Executive Function Interventions that Improve Health
As mental and physical health services place a large financial burden on the Canadian healthcare system, interventions that can prevent the deterioration of, or increase the quality of individuals’well-being have the potential to reduce public health costs. Recent research suggests that programs that which strengthen executive functions (e.g. response inhibition, sustained attention cognitive flexibility) also improve certain physical and mental health outcomes, including treatment outcomes associated with drug addiction, and depressive symptoms associated with major depressive disorder and bipolar disorder. Although it is still unclear what mechanisms of action these treatment effects depend upon effect, the current literature on executive function interventions indicates that executive function interventions are a potential approach to reduce the societal stress associated with adverse mental and physical health outcomes.Executive Function Interventions that Improve Health
Mental health is a field where in which resources for services and supports place a large financial burden on the Canadian healthcare system. Both the public and private sectors face massive expenditures, and with a wide array of different ministries of government, health regions, private, and non-profit organizations providing resources to individuals with mental health needs, the Institute of Health Economics (2010) has calculated that the total amount spent in Canada to support of mental health exceeds $14.3 billion anually. Of this amount, approximately 74% is related to services such as pharmaceuticals, hospitalizations, and community health support, and 26% is related to disability payments (the Institute of Health Economics, 2010). Likewise, as obesity is a major public health concern within the country, there are large financial costs associated with the condition the disorder and related chronic health problems. For example, with over 34% of the adult population overweight and 26% obese, the related morbidity and mortality costs in Canadawere have been estimated in 2010 to be equal to $3.9 billion in direct healthcare billings (e.g. hospitalizations and physician visits) and $3.2 billion in indirect costs (e.g. disability payments and premature death) (Jannsen, 2013).Executive Function Interventions that Improve Health
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To address these growing public health concerns, policy-makers need to consider novel strategies that can mitigate the development of such adverse health outcomes and promote the health and well-being of the Canadian citizenry, such as the use of cognitive-enhancing interventions. There is a growing amount of evidence to suggest that higher-order higher order cognitive processes are associated with changes in health status (Diamond, 2012; Miller, Barnes, & Beaver, 2011; Moffit et al., 2011), and consequently, the goal of this review is to provide an overview of the rationale for targeting cognitive-enhancement strategies to improve mental and physical health outcomes.
What are executive functions (EFs)?
EFs are a set of cognitive abilities that enable individuals to organize and regulate their behaviours and successfully complete goal- directed behaviours (Christoff, Rea, Geddes, & Gabrieli, 2003; Miyake, Friedman, Emerson, Witzki, & Howerter, 2000). These functions are coordinated by two parallel networks of the prefrontal cortex: the dorsolateral and orbit frontal network. While the former is the primary regulator of goal-directed behaviour, the latter is connected with many sensory cortical areas and limbic regions that determine the salience of environmental stimuli (Logue & Gould, 2013). Together, these networks provide top-down control over the ascending neurotransmitters which include, but are not limited to, dopamine, serotonin, norepinephrine and acetylcholine (Robbins & Arnsten, 2009). These neurotransmitters also have powerful influences over prefrontal cortex functions (Robbins & Arnsten, 2009). There is a general agreement that there are three core EFs: response inhibition, sustained attention cognitive flexibility, and working memory. Together, these functions form the basis forhigher-order, or “global EFs”, such as self-control, problem solving, and decision-making. (Collins & Koechlin, 2012; Lunt et al., 2012). Response inhibition refers to the ability to voluntarily inhibit a dominant or automatic response. It is important for controlling one’s attentional patterns, emotions and behaviours to achieve goals, and is often assessed via tasks such as the Stop-Signal Task, or and Go/No Go (Eagle, Bari, & Robbins, 2008). Sustained attention Cognitive flexibility refers to the ability to direct and focus switch cognitive activity focus on specific stimuli and is controlled by both bottom-up and top-down processes.Executive Function Interventions that Improve Health
Sustained attention
Cognitive flexibility is often measured by tasks such as the A-not-B Task and Rapid Visual Information Processing task the Wisconsin Card Sorting Task (Kirkham, Cruess, & Diamond, Turner, Blackwell, Dowson, McLean, & Sahakian, 2005). Working memory involves temporarily storing and managing information required to carry out complex cognitive abilities such as learning, reasoning, and comprehension. This function is frequently measured by dual-task paradigms that combine memory span tasks with concurrent processing tasks, such as the Dual N-back task (Fukuda & Vogel, 2009; Owen, Doyon, & Petrides, & Evans, 2006). However, due to a limited amount of research showcasing the relationship between working memory and mental and physical health, discussions of this EF in later sections will be limited.Executive Function Interventions that Improve Health
