Executive Skills


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. Generally, executive skills tend to be linked to increased physical disability. When people with MS report difficulties in these areas, they are also likely to 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).

Reduced executive skills can also make people with MS less good at coping. They can find it harder to choose the right coping response and implement it successfully. People with MS who have reduced executive skills are also more likely to experience apathy.

Further Reading

Dagenais E, Rouleau I, Tremblay A, Demers M, Roger É, Jobin C, Duquette P. Prospective memory in multiple sclerosis: The impact of cue distinctiveness and executive functioning. Brain Cogn. 2016 Nov;109:66-74

Grech LB, Kiropoulos LA, Kirby KM, Butler E, Paine M, Hester R. Executive function is an important consideration for coping strategy use in people with multiple sclerosis. J Clin Exp Neuropsychol. 2017 Jan 16:1-15.

Raimo S, Trojano L, Spitaleri D, Petretta V, Grossi D, Santangelo G. The relationships between apathy and executive dysfunction in multiple sclerosis. Neuropsychology. 2016 Sep;30(6):767-74.


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. Another study just using a computerised training programme improved executive skills. Planning in advance improves remembering to do something, especially when it makes the act more automatic.

Further Reading

De Giglio L, De Luca F, Prosperini L, Borriello G, Bianchi V, Pantano P, Pozzilli C. A low-cost cognitive rehabilitation with a commercial video game improves sustained attention and executive functions in multiple sclerosis: a pilot study. Neurorehabil Neural Repair. 2015 Jun;29(5):453-61.

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