DEAR DOCTOR K >> An aging friend was told he has problems with "executive function." So, of course, I'm wondering what that is, if I also could have that problem, and what can be done about it.

DEAR READER >> Executive function refers to a set of mental attributes required to make choices, plan, initiate action and inhibit impulses. While "executive function" is a term used to describe attributes of business executives, it applies to everyone.

For example, consider a stay-at-home mom who has to drive three young kids to different places at different times. And who must arrange for and monitor work that needs to be done on the house. And who is responsible for organizing the next family vacation. And who is "on point" (in the absence of dad) to settle disputes among the kids efficiently and with equanimity. That mom is demonstrating all of the attributes of executive function [—] and being paid nothing for it!

So ask yourself the following questions. If you are responsible for planning something, is it clear what the steps are, and in what order? Will you be able to focus on the task at hand and ignore other tasks? Will you be able to control any anger and impatience that might make you less efficient or effective? Do you shy away from asking others for help? Can you improve how you explain your vision or plans to others? If you're easily distracted, does your smartphone always need to be on, or can callers leave text messages or voicemails? That's just a partial list.

The good news is that you can help preserve executive function by doing many of the same things you should already be doing to stay healthy. Older people who exercise, for example, have better executive function than those who remain idle. Aerobic exercise may be especially beneficial.


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Lack of sleep scrambles executive function, so there's another reason to get enough sleep. High blood pressure seems to have a harmful effect on executive function. So if you have it, make the lifestyle changes required and take the medicines prescribed.

Researchers are looking into whether certain drugs might help older people with executive function deficits. So far, the results have been mixed.

In the meantime, try the following:

• Do what you can to eliminate distractions.

• Pay attention to paying attention. In other words, work on maintaining focus.

• Make it a habit. Always put keys and other personal items in the same place so you don't have to remember where you put them.

• Write it down. Lists and plans of action are a way of "outsourcing" executive function from the brain to a piece of paper or a computer file.

Dr. Komaroff is a physician and professor at Harvard Medical School.