Subjective cognitive complaints in patients with stress-related exhaustion disorder: a cross sectional study

Andreas Nelson, Hanna Malmberg Gavelin, Carl-Johan Boraxbekk, Therese Eskilsson, Maria Josefsson, Lisbeth Slunga Järvholm, Anna Stigsdotter Neely, Andreas Nelson, Hanna Malmberg Gavelin, Carl-Johan Boraxbekk, Therese Eskilsson, Maria Josefsson, Lisbeth Slunga Järvholm, Anna Stigsdotter Neely

Abstract

Background: Stress-related exhaustion is associated with cognitive impairment as measured by both subjective cognitive complaints (SCCs) and objective cognitive test performance. This study aimed to examine how patients diagnosed with exhaustion disorder differ from healthy control participants in regard to levels and type of SCCs, and if SCCs are associated with cognitive test performance and psychological distress.

Methods: We compared a group of patients with stress-related exhaustion disorder (n = 103, female = 88) with matched healthy controls (n = 58, female = 47) cross-sectionally, concerning the type and magnitude of self-reported SCCs. We furthermore explored the association between SCCs and cognitive test performance as well as with self-reported depression, anxiety and burnout levels, in the patient and the control group, respectively.

Results: Patients reported considerably more cognitive failures and were more likely than controls to express memory failures in situations providing few external cues and reminders in the environment. In both groups, SCCs were associated with demographic and psychological factors, and not with cognitive test performance.

Conclusion: Our findings underline the high burden of cognitive problems experienced by patients with exhaustion disorder, particularly in executively demanding tasks without external cognitive support. From a clinical perspective, SCCs and objective cognitive test performance may measure different aspects of cognitive functioning, and external cognitive aids could be of value in stress rehabilitation.

Trial registration: Participants were recruited as part of the Rehabilitation for Improved Cognition (RECO) study (ClinicalTrials.gov: NCT03073772). Date of registration: 8 March 2017.

Keywords: Burnout; Cognition; Exhaustion; Stress; Stress-induced; Subjective cognitive complaints.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Effect sizes of differences between patients and controls in SCCs and cognitive test performance. Note: Bars indicate group differences in Glass’s Δ. Error bars indicate confidence intervals (95%). *p < .05. **p < .01
Fig. 2
Fig. 2
Mean of reported memory failures for patient and control participants. Note: Error bars indicate confidence intervals (95%)

References

    1. Eurofond. Burnout in the workplace: A review of data and policy responses in the EU, 2018.
    1. European Agency for Safety and Health at Work. Calculating the cost of work-related stress and psychosocial risks 2014.
    1. Maslach C, Schaufeli WB, Leiter MP. Job burnout. Annu Rev Psychol. 2001;52(1):397–422. doi: 10.1146/annurev.psych.52.1.397.
    1. World Health Organization. International statistical classification of diseases and related health problems (11th Ed.) 2019. https:// browse11/l-m/en#/
    1. Grossi G, Perski A, Osika W, Savic I. Stress-related exhaustion disorder - clinical manifestation of burnout? A review of assessment methods, sleep impairments, cognitive disturbances, and neuro-biological and physiological changes in clinical burnout. Scand J Psychol. 2015;56(6):626–636. doi: 10.1111/sjop.12251.
    1. Eskildsen A, Andersen LP, Pedersen AD, Vandborg SK, Andersen JH. Work-related stress is associated with impaired neuropsychological test performance: a clinical cross-sectional study. Stress. 2015;18(2):198–207. doi: 10.3109/10253890.2015.1004629.
    1. Oosterholt BG, Maes JH, Van der Linden D, Verbraak MJ, Kompier MA. Cognitive performance in both clinical and non-clinical burnout. Stress. 2014;17(5):400–409. doi: 10.3109/10253890.2014.949668.
    1. Öhman L, Nordin S, Bergdahl J, Slunga LB, Stigsdotter AN. Cognitive function in outpatients with perceived chronic stress. Scand J Work Environ Health. 2007;33(3):223–232. doi: 10.5271/sjweh.1131.
    1. Österberg K, Karlson B, Hansen Å. Cognitive performance in patients with burnout in relation to diurnal salivary cortisol. Stress. 2009;12(1):70–81. doi: 10.1080/10253890802049699.
    1. Deligkaris P, Panagopoulou E, Montgomery AJ, Masoura E. Job burnout and cognitive functioning: a systematic review. Work Stress. 2014;28(2):107–123. doi: 10.1080/02678373.2014.909545.
    1. Ellbin S, Engen N, Jonsdottir IH, Nordlund AI. Assessment of cognitive function in patients with stress-related exhaustion using the Cognitive Assessment Battery (CAB) J Clin Exp Neuropsychol. 2018;40(6):567–575. doi: 10.1080/13803395.2017.1388359.
    1. Jonsdottir I, Nordlund A, Ellbin S, Ljung T, Glise K, Währborg P, Wallin A. Cognitive impairment in patients with stress-related exhaustion. Stress. 2013;16(2):181–190. doi: 10.3109/10253890.2012.708950.
    1. Österberg K, Karlson B, Malmberg B, Hansen ÅM. A follow-up of cognitive performance and diurnal salivary cortisol changes in former burnout patients. Stress. 2012;15(6):589–600. doi: 10.3109/10253890.2011.648972.
    1. Österberg K, Skogsliden S, Karlson B. Neuropsychological sequelae of work-stress-related exhaustion. Stress. 2014;17(1):59–69. doi: 10.3109/10253890.2013.862615.
    1. Gelonch O, Garolera M, Valls J, Rosselló L, Pifarré J. Executive function in fibromyalgia: comparing subjective and objective measures. Compr Psychiatry. 2016;66:113–122. doi: 10.1016/j.comppsych.2016.01.002.
    1. Kliegel M, Zimprich D, Eschen A. What do subjective cognitive complaints in persons with aging-associated cognitive decline reflect? Int Psychogeriatr. 2005;17(3):499–512. doi: 10.1017/s1041610205001638.
    1. Luo X, Zhu Y, Lu D, Zong K, Lin X. Subjective cognitive dysfunction in patients with bipolar disorder: The prevalence, related factors and effects on predicting psychosocial functioning and suicidal ideation. Psychiatry Res. 2020;284:112669. doi: 10.1016/j.psychres.2019.112669.
    1. Rasouli O, Gotaas ME, Stensdotter A-K, Skovlund E, Landrø NI, Dåstøl P, Fors EA. Neuropsychological dysfunction in chronic fatigue syndrome and the relation between objective and subjective findings. Neuropsychology. 2019;33(5):658. doi: 10.1037/neu0000550.
    1. Burmester B, Leathem J, Merrick P. Subjective cognitive complaints and objective cognitive function in aging: a systematic review and meta-analysis of recent cross-sectional findings. Neuropsychol Rev. 2016;26(4):376–393. doi: 10.1007/s11065-016-9332-2.
    1. Carrigan N, Barkus E. A systematic review of cognitive failures in daily life: healthy populations. Neurosci Biobehav Rev. 2016;63:29–42. doi: 10.1016/j.neubiorev.2016.01.010.
    1. Miskowiak KW, Petersen JZ, Ott CV, Knorr U, Kessing LV, Gallagher P, Robinson L. Predictors of the discrepancy between objective and subjective cognition in bipolar disorder: a novel methodology. Acta Psychiatr Scand. 2016;134(6):511–521. doi: 10.1111/acps.12649.
    1. Eskilsson T, Järvholm LS, Gavelin HM, Neely AS, Boraxbekk C-J. Aerobic training for improved memory in patients with stress-related exhaustion: a randomized controlled trial. BMC Psychiatry. 2017;17(1):322. doi: 10.1186/s12888-017-1457-1.
    1. Gavelin HM, Eskilsson T, Boraxbekk C-J, Josefsson M, Neely AS, Järvholm LS. Rehabilitation for improved cognition in patients with stress-related exhaustion disorder: RECO—a randomized clinical trial. Stress. 2018;21(4):279–291. doi: 10.1080/10253890.2018.1461833.
    1. Crawford J, Smith G, Maylor E, Della Sala S, Logie R. The Prospective and Retrospective Memory Questionnaire (PRMQ): Normative data and latent structure in a large non-clinical sample. Memory. 2003;11(3):261–275. doi: 10.1080/09658210244000027.
    1. Rönnlund M, Mäntylä T, Nilsson L-G. The Prospective and Retrospective Memory Questionnaire (PRMQ): factorial structure, relations to global subjective memory ratings, and Swedish norms. Scand J Psychol. 2008;49(1):11–18. doi: 10.1111/j.1467-9450.2007.00600.x.
    1. Gavelin HM, Neely AS, Andersson M, Eskilsson T, Järvholm LS, Boraxbekk C-J. Neural activation in stress-related exhaustion: Cross-sectional observations and interventional effects. Psychiatry Res: Neuroimaging. 2017;269:17–25. doi: 10.1016/j.pscychresns.2017.08.008.
    1. Gavelin HM, Boraxbekk C-J, Stenlund T, Järvholm LS, Neely AS. Effects of a process-based cognitive training intervention for patients with stress-related exhaustion. Stress. 2015;18(5):578–588. doi: 10.3109/10253890.2015.1064892.
    1. World Health Organization. International statistical classification of diseases and related health problems, 10th ed. 2016.
    1. Broadbent DE, Cooper PF, FitzGerald P, Parkes KR. The cognitive failures questionnaire (CFQ) and its correlates. Br J Clin Psychol. 1982;21(1):1–16. doi: 10.1111/j.2044-8260.1982.tb01421.x.
    1. Delis DC, Kramer JH, Kaplan E, Holdnack J. Reliability and validity of the Delis-Kaplan Executive Function System: an update. J Int Neuropsychol Soc. 2004;10(2):301–303. doi: 10.1017/S1355617704102191.
    1. Miyake A, Friedman NP, Emerson MJ, Witzki AH, Howerter A, Wager TD. The unity and diversity of executive functions and their contributions to complex “frontal lobe” tasks: A latent variable analysis. Cogn Psychol. 2000;41(1):49–100. doi: 10.1006/cogp.1999.0734.
    1. Wechsler D. Adult Intelligence Scale—revised manual. New York: The Psychological Corporation; 1981.
    1. Wechsler D. Adult Intelligence Scale. 3. New York: The Psychological Corporation; 1997.
    1. Buschke H. Selective reminding for analysis of memory and learning. J Verb Learn Verb Behav. 1973;12(5):543–550. doi: 10.1016/S0022-5371(73)80034-9.
    1. Raven J. Manual for Raven’s progressive matrices and vocabulary scales. Assesment. Oxford: Oxford Psychologists Press; 1998.
    1. Lundgren-Nilsson Å, Jonsdottir IH, Pallant J, Ahlborg G. Internal construct validity of the Shirom–Melamed Burnout questionnaire (SMBQ) BMC Public Health. 2012;12(1):1. doi: 10.1186/1471-2458-12-1.
    1. Melamed S, Kushnir T, Shirom A. Burnout and risk factors for cardiovascular diseases. Behav Med. 1992;18(2):53–60. doi: 10.1080/08964289.1992.9935172.
    1. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67(6):361–370. doi: 10.1111/j.1600-0447.1983.tb09716.x.
    1. Honaker J, King G, Blackwell M. Amelia II: A program for missing data. J Stat Softw. 2011;45(7):1–47. doi: 10.18637/jss.v045.i07.
    1. R Core Team. R: a language and environment for statistical computing: R Foundation for Statistical Computing. 2018. .
    1. Kliegel M, McDaniel MA, Einstein GO. Plan formation, retention, and execution in prospective memory: A new approach and age-related effects. Mem Cognit. 2000;28(6):1041–1049. doi: 10.3758/BF03209352.
    1. Friedman NP, Miyake A, Corley RP, Young SE, DeFries JC, Hewitt JK. Not all executive functions are related to intelligence. Psychol Sci. 2006;17(2):172–179. doi: 10.1111/j.1467-9280.2006.01681.x.
    1. Skau S, Jonsdottir IH, Sjörs Dahlman A, Johansson B, Kuhn HG. Exhaustion disorder and altered brain activity in frontal cortex detected with fNIRS. Stress. 2021 doi: 10.1080/10253890.2020.1777972.
    1. Beck J, Gerber M, Brand S, Puehse U, Holsboer-Trachsler E. Executive function performance is reduced during occupational burnout but can recover to the level of healthy controls. J Psychiatr Res. 2013;47(11):1824–1830. doi: 10.1016/j.jpsychires.2013.08.009.
    1. Teodoro T, Edwards MJ, Isaacs JD. A unifying theory for cognitive abnormalities in functional neurological disorders, fibromyalgia and chronic fatigue syndrome: systematic review. J Neurol Neurosurg Psychiatry. 2018;89(12):1308–1319. doi: 10.1136/jnnp-2017-317823.
    1. Walitt B, Čeko M, Khatiwada M, Gracely JL, Rayhan R, VanMeter JW, Gracely RH. Characterizing “fibrofog”: subjective appraisal, objective performance, and task-related brain activity during a working memory task. NeuroImage: Clin. 2016;11:173–180. doi: 10.1016/j.nicl.2016.01.021.
    1. Stenfors CUD, Marklund P, Magnusson Hanson LL, Theorell T, Nilsson L-G. Subjective cognitive complaints and the role of executive cognitive functioning in the working population: a case-control study. PLoS ONE. 2013;8(12):e83351. doi: 10.1371/journal.pone.0083351.
    1. Toplak ME, West RF, Stanovich KE. Practitioner review: Do performance-based measures and ratings of executive function assess the same construct? J Child Psychol Psychiatry. 2013;54(2):131–143. doi: 10.1111/jcpp.12001.
    1. Costa A, Carlesimo GA, Caltagirone C. Prospective memory functioning: a new area of investigation in the clinical neuropsychology and rehabilitation of Parkinson’s disease and mild cognitive impairment. Rev Evidence Neurol Sci. 2012;33(5):965–972. doi: 10.1007/s10072-012-0935-y.
    1. Dong L, Lee JY, Harvey AG. Memory support strategies and bundles: a pathway to improving cognitive therapy for depression? J Consult Clin Psychol. 2017;85(3):187. doi: 10.1037/ccp0000167.
    1. Kanai R, Dong MY, Bahrami B, Rees G. Distractibility in daily life is reflected in the structure and function of human parietal cortex. J Neurosci. 2011;31(18):6620–6626. doi: 10.1523/JNEUROSCI.5864-10.2011.
    1. Reese CM, Cherry KE. Effects of age and ability on self-reported memory functioning and knowledge of memory aging. J Genet Psychol. 2006;167(2):221–240. doi: 10.3200/gntp.167.2.221-240.
    1. Zimprich D, Kurtz T. Subjective and objective memory changes in old age across five years. Gerontology. 2015;61(3):223–231. doi: 10.1159/000369927.
    1. Oosterholt BG, Maes JH, Van der Linden D, Verbraak MJ, Kompier MA. Getting better, but not well: A 1.5 year follow-up of cognitive performance and cortisol levels in clinical and non-clinical burnout. Biol Psychol. 2016;117:89–99. doi: 10.1016/j.biopsycho.2016.02.009.

Source: PubMed

Sponsors et collaborateurs

Les conditions médicales

Interventions en matière de drogue

3
S'abonner