Executive Skills
Research
Cognitive difficulties
The term executive skills covers a range of supervisory processes. It includes monitoring, error detection, flexibility, planning, prioritising, remembering to do things and other aspects of organisation. In general novelty and departures from routine may prove difficult. This range of skills can be affected in patchy and individual ways for any one person, which makes characterising this cognitive domain hard to do. When people with MS report difficulties in these areas, they are also likely to do poorly on clinical cognitive tests and manage less well on everyday tasks. In an experimental study that asked people to complete as many simple tasks as possible within a given time, people with MS were less good at optimizing their responses, compared to people without MS. People with MS also often find tasks that require switching between different parameters and rules challenging. Remembering to do things can also be a problem for people with MS (confusingly, remembering to do things is known as “prospective memory”. This is different from pure memory because it is not what to do that is forgotten. It is the organisation and alerting process of remembering to do something at a given time or point in a sequence of events that is an executive skill).
Further Reading
Basso MR, Shields IS, Lowery N, et al. Self-reported executive dysfunction, neuropsychological impairment, and functional outcomes in multiple sclerosis. J Clin Exp Neuropsychol 2008;3:1-11.
Birnboim S, Miller A. Cognitive strategies application of multiple sclerosis patients. Mult Scler 2004:10:67-73.
Drew M, Tippett LJ, Starkey NJ, et al. Executive dysfunction and cognitive impairment in a large community-based sample with Multiple Sclerosis from New Zealand: a descriptive study. Arch Clin Neuropsychol 2008;23:1-19.
Henry JD, Beatty WW. Verbal fluency deficits in multiple sclerosis. Neuropsychologia 2006;44:1166-74.
Rendell PG, Jensen F, Henry JD. Prospective memory in multiple sclerosis. J Int Neuropsychol Soc 2007;13:410-6.
Rehabilitation
One study that used a computerised training package and also a general compensatory package (which included building up routines of behaviour, problem-solving and planning) showed an improvement on clinical tests of executive skills after treatment. Planning in advance improves remembering to do something, especially when it makes the act more automatic.
Further Reading
Kardiasmenos KS, Clawson DM, Wilken JA, et al. Prospective memory and the efficacy of a memory strategy in multiple sclerosis. Neuropsychology 2008;22:746-54.
Tesar N, Bandion K, Baumhackl U. Efficacy of a neuropsychological training programme for patients with multiple sclerosis- a randomised controlled trial. Wien Klin Wochenschr 2005;117:747-54.