Seniors' Executive Functioning Plays Key Role in Behavior, Suicidality
> 3/21/2008 10:44:35 AM

The latest issue of Psychiatric News draws attention to two important studies that examined the potential negative outcomes of degrading executive function in older individuals. Both of these studies appeared in last month's edition of the American Journal of Geriatric Psychiatry: one looking at the connection between poor executive function and suicidality, and the other investigating executive functioning's role in the disturbed behavior of individuals with dementia.

In the first study, a collaborative effort between researchers at the University of Pittsburgh and the University of Cambridge, a group of 32 depressed participants over the age of 60 were compared with a similar group of 32 participants over 60 who were not only depressed, but also suicidal. This second cohort included only individuals who had made a recent attempt or had been hospitalized for suicidal thoughts or behaviors. As Psychiatric News explains:

Both groups met DSM-IV criteria for depression and had similar scores on the Mini-Mental State Examination. But the suicidal participants had significantly worse executive function than nonsuicidal ones in the Executive Interview (EXIT25), a 25-item test that detects left frontal cortical pathology. This difference in executive function persisted after the authors controlled for dementia, substance use, medications, or brain injury due to suicide attempts.

In the other report, researchers describe the results of followups with individuals diagnosed with mild to moderate dementia between 3 and 6 years from baseline. Of the 42 participants, those with lower baseline scores of executive functioning were found to be more likely to have disturbed behavior issues and their caretakers were found to have likely experienced more distress upon followup. This correlation was found to exist even when overall cognitive functioning was controlled for. The findings with relation to the caretakers serves to illustrate the toll that caring for a loved one or acting as a paid caretaker in a dementia-related situation can take on a person. It's important that those who may be training to act as caretakers understand the implications that loss of executive function can have so that they are better prepared to face the different aspects of the change.

Executive functions, in cognitive science, are those that act as managers of our other functions. Making lists, planning our day, counter-acting habitual behaviors and over-riding other cognitive functions, are all aspects of executive functioning. While researchers are clear that they do not know exactly why these losses in particular can be so damaging, it would seem that loss of executive functions may lead to a more general sense of lost control than do the loss of other areas of cognition. Research is being done to explore what might counteract these losses, but until we know more, understanding and compassion may be our best weapons.

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