Dementia affects more than memory. As symptoms progress, changes in the brain can impact many aspects of thinking and everyday functioning, including attention, problem-solving, communication, judgment, planning and organization. These changes can make everyday activities that once felt familiar and manageable more challenging.

One area that plays an important role in how we manage everyday activities is executive function. Understanding what executive function is, how dementia can affect it, and what these changes can mean for everyday life can help families and caregivers better support their loved ones.

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What is Executive Function?

Executive function refers to a group of mental skills that help us manage everyday activities and respond to the world around us. These skills support many of the abilities we rely on to plan, organize, solve problems, make decisions and manage everyday responsibilities. They work together throughout the day, often without us realizing it. The three important parts of executive functioning are:

• Working Memory: The ability to hold and use information while completing a task. This includes remembering an instruction long enough to follow it or keeping track of the steps involved in an activity.
• Cognitive Flexibility: The ability to adjust our thinking or approach when situations change. It helps us switch between tasks, adapt to changes in routine and find another way to solve a problem.
• Inhibitory Control: The ability to pause and think before acting or speaking. It helps us manage impulses, stay focused and control our responses.

Executive functioning skills can naturally decline as we age. Many older adults find that managing several demands at once or adapting quickly to new information takes more effort than it once did.

However, dementia symptoms can cause significant changes in executive function, which can increasingly interfere with a person’s ability to manage everyday tasks and may lead to changes in behaviour that can be difficult or hurtful for others. Recognizing these changes as possible symptoms of dementia can help families and caregivers respond with patience and reduce frustration and conflict.

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Tips for Caregivers

When executive function skills are changing, the goal is not to make the person do things the way they used to. Instead, caregivers can adapt the environment and the way tasks are approached to make things more manageable. The following strategies can help:

Simplify the Environment

Too much information, too many choices and unnecessary clutter can make it harder to focus and make decisions. Keep frequently used items in consistent, easy-to-find places and reduce unnecessary distractions. When offering choices, keep them simple. Rather than asking, “What do you want to wear today?” try, “Would you like the blue shirt or the green one?” If your loved one is preparing a meal, place only the ingredients and tools needed for that task within reach.

Maintain Familiar Routines

Regular routines reduce the amount of planning and decision-making required throughout the day. Try to keep important activities, such as meals, medications, bathing and bedtime, around the same time each day. Familiar routines can also reduce frustration and help prevent situations that may lead to difficult behaviours. When a change to the routine is absolutely necessary, give your loved one advance notice and explain the change simply.

Break Tasks Into Steps

A task that once felt simple may become overwhelming when planning or remembering a sequence of steps is more difficult. Break activities into smaller parts, provide one step at a time and offer a few choices to make the task easier. Instead of saying, “Get ready for bed,” you might start with, “Let’s put your pyjamas on,” and then move on to the next step. The same approach can be used for activities such as preparing a meal, making coffee or getting ready to leave the house.

Use Reminders

Give instructions using simple, specific language. Visual cues such as calendars, labels, pictures and checklists can also provide helpful prompts. A short checklist beside the bathroom mirror or a calendar in a familiar location may be more helpful than repeatedly explaining the same information.

Support Independence

Avoid rushing or stepping in too quickly. Whenever it is safe to do so, allow the person to complete as much of the task as they can instead of automatically taking over. For example, if your loved one is having difficulty figuring out how to open a container, give them time to try different approaches before stepping in to help. Providing the right amount of support can help maintain confidence, dignity and a sense of independence.

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Changes in executive function can be challenging for both the person living with dementia and the people who care for them. Understanding these changes can help caregivers focus less on what a person is struggling to do and more on how they can help make the task easier by adapting the way it is approached.

Most importantly, supporting someone with dementia means meeting them where they are. As their abilities change, the way we provide support needs to change with them, helping them maintain as much dignity, confidence and independence as possible.

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If you enjoyed this article, you may also want to read: 

• Compassionate Care Strategies Using the 7 ‘A’s of Dementia
• The Importance of Routine in Dementia Care