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What is executive dysfunction?

Elderly man resting chin on his hands, looking pensive and lost in thought

In healthcare, executive functioning is an umbrella term that refers to the cognitive functions of the brain that support complex thought processes and processing skills, including decision-making, problem-solving, planning, reflection and more. However, normal function can be disturbed as the result of illness or trauma such as brain injury or stroke. It may also be disturbed as a symptom of ADHD and several other conditions. When this happens, mental processing can become impaired. This is known as executive dysfunction.


The symptoms of executive dysfunction may include:

  • Impaired working memory.
  • Impaired planning.
  • Impaired critical thought and reflection.
  • Increased cognitive flexibility/inflexibility, impacting the person’s ability of to transition between topics or tasks.
  • Disturbed ability to control one’s inhibitions (Note: this can increase a person’s vulnerability,) 
  • Difficulties initiating or disengaging from a task.
  • Hyper-fixation and/or difficulties in attention.

As a result Mental Capacity for a specific decision may be impacted, this may be observed through the presentation of executive dysfunction noted above. A common presentation of which can be a ‘disconnect’ between what a person says and what they do.

Mental capacity and executive dysfunction

When considering the Mental Capacity Act (2005) one must always start with the key principles of the Act, which remind us to start from a position where we should presume capacity in the first instance. If there is a reasonable belief of a lack of capacity, or risk that a decision may be contested, then a mental capacity assessment should be completed. 

If there is sign of executive dysfunction then this must be evidenced in the context of the decision being addressed, as part of Stage 2 of the two-stage test – the diagnostic and causative nexus.

It can be very difficult to sufficiently evidence that an individual has executive dysfunction such that they are unable to make a specific decision at a specific time. As such, we should not use the term lightly. If you are unsure about how to measure and record executive dysfunction in a mental capacity assessment, we advise you contact a registered professional.

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