Executive Dysfunction and Covid-19

Firstly, what is executive function?

We have an area in our brain called the Frontal Lobe. There are two, the right and the left, and they are situated in the part of your brain called in the Frontal Cortex. They make up a third of the whole brain. They are larger in primates as they house our "human" skills such as reasoning and language. They are highly connected to the rest of the brain so damage to the Frontal Lobe can cause a “ripple effect” to other parts of the brain. They are the last part to mature - sometimes not until our mid-30s. It is highly involved with:

  • multistep voluntary movements such as getting dressed or making a cup of tea.

  • speech and language production in the dominant frontal lobe (opposite your dominant hand)

  • attention and concentration

  • working memory, which involves processing recently acquired information

  • reasoning and judgment

  • organization and planning

  • problem-solving

  • regulation of emotions and mood, including reading the emotions of others

  • personality expression

  • motivation, including evaluating rewards, pleasure, and happiness

  • impulse control

  • controlling social behaviours

So within the frontal lobe are the executive functioning skills - the tools to help you get things done.

Executive function helps you:

  • Manage time effectively

  • Pay attention

  • Remember things

  • Switch focus

  • Plan and organize tasks

  • Remember details

  • Avoid saying or doing the wrong thing

  • Do things based on your experience

  • Multitask

  • Think creatively

  • Control your behaviour

When it isn’t functioning well it can affect your ability to Work or go to school, do things independently and maintain relationships.

What Causes Executive Function Problems?

How Do I Know if I have problems With Executive Function?

You will have problems with:

  • Planning projects

  • Estimating how much time a project will take to complete

  • Telling stories (verbally or in writing)

  • Memorizing

  • Starting activities or tasks

  • Shifting plans when situations change

  • Focusing only on one task

  • Multitasking

  • Shutting down when parents or peers don’t act as expected “switching off”

How Are Executive Function Problems Diagnosed?

It is not an official illness so there isn’t a set of criteria you can use to diagnose someone. But there are tests to gauge how well your executive function works. These include:

  • Barkley Deficits in Executive Functioning Scale (BDEFS)

  • Comprehensive Executive Function Inventory (CEFI) - children aged 5 to 18

  • Conners 3-Parent Rating Scale: children aged 6 to 18

How to Manage Executive Function Problems?

  • Take a step-by-step approach to work/home life

  • Rely on visual aids to get organized ; checklists, post it notes

  • Use tools like time organizers, computers, or watches with alarms

  • Make schedules, and look at them several times a day

  • Break long projects into bite size pieces

  • Ask for written and oral instructions whenever possible

  • Plan for transition times and shifts in activities

  • Organise your workspace with as little clutter as possible

  • Basically Brain Pacing!!

What else can I do for Executive Dysfunction?

Good nutrition can help maintain brain structure, increase neurotransmitter levels, help neuroinflammation and reduce oxidative stress. It can also increase Brain Derived Neurotrophic Factor (BDNF) a key protein involved in learning and memory

Foods to eat

  • Oily fish - SMASH fish, salmon, mackerel, anchovies, sardines and herring. To increase DHA/EPA Omega 3

  • Polyphenols - the “Rainbow foods”

  • Coffee

  • Green tea

  • Purple and blue fruits

  • Red wine

  • Nuts and seeds

  • Olive oil

  • Eggs

Please refer to my Brain fog posts for practical things you can do to help executive dysfunction.

Executive dysfunction and long covid?

A paper written by Dr Ardila MD published in Diabetes Metabolic Syndrome September 2020

"Executive dysfunction in COVID-19 patients" was a detailed review of the COVID-19 literature referring to multiple papers stating confusion and attention difficulties in the affected patients, suggesting a dysexecutive syndrome.

Encephalopathy has been frequently mentioned in cases of infections with COVID-19 and it is already known that encephalopathy is usually associated with cognitive disturbances, including executive function disturbances.

It suggests than in a significant number of cases COVID-19 infection may be associated with an executive dysfunction syndrome both in the acute phase and in Long Covid. It can be

anticipated to be a part of neurological consequences of this viral infection.

Hampshire A, et al. have publishes a paper "Cognitive deficits in people who have recovered from COVID-19 relative to controls" The aim was to determine whether recovered COVID-19 patients showed any signs of cognitive deficits related to problem solving, spatial working memory, selective attention, and emotional processing.

They found that hospitalized cases showed large-to-medium scale global performance deficits, depending on whether they had required a ventilator or not.

Those who had not required support in hospital and remained at home exhibited small but statistically significant global performance deficits that scaled with the severity of respiratory symptoms.

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