Executive function is the term used for a set of mental skills that enable a person to plan, focus attention, remember and follow instructions, and manage multiple tasks. These higher-order thinking abilities are controlled primarily by the prefrontal cortex, a region of the brain that is particularly vulnerable to hypoxic injury after cardiac arrest.
What executive function includes
Executive function is not a single ability but a collection of related skills:
- Planning and organisation: the ability to work out the steps needed to complete a task and carry them out in the right order
- Working memory: holding information in mind while using it (for example, remembering the beginning of a sentence while reading to the end)
- Cognitive flexibility: switching between tasks or ways of thinking, adapting to changes
- Inhibitory control: suppressing impulsive responses and staying focused
- Problem-solving: identifying options and choosing between them
- Initiation: getting started on tasks without needing prompting
How cardiac arrest affects executive function
Because the prefrontal cortex is highly sensitive to oxygen deprivation, even a relatively short cardiac arrest can cause measurable changes to executive function. Survivors may find they struggle to plan a meal, manage a diary, follow a recipe, handle complex conversations, or manage the competing demands of a busy workplace, even if their basic memory and language abilities appear intact.
Assessment
Executive function difficulties may not be obvious in everyday conversation but can be identified through neuropsychological assessment. Tests such as the Trail Making Test, verbal fluency tasks, and the Wisconsin Card Sorting Test assess different aspects of executive function.
Rehabilitation
Occupational therapists and neuropsychologists can help survivors develop compensatory strategies: breaking tasks into steps, using lists and reminders, structuring the day, and reducing background demands. With time and practice, many survivors make significant improvements.
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