PWD David Kramer November 10, 2015

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Excerpt from one of my retired doctor PWD friends, David Kramer, on his FaceBook Page called …

  Living Well with Alzheimer’s on November 10, 2015

Executive DYSfunction

Apathetic about executive function? You might just have executive dysfunction!

Personal examples you want? I’ll make up a few. ((wink))

But first, let’s define our terms. I’ve distilled the pertinent points from Wikipedia and other online resources. Executive function involves the management and control of cognitive processes, including working memory, reasoning, task flexibility, problem-solving including planning and execution. It also includes control of challenging and dysfunctional behaviors, such as impulse control in situations that require reigning in a strong habitual response. There’s no simple way to measure executive function since it is the online dynamic coordination of many cognitive resources. Its effect can only be observed by measuring other cognitive processes. It has also been shown that executive function does not fully engage outside of real-world situations. Neurologists have reported that a patient with severe day-to-day executive problems may still pass paper and lab-based tests of executive function.

Bottom line is we are talking about significant issues with overall cognitive MANAGEMENT that often impact the daily life of a person with dementia.

I know what you’re thinking. “That’s a lot of fancy words, Dave! How about using English or just give us an example or two.” Happy to oblige! Here are some hypothetical (I’m lying; they’re true.) stories that I made up (still lying, these really happened) about a good friend of mine (yes, it’s me).

1) Alone…Lost…In the woods. Need I say more?
So Tiffany and I were on a hike. I got turned around, lost my sense of direction, and wasn’t sure which way to go. Tiffany went ahead to ask for directions. I had my back to her and started to panic. The details aren’t important, but let’s just say there might have been some yelling and crying involved. Turns out she was just around a curve in the path, but I felt alone and completely lost. I don’t like it when she is in a different aisle in the supermarket; this was a hundred times worse.

2) Tiffany: “Change of plans, while we’re out let’s do X, Y, and Z in addition to A and B.” Dave: “Say WHAAAT?!”
Flexibility is not a strong suit of those with Alzheimer’s. Plans and schedules are very helpful for those with dementia. I like to know what I will be doing (and preferably when, too). I’m cool if the plan is to go out without having one. But once we have a plan, my brain wants me to stick with it. I like knowing what to expect. My brain doesn’t readjust like it used to. Once I have a plan or path in mind, changing it leads to confusion, which leads to frustration for me, which causes frustration for Tiffany. Sometimes there are “words.” Every man knows that no good ever comes from “words.”

3) Choice is good. Right? Wrong!
Sneakers or flip-flops? Which shirt? Putting clothes on is easy. Choosing them is hard. My closet has a lot of polo shirts, both with and without collars. Regardless, I tend to wear the same ones over and over. It’s just easier that way. Decision-making is difficult. I actually am afraid of making the wrong choice, even when there is no wrong choice. I was actually afraid that I made the wrong choice when I chose “I actually am afraid…” rather than “I am actually afraid…” Those of us with dementia often take a long time making even simple choices. Often it is much easier if the choice is made for me. Salmon or hot dogs and eggs for breakfast? By the time I decide, the salmon is on the plate in front of me. Executive DYSfunction strikes again!

Here’s the take home message. It’s hard to fix problems with executive function, but it’s a noble goal and one that I fight for. So I try often and succeed sometimes. And that’s better than accepting the status quo. I know that ultimately I will lose the war, but I aim to win many battles along the way.

Stay tuned!

P.S.: These are getting harder to write. This one took quite a few days to put together. I’m not complaining, just stating the facts. That and my wife is very patient. ((wink))

This specific entry and comments can be found at .

Excerpts above from my friend David Kramer‘s FaceBook Page called Living Well with Alzheimer’s at

* Admin issues: SHARE dementia awareness thru buttons below. If interested in receiving notice of future blog postings there is a “follow” button in the upper left corner (MS Explorer) or lower right (Safari and Chrome). Feel free to leave your thoughts in the form of comments, but please filter your comments with truthful loving kindness to all concerned. If there is an advertisement below, I have no control over what is shown. —  David Kramer has exclusive copyright for this on 2015-11/10 Registered & Protected


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