Executive function and medical non-adherence: a different perspective

Medical non-adherence is multifactorial: cost, convenience, side effect profile, and cognitive impairment are all implicated in medical nonadherence. We explore impaired executive function (EF) as a cause for medical non-adherence when other causes can be ruled out. EF describes the coordination and manipulation of higher-order cognitive processes involved in problem-solving, planning, and decision-making. EF has three components: working memory, mental flexibility, and inhibitory control. The latter, inhibitory control, when impaired will affect an individual's ability to make choices to produce long-term benefits, in favor of short-term gratification. When applied to adults with chronic diseases, like diabetes, that require lifestyle modification and, at times, complicated medical regimens to forestall long term complications, an intact EF has a role in adherence. EF development is protracted with behavioral corollaries observable from early childhood. Thus, teachers, family physicians, and pediatricians will be the professionals to first encounter and manage such individuals. We suggest screening tests for children in the doctor's office to detect impaired EF, and postulate a cognitive behavioral therapeutic approach for adults with uncontrolled DM and impaired EF.