Cognitive impairment in patients with stress-related exhaustion

Jonsdottir, I.H., Nordlund, A., Ellbin, S., Ljung, T., Glise, K., Währborg, P., & Wallin, A.

Katie Steck Alliant International University, October 2015

BURNOUT

Classic burnout characterized by:- mental exhaustion- physical fatigue- detachment from work- diminished competence- loss of energy- increased irritability and sleep- concentration problems

Historically studied mainly in context of continuous psychosocial stressors related to work

Burnout vs. Exhaustion DisorderExhaustion Disorder ICD-10: F43.8A (Under “Other reactions to severe stress)

Participants

49 Healthy controls (Mostly health care workers and social insurance officers)40 ambulatory patients who meet ED (no previous treatment for illness):

Comorbid depression/anxiety allowed45% on sick leave40% on part time sick leave38% on AntidepressantsSmoking/snuff allowed, but not on test dayExclusion criteria: Brain damage, naemia, current infection, diabetes mellitus, thyroid problems, vitamin B12 deficiency, other somatic

diseases that might influence cognition (as judged by a physician), excessive alcohol consumption, medication that could influence (temporary beta blockers, or meds with codine), fibromayalgia, chronic fatigue syndrome. Additional self reports of health and blood analyses taken of haemoglobin, erythrocyte sedimentation rate, blood glucose concentration, thyroid hormones, and homocysteine.

Demographics

The process as if you were a patient

Primary care or occupational health care center (screening and

questionnaires completed)

Health care workers and social insurance officers

Questionnaires and blood sampling

Screening

Burnout group (40) Healthy controls (49)

Boston naming test (Language)Logical memory immediate recall (Verbal Episodic Memory)Digit symbol (Speed, attention and working memory)Digit span (Attention span/working memory)Token test (Syntax comprehension)VOSP silhouettes (Perception)Stroop (Distractability)PaSMO (Mental control)Logical memory delayed recall (Verbal episodic memory)

Neuropsych testing:

Questionnaires

1. Self-reported memory (not originally part of this study)

Self-reported mental health: 2. Shirom-Melamed Burnout Questionnaire (SMBQ)3. Hospital anxiety and depression scale (HAD)

The process as if you were a patient

Primary care or occupational health care center (screening and

questionnaires completed)

Health care workers and social insurance officers

Questionnaires and blood sampling

Screening

Burnout group (40) Healthy controls (49)

Boston naming test (Language)Logical memory immediate recall (Learning and Memory)Digit symbol (Speed, attention and working memory)Digit span (Attention span/working memory)Token test (Syntax comprehension)VOSP silhouettes (Perception)Stroop (Distractability)PaSMO (Mental control)Logical memory delayed recall (Verbal episodic memory)

Neuropsych testing:

Results I - Comparing ED with healthy controls

Results II: Self-reported memory problems to actual memory problems

Split into hi/lo

Those who reported pronounced memory loss clearly affecting their life didn’t perform any differently than those who reported their memory was intact or less affected.

Results III - Comparing hi and lo burnout

Results IV: Hi and lo HAD scales

High anxiety scorers performed significantly worse on delayed recall and immediate recall

Hi depressive scorers performed significantly worse on VOSP Silhouettes

No difference between those taking antidepressants and those who were not

Considerations

Lo to hi burnout comparison- Only significant one was logical memory

delayed recall- Very last test - high burnout scorers more

affected by length of test?Self report of memory problems

- Potential misunderstanding of what “memory” entails, instrument not yet validated

Executive Functioning results- More complexity in testing might reveal subtle

differences

Limitations

- Overlap between depression, anxiety, and burnout- Allowed use of antidepressants- Timing of the tests (before or after lunch)

The End

References

Bährer-Kohler, S. (2012). Burnout for experts: Prevention in the context of living and working. Springer Science & Business Media.

Danhof-Pont, M., Van Veen, T., Zitman, F. (2011) Biomarkers in burnout: A systematic review. Journal of Psychosomatic Research, 70, p. 505-524

(Bährer-Kohler, 2012)

Neuropsych tests and cognitive domains