Executive function refers to a set of cognitive processes that help with managing oneself and one's resources to achieve a goal. In other words, the mental tools needed to help us plan, solve problems, organize, and regulate ourselves. In loved ones with advanced dementia, these functions can be significantly impaired, impacting the ability to perform everyday tasks.
Impact on Daily Living: With advanced dementia, your loved one may struggle with tasks that require planning and decision-making, such as managing finances, preparing meals, or even following a daily routine. It's important to provide clear, step-by-step guidance and simplify tasks to help them navigate daily activities. Sometimes this means, giving directions one step at a time, writing down directions or labeling items and rooms in the home.
Behavioral Changes: Impairments in executive function can lead to behavioral changes. Your loved one might become easily frustrated, exhibit impulsive behaviors, or struggle with maintaining attention. Understanding these changes as part of the disease can help you respond with patience and empathy. Your loved one may demonstrate personality behaviors that you've not seen before, it can be helpful to separate the disease from your loved ones. Much like one wouldn't be expected to walk the same after spraining an ankle, one shouldn't be expected to act the same after experiencing changes to their brain.
Communication Strategies: To support your loved one, use clear and concise communication. Break down instructions into simple steps and use visual aids or written cues to reinforce verbal messages. Encourage them gently and avoid overwhelming them with too much information at once. Speaking at a normal rate (as opposed to slowing down too much) can help reduce the strain on working memory (similar to 'short-term' memory), which is usually impacted first in this population.
Creating a Supportive Environment: A structured and predictable environment can help mitigate some of the challenges associated with impaired executive function. Keep their living space organized, establish consistent routines, and minimize distractions. This can reduce confusion and provide a sense of stability and security. Be especially mindful of background noise, such as having the television on all the time, or the radio. Although, soothing music can be comforting and elicit a positive emotional response, it can be taxing on your loved one's attention (think of how you turn the radio in the car when you're lost).
By understanding these aspects of cognitive executive function and implementing supportive strategies, you can better assist your loved one in managing their daily life and maintaining their dignity and quality of life.
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