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Cognitive Flexibility - What It Really Is
Posted: Thursday, September 10, 2015 4:54 PM
Joined: 7/24/2015
Posts: 3020

Cognitive Flexibility

Cognitive Flexibility is the ability to switch thinking between two (or more) different concepts or ideas. It often becomes significantly declined in the dementia process starting fairly early on. Although it does not necessarily impair one in doing tasks, it does significantly alter the way one does the task.

To help understand it better for yourself, Cognitive Flexibility is often tested with a series of cards that have printed on them the word of a color (ie red) printed in another color (ie the word red printed with blue ink), and the person needs to say the color of the ink. Most people can do this. When one has decline in cognitive flexibility, then it becomes very difficult to switch one's attention back and forth and say the right color (word is red, the color is blue, you need to ay blue, but someone with decline in this area will usually say red).

Another test used is the trail making test, where a person is required to draw a line connecting letters and numbers in a back and forth order (ie A-1-B-2-C-3-D-4-E, etc). This tests the ability one has to switch from one task to another and back again.

Cognitive Flexibility is the ability to switch your thinking or attention. It is the ability to hold multiple concepts in your mind at one time, or to consider multiple aspects of thought at one time. It is the ability to shift one's thinking or belief pattern in response to changing goals, or in response to a change of rules. Or to just simply adjust one's thinking from something in the past to something happening now.

I believe that Cognitive Flexibility may account for why some folks find it really hard to adjust to their memory of their child (as a child) to the adult standing in front of them. These just seem like two completely different and unconnected concepts in the mind of someone with advanced dementia. For a while many will be able to still do this, but eventually the ability to tie those two concepts together may fail.

The most common way we use Cognitive Flexibility in our daily lives is multitasking. This might even be the first thing someone notices when the disease process starts affecting them, that they can no longer multitask very well. Or, one might only notice is that focus much more greatly on single tasks than they did before. As the disease advances, many lose they ability to multitask at all.

Another way we use Cognitive Flexibility is when we talk with someone. We have to switch back and forth from the way we see something to the way that they see something, and then adapt this to the person we are talking with. This becomes a real challenge for someone with dementia. They can see your way, and they can see their way, but they cannot connect the two of them together.

A more subtle way that we might use Cognitive Flexibility in our daily life is thinking and planning something in the future. In order to do that we to think about all the things we would like to do. Then we have to think about all that we know about those things (like, you cannot go skiing in the summer). Then we have to think about our week. And a person with dementia will have difficulty holding these thoughts at the same time.

This is also seen in difficulties in decision making like trying to decide what they might want to eat for dinner. First they have to call into their mind what they like eating. Then they have to filter it with knowledge (i.e. you don't eat chocolate cake for dinner, or I had that yesterday). Then they have to make a decision.

To make that decision, they have to bounce back and forth between all these concepts, and that is what becomes damaged when Cognitive Flexibility becomes damaged in dementia.