PREVALENCE OF EXECUTIVE DYSFUNCTION IN OLDER ADULTS WITH NEUROLOGICAL DISORDERS IN PAKISTAN: A PRISMA-COMPLIANT SYSTEMATIC REVIEW

Abstract

Background: Executive dysfunction, characterized by impairments in working memory, attentional shifting, inhibitory control, and task planning, significantly affects the daily functioning of older adults. Neurological diseases, including Parkinson’s disease, stroke, and epilepsy, contribute to executive dysfunction; however, prevalence patterns among older adults in Pakistan remain unclear. Aims: The current systematic review aimed at quantifying the prevalence of executive dysfunction in Pakistani adults aged 60 years and above with the diagnosis of neurological disorders, to identify demographic and clinical features, and identify critical gaps in the existing literature. Methods: A systematic search was implemented in the PubMed, Scopus, Web of Science, PsycINFO, PakMediNet, and Google Scholar according to the PRISMA guidelines. Studies reporting executive-function outcomes in older adults diagnosed with Parkinson’s disease, stroke, dementia, epilepsy, multiple sclerosis, or traumatic brain injury were included. Data were extracted in the following categories; disorder type, sample characteristics, regional distribution, assessment tools and prevalence estimates of executive dysfunction. Results: The inclusion criteria were met in eight studies, which included about 29,700 participants. Executive dysfunction prevalence was 22-38% with the highest prevalence in Parkinson’s disease (30-38%), then post stroke cognitive impairment (22.4%), and epilepsy (28-35%). The most commonly affected domains were the working memory, attentional shifting and the inhibitory control. The urban centers (Karachi, Lahore, and Rawalpindi) were found to be the main source of providing the evidence base, whereas rural populations were underrepresented. Conclusion: Executive dysfunction is a common but under-recognized outcome of neurological diseases among older adults in Pakistan. The current results demonstrate the dire necessity of culturally validated, standardized executive-function tests, population-based and longitudinal studies. It is recommended that cognitive screening should be introduced into regular clinical practice to inform early intervention measures, cognitive rehabilitation programs and the public health policy initiatives in improving the functional outcomes and quality of life of older adults in Pakistan.