The vulnerability of executive functioning: The additive effects of recent non-restorative sleep, pain interference, and use of expressive suppression on test performance

Abstract Objective: Certain transient contextual factors (i.e. higher expressive suppression, pain, and non-restorative sleep) are all associated with temporary decrements in performance on measures of executive functioning (EF), making clinical interpretation of EF scores challenging. Additionally, pain, non-restorative sleep, and expressive suppression are thought to be mutually interrelated with one another and with depression. This study sought to investigate how these factors impact EF when considered simultaneously. Methods: A total of 95 community-dwelling older adults completed the Push-Turn-Taptap (PTT) task as a measure of EF, and self-report measures of expressive suppression, pain interference, non-restorative sleep, and depressive symptoms. Results: Expressive suppression and pain interference, but not non-restorative sleep, demonstrated unique relationships with EF performance when all factors were considered simultaneously. Expressive suppression fully mediated the relationship between non-restorative sleep and EF performance, but not when controlling for depression. When a single contextual burden composite was generated collapsing across transient contextual factors, a composite that included all three examined factors (i.e. including non-restorative sleep) accounted for more variance in EF scores beyond depression than a composite that only included expressive suppression and pain interference. Conclusion: Expressive suppression, pain interference, and non-restorative sleep share some overlap with one another and with depression, but nonetheless have an additive negative effect on EF performance beyond depression. Quantifying these transient contextual factors may improve the accuracy of EF assessment and, by extension, the utility of EF measures in predicting daily functioning. These transient contextual factors also represent targets that, if better managed, may reduce EF lapses in daily life.