What Is Executive Dysfunction?

Executive dysfunction involves problems with thinking, memory, and planning. These skills are also described as cognitive processes. When you have a problem with any of your executive functions, it can interfere with all aspects of life, such as self-care, work, socializing, and managing your home and finances.

Health problems that affect the brain, including dementia (chronic or persistent disorder impairing at least two brain functions), a stroke (a blockage of blood flow or bleed in the brain), psychosis (disconnection from reality), and more can cause executive dysfunction. 

What Is Executive Function?

Executive function includes several different components of thinking and planning.

Aspects of executive function include:

• Memory 
• Learning 
• Concentrating 
• Self-control 
• Planning 
• Organizing 
• Problem-solving 
• Making calculations 
• Imagination 

These different functions work together to help you process the information you’ve been exposed to, decide whether you want to remember it or not, and make decisions. 

What Is Executive Dysfunction?

Executive dysfunction is an impairment of one or more aspects of executive function. This can interfere with a person’s ability to take care of themselves, interact with family and friends, maintain peace of mind, or work productively. Often, executive dysfunction begins with just a few symptoms and can progress to involve more aspects of life. 

Signs and Symptoms

The signs and symptoms of executive dysfunction can be subtle with progressive conditions like dementia, and they can be severe and even life-threatening in some situations, like a drug overdose. 

Signs and symptoms can include:

• Difficulty learning or concentrating, at any age
• Confusion 
• Not recognizing familiar people 
• Getting lost 
• Forgetting how to do familiar activities or use familiar objects 
• Neglecting self-care 
• Forgetting responsibilities, like assignments or paying bills 
• Mistakes, like leaving the stove on 
• Problems with language or simple calculations that a person used to know how to do 
• Unusual thoughts or beliefs 
• Difficulty getting along with others 

With executive dysfunction, you can have one or more of these problems. Sometimes a person can have other associated symptoms too, such as weakness of one side of the body with a stroke. 

What Causes Executive Dysfunction?

Many different medical and psychiatric conditions can lead to executive dysfunction. The different causes include temporary medication side effects that will wear off, medical problems like infections that can fully resolve with treatment, psychiatric issues like schizophrenia that can be managed with medication, head trauma that can partially or fully improve, and more. 

Short-Term Causes

Some causes of executive dysfunction will not last for long and can resolve with or without treatment. 

Causes of short-term executive dysfunction include:

• Medication side effects 
• Anesthesia effects 
• Drug overdose 
• Severe systemic infections
• Meningitis (inflammation of the lining of the brain and spinal cord) or encephalitis (inflammation of the brain)
• After a seizure (episode of uncontrolled electrical activity in the brain)
• Depression or bipolar disorder (two types of mood disorders)
• Anxiety
• Migraine (a headache disorder)
• Heart surgery

Some people are experiencing executive dysfunction after COVID-19, which is described as a feature of long haul COVID. Because it’s a new condition, the long-term prognosis is not known.

Post-traumatic stress disorder and generalized anxiety disorder can cause executive dysfunction that may improve with treatment of the underlying condition. Head trauma, bleeding in the brain, and tumors in the brain may cause short-term or long-term executive dysfunction. 

Long-Term Conditions

Some conditions cause progressively worsening, intermittent, or stable long-term executive dysfunction. 

Causes of long-term executive dysfunction include: 

• Neurodevelopmental disorders, such as autism and attention deficit hyperactivity disorder (ADHD)
• Congenital (present at birth) disabilities, such as cerebral palsy (affects the brain and muscles) 
• Dementia
• Stroke 
• Advanced Parkinson's disease (a progressive neurological disorder)
• Multiple sclerosis (MS) (an autoimmune disease that attacks the protective myelin around the nerves) can affect executive function during exacerbations, or gradually as the disease progresses
• Huntington's disease (a hereditary degenerative neurological disease)
• Severe or recurrent head trauma 
• Brain damage due to infection or bleeding
• Schizophrenia (a psychiatric disorder that causes psychosis, disorganization, and unusual behavior)
• End-stage liver disease
• Electrolyte imbalances (imbalance of important minerals in the blood)
• Creutzfeldt-Jacob disease (a rare degenerative brain disease)
• AIDS (a complication of HIV infection in which the immune system is severely compromised)

These conditions may interfere with self-care and awareness of surroundings. 

Diagnosis and Evaluation

Signs of executive dysfunction require a medical, neurological, and psychiatric evaluation. A medical history and physical examination, including a neurological examination, will usually identify whether the problem is a medical emergency or a chronic illness. 

Further testing is sometimes necessary to identify the cause and severity of executive dysfunction. 

Examples include:

• Cognitive testing, such as the Alzheimer's Disease Assessment Scale-Cognitive Subscale test or the Montreal Cognitive Assessment
• Tests of learning skills 
• Complete blood count (CBC)
• Electrolyte blood levels 
• Blood culture 
• Urinalysis 
• Brain imaging tests 
• Lumbar puncture (spinal tap)
• Screening tests for depression, anxiety disorders, and psychotic disorders

Once a diagnosis is established, the treatment plan will address management of executive dysfunction, as well as treatment of other associated symptoms and treatment of the underlying condition. 

Treatment for Executive Dysfunction

Many of the causes of executive dysfunction can be treated. Additionally, sometimes therapies can help improve executive function. This is especially true with learning and behavioral disabilities, which can often improve partially or fully with interventions.

Treatments for executive function disorders can include: 

• Antibiotics or antiviral treatments for infections 
• Intravenous fluid, electrolytes, dialysis for electrolyte imbalance
• Antipsychotic, antidepressant, or anti-anxiety medication for psychiatric disorders 
• Counseling and cognitive behavioral therapy for treatment of psychiatric and psychological disorders 
• Disease-modifying therapy for MS 
• Parkinson’s disease medication 
• Medications used to slow the progression of dementia
• Surgery for the treatment of structural problems, such as bleeding or tumors in the brain

Importantly, cognitive rehabilitation and occupational therapy can help with learning self-care skills. These interventions are valuable for most types, severity, and causes of executive dysfunction.

Summary 

Executive dysfunction is a problem with thinking skills. It can range in severity, and it can occur due to many different conditions. Diagnosis involves a comprehensive medical history and examination, and sometimes involves diagnostic tests as well.

Some types of executive dysfunction are temporary, such as when it occurs as a medication side effect. Other types, such as dementia, are expected to progressively worsen with time. There are treatments that can help prevent the progression of symptoms, and cognitive rehabilitation can help to maximize executive functions 

A Word From Verywell

If you or someone you care about has been born with or developed executive dysfunction, it can have a major effect on your life. Prompt medical attention is necessary, and patience is key to coping and trying to gain or maintain as much independence as possible.

It’s important to ask for help and support from friends, family, and healthcare and community resources to have the best outcome possible.