Executive function refers to the brain’s ability to manage tasks like planning, decision-making, problem-solving, and self-control. When dementia begins to affect these abilities, daily life can become disorganized and unpredictable.

Not all forms of dementia impact executive function the same way. Understanding how it changes across different dementia types can help families and clinicians better anticipate needs and adjust care strategies.

What Are Executive Functions?

These cognitive skills allow us to:

• Plan and sequence tasks
• Organize thoughts and belongings
• Adapt to new situations or switch between tasks
• Manage time and stay focused
• Regulate emotions and behavior

Decline in executive function is often one of the first things families notice, even before significant memory loss.

Alzheimer’s Disease

In the early stages of Alzheimer’s, executive function may remain mostly intact, with memory issues being more noticeable. As the disease progresses, planning, reasoning, and judgment gradually decline.

Common signs include:

• Difficulty managing finances or appointments
• Poor decision-making
• Trouble following multistep instructions

Frontotemporal Dementia (FTD)

FTD often begins with significant executive dysfunction, even before memory is affected. People may show:

• Impulsivity and poor judgment
• Lack of planning or goal-setting
• Emotional outbursts or apathy
• Reduced ability to organize or prioritize tasks

These symptoms can be mistaken for psychiatric issues or personality changes.

Lewy Body Dementia (LBD)

LBD causes fluctuations in attention and alertness, which affect executive function inconsistently. A person may perform well one moment but struggle the next. Planning, attention, and problem-solving often decline early.

Vascular Dementia

Because vascular dementia results from reduced blood flow to specific brain areas, executive function may decline suddenly or unevenly. Common symptoms include slowed thinking and difficulty organizing or adapting to change.

Final Thoughts

Declines in executive function affect independence, relationships, and daily safety. By recognizing how these skills are impacted differently across dementia types, families and healthcare providers can create more effective care plans that meet the individual’s needs.