lectures heard will too reduce the risk of dementia by strengthening the higher functions of the brain.
• Reduce stress – Older people experience more stress because of problems related to old age, resulting in an accumulation of stress hormone called cortisol. The prolonged exposure of the brain to cortisol can shrink up hippocampus as much as 14%. In fact, the hippocampus is one of the few areas of the brain that can produce new brain cells as we age. Surprisingly, the atrophy of hippocampus is one of the early signs of Alzheimer’s disease. Because the brains of seniors are more vulnerable to the stress hormone, they are, therefore, more liable to experience the damage to their executive functions. So, in order to reduce the risk of dementia related changes, they should adopt various stress relieving measures.

Loss or deficits of executive functions in a person causes great stress in the individual because of the disabilities faced by him or her. Notwithstanding, it measurably affects the lives of those associated with the person, causing stress in them too. So, adequate knowledge of the measures to reduce dementia will guide both the persons having dementia as well as those entrusted with their care to achieve a better outcome of the problem.