Cognitive impairment in patients with stress-related exhaustion

Figures & data

Table I.  Diagnostic criteria for exhaustion disorder according to the National Board of Health and Welfare.

(A) Physical and mental symptoms of exhaustion with minimum 2 weeks duration. The symptoms have developed in response to one or more identifiable stressors which have been present for at least 6 months.

(B) Markedly reduced mental energy, which is manifested by reduced initiative, lack of endurance or increase of time needed for recovery after mental efforts.

(C) At least four of the following symptoms have been present most of the day, nearly every day, during the same 2-week period:

1. Persistent complaints of impaired memory.

2. Markedly reduced capacity to tolerate demands or to work under time pressure.

3. Emotional instability or irritability.

4. Insomnia or hypersomnia.

5. Persistent complaints of physical weakness or fatigue.

6. Physical symptoms such as muscular pain, chest pain, palpitations, gastrointestinal problems, vertigo or increased sensitivity to sounds.

(D) The symptoms cause clinically significant distress or impairment in social, occupational or other important areas of functioning.

(E) The symptoms are not due to the direct physiological effects of a substance (e.g. a drug of abuse and a medication) or a general medical condition (e.g. hypothyroidism, diabetes and infectious disease).

(F) If criteria for major depressive disorder, dysthymic disorder or generalised anxiety disorder are met, ED is set as co-morbid condition.

Table II.  Neuropsychological tests and cognitive domains.

Cognitive domain	Specific functions and neuropsychological tests
Speed, attention and working memory	Digit symbol (WAIS-R)^* Attention span/working memory: Digit span (WAIS-R)^*
Learning and memory	Verbal episodic memory: logical memory (WMS-R)^†
Executive functions	Mental control: PaSMO^‡ Distractibility: Stroop colour word test, Victoria version^¶
Visuospatial functions	Perception: Silhouettes (VOSP)^§
Language	Naming: Boston naming test^‖ Syntax comprehension: Token test, subtest V^#

Notes: WAIS-R, The Wechsler Adult Intelligence Scale Revised; WMS-R, Wechsler Memory Scale Revised; PaSMO, parallel serial mental operations; VOSP, the visual object and space perception battery

^* Wechsler (1981)

^† Wechsler (1987)

^‡ Lezak (2004)

^¶ Regard (1981)

^§ Rapport et al. (1998)

^‖ Kaplan and Weintraub (1983)

^# Bandera et al. (1985).

Table III.  Demographics for patients and controls.

	Patients (n = 33)	Controls (n = 37)	p-value
Sex (male/female)	(15/18)	(11/26)	0.174^*
Age (years)	46.3 (SD 3.9)	46.9 (SD 4.3)	0.555^†
Educational level (years)	14.6 (SD 2.6)	14.5 (SD 2.6)	0.552^†
Percent scoring>4.0 on burnout measured with SMBQ	70%	3%	< 0.0005^*
Percent with depression (clinical diagnoses)	73%	N/A
Percent with anxiety (clinical diagnoses)	76%	N/A
HAD score
≤ 7	73%	100%	< 0.0005^*
≥ 8	27%	0%
HAD-anxiety score
≤ 7	39%	91%	< 0.0005^*
≥ 8	61%	9%

Note: Values represent mean and SD. N/A, not applicable; SMBQ, Shirom–Melamed Burnout Questionnaire; HAD, Hospital and anxiety depression scale

^* Pearson Chi-square test

^† Student's t-test.

Table IV.  Neuropsychological test outcome in patients (n = 33) and controls (n = 37).

	Domain	Controls mean (SD)	Patients mean (SD)	z Value	Effect size	P
Digit symbol	SAW	58.9 (12.0)	54.0 (12.9)	− 1.696	0.20	0.090
Digit span forwards	SAW	8.1 (2.3)	7.0 (1.7)	− 2.071	0.25	0.038
Digit span backwards	SAW	6.7 (2.1)	5.7 (1.8)	− 2.243	0.27	0.025
Logical memory immediate recall I	LM	26.8 (6.4)	24.8 (6.3)	− 1.308	0.16	0.191
Logical memory delayed recall II	LM	24.1 (6.5)	19.8 (6.6)	− 2.513	0.30	0.012
Logical memory differences I–II	LM	2.7 (2.6)	5.0 (3.1)	− 3.225	0.38	0.001
PaSMO (s)	EF	60.4 (25.6)	81.8 (32.1)	− 3.426	0.41	0.001
Stroop (s)	EF	21.5 (5.1)	25.0 (8.0)	− 1.833	0.22	0.067
VOSP Silhouettes	VSP	21.0 (4.0)	21.0 (3.3)	− 0.421	0.05	0.674
BNT	L	54.0 (2.9)	53.2 (3.2)	− 1.106	0.13	0.269
Token test	L	20.8 (1.4)	20.0 (2.1)	− 1.567	0.19	0.117

Notes: Data were analysed using Mann–Whitney U-tests. Effect size is given as Cohen's d. Significant differences are emboldened. PaSMO, parallel serial mental operations; VOSP, the visual object and space perception battery; BNT, Boston naming test; SAW, speed, attention and working memory; LM, learning and memory; EF, executive function; VSP, visuospatial functions; L, language.

Table V.  Neuropsychological test outcome in patients with higher (n = 15) and lower (n = 25) burnout (BO) scores, determined by median split on SMBQ (higher burnout defined as ≥ 5).

	Domain	Patients lower BO mean (SD)	Patients higher BO mean (SD)	z Value	Effect size	p
Digit symbol	SAW	56.2 (12.5)	50.2 (11.4)	− 1.552	0.25	0.121
Digit span forwards	SAW	6.7 (1.2)	7.5 (2.2)	− 0.516	0.08	0.606
Digit span backwards	SAW	5.6 (1.5)	5.9 (2.6)	− 0.227	0.03	0.820
Logical memory immediate recall I	LM	25.2 (6.0)	21.9 (5.9)	− 1.614	0.26	0.106
Logical memory delayed recall II	LM	21.0 (5.9)	16.7 (5.9)	− 2.173	0.35	0.030
Logical memory differences I–II	LM	4.3 (3.2)	5.1 (2.9)	− 0.721	0.12	0.471
PaSMO (s)	EF	81.1 (35.1)	82.5 (32.6)	− 0.666	0.10	0.505
Stroop (s)	EF	23.2 (7.5)	26.5 (7.4)	− 1.737	0.27	0.082
VOSP Silhouettes	VSP	21.4 (2.8)	19.7 (3.8)	0.215	0.03	0.215
BNT	L	53.2 (3.9)	52.9 (2.5)	− 0.562	0.09	0.574
Token test	L	20.0 (2.1)	19.9 (2.1)	0.491	0.07	0.491

Notes: Data were analysed using Mann–Whitney U-tests. Effect size is given as Cohen's d. Significant differences are emboldened. PaSMO, parallel serial mental operations; VOSP, the visual object and space perception battery; BNT, Boston naming test; SAW, speed, attention and working memory; LM, learning and memory; EF, executive function; VSP, visuospatial functions; L, language.

Wechsler D. 1981. WAIS-R manual. New York: The Psychological Corporation.

 Google Scholar

Wechsler D. 1987. Wechler memory scale-revised manual. San Antonio, TX: The Psychological Corporation.

 Google Scholar

Lezak M. 2004. Neuropsychological assessment. New York: Oxford University Press.

 Google Scholar

Regard M. 1981. Cognitive rigidity and flexibility: A neuropsychological study. Victoria: University of Victoria.

 Google Scholar

Rapport LJ, Millis SR, Bonello PJ. 1998. Validation of the Warrington theory of visual processing and the Visual Object and Space Perception Battery. J Clin Exp Neuropsychol. 20 2: 211–220.

 PubMed Web of Science ®Google Scholar

Kaplan E, Weintraub S. 1983. Boston naming test. Philadelphia, PA: Lea & Febiger.

 Google Scholar

Bandera R, Capitani E, Della Sala S, Spinnler H. 1985. Discrimination between senile dementia Alzheimer type patients and -education matched normal controls by means of a 6-test set. Ital J Neurol Sci. 6 3: 339–344.

 PubMedGoogle Scholar