Changes in memory and attention during and after occupational rehabilitation: A longitudinal study.

BACKGROUND: There is need for more knowledge about the relationship between work and cognitive functioning in sick-listed individuals. OBJECTIVE: This study investigated whether the degree of work participation is relevant for recovery of cognitive functioning in sick-listed individuals. METHODS: 177 occupational rehabilitation participants and 70 controls participated in a non-randomised, longitudinal study. Participants completed computerised cognitive tests targeting sustained attention and working memory at start and end of rehabilitation and 3 and 12 months after rehabilitation. The change score performance in attention and memory between start and end, start and 3 months and 12 months was compared in individuals on sick leave 100-75%, 74-40% and 39-0% (three sick leave groups) of the time in the year after rehabilitation, and a control group not being on sick leave. Fixed effect analysis of covariance adjusting for education and work ability was used. RESULTS: The sick leave group 100-75% had significantly lower score on work ability compared to the other groups at baseline. The main findings indicated that the sick leave group 39-0% improved significantly more in sustained attention compared to the sick leave group 100-75% between start and end of rehabilitation and from start of rehabilitation to 3 and 12 months after. CONCLUSION: The degree of work participation seems relevant to recovery of the cognitive function sustained attention in sick-listed individuals. These findings encourage work rehabilitation clinicians, work consultants and employers to develop RTW plans which take into account that graded employment influence cognitive functioning.

Sustained Attention and Working Memory Predict the Number of Days on Health-Related Benefits in the Year Following Occupational Rehabilitation.

Purpose The objective of this study was to investigate the association between cognitive and emotional functioning and the number of days on health-related benefits such as sick leave, work assessment allowance and disability pension. We investigated whether cognitive and emotional functioning at the start of rehabilitation and the change from the start to the end of rehabilitation predicted the number of days on health-related benefits in the year after occupational rehabilitation. Methods A sample of 317 individuals (age 19-67 years), mainly diagnosed with a musculoskeletal or mental and behavioural ICD-10 disorder, participated. The sample was stratified depending on the benefit status in the year before rehabilitation. Those receiving health-related benefits for the full year comprised the work assessment allowance and disability pension (WAA) group and those receiving benefits for less than a year comprised the sick leave (SL) group. The participants were administered cognitive and emotional computerised tests and work and health questionnaires at the beginning and end of rehabilitation. The cumulative number of days on health-related benefits during 12 months after rehabilitation was the primary outcome variable and age, gender, educational level, subjective health complaints, anxiety, and depression were controlled for in multiple regression analyses. Results The WAA group (n = 179) was significantly impaired at baseline compared to the SL group (n = 135) in focused attention and executive function, and they also scored worse on work and health related variables. Higher baseline scores and change scores from the start to the end of rehabilitation, for sustained attention, were associated with fewer number of health-related benefit days in the WAA group, while higher baseline scores for working memory were associated with fewer number of health-related benefit days in the SL group. Conclusions New knowledge about attention and memory and return to work in individuals with different benefit status may pave the way for more targeted programme interventions. Rehabilitation programmes could benefit from designing interventions that respectively improve sustain attention and working memory related to working life in individuals on sick leave or work assessment allowance and disability pension.

Occupational Rehabilitation Is Associated With Improvements in Cognitive Functioning.

INTRODUCTION: Occupational rehabilitation may be offered to workers on long-term sick leave who often report problems with cognitive functioning, anxiety, depression, pain, and reduced work ability. The empirical knowledge is sparce on how occupational rehabilitation may influence cognitive and emotional functioning and patients have not previously been subjected to comprehensive objective testing. The main aim of this study was to assess possible changes in cognitive and emotional functioning such as memory, attention, executive function, and emotion recognition among patients in occupational rehabilitation. METHODS: A large sample of 280 sick-listed workers referred to inpatient and outpatient occupational rehabilitation was recruited. The rehabilitation programs had a mean duration of 28 days and comprised physical activity, cognitive behavior treatment components and collaboration with the workplace. A pre-post design was applied to investigate possible changes in cognitive and emotional functioning (primary outcomes) and work and health measures (secondary outcomes), comparing the rehabilitation group with a control group of 70 healthy workers. Individuals in the control group were tested at random time points with an approximately 28 day interval between pre- and post-test, thus coinciding with the duration of rehabilitation. Repeated measures analysis of variance was used for the main analyses. RESULTS: Compared to the control group, the rehabilitation group had greater gains from pre- to post-test in focused and sustained attention, as well as greater improvements in work ability and reduction in subjective health complaints (SHC), helplessness, pain, pain related to work, anxiety, and depression. In the rehabilitation group, exploratory correlational analysis indicated that improvements in focused and sustained attention were associated with improvements in return-to-work self-efficacy, work ability as well as a reduction in SHC. CONCLUSION: The sick-listed workers improved in focused and sustained attention and work and health measures after participating in occupational rehabilitation. This study is one of the first to systematically investigate changes in cognitive and emotional functioning during occupational rehabilitation. Clinical practice should benefit from increased knowledge about all cognitive functions and should be specifically aware of the improvements in focused and sustained attention, while memory, executive function and emotion recognition remained unchanged. The results can be used as a motivation to tailor specific interventions to gain further improvements in all cognitive and emotional functions.

Changes in cognitive functioning in sick-listed participants in occupational rehabilitation: A feasibility study.

BACKGROUND: Individuals on long-term sick leave attending occupational rehabilitation often complain about impairments in cognitive functions such as memory and attention. Knowledge of cognitive functioning in these individuals is limited. Such knowledge is clinically relevant for improving occupational rehabilitation programmes. OBJECTIVE: The aims of this feasibility study were to assess the methodological design and to investigate changes in memory and attention on participants during occupational rehabilitation. METHODS: Individuals attending occupational rehabilitation (n = 28) and individuals working full time (n = 25) matched for age, gender, and education participated. The two groups were administered cognitive tests targeting memory and attention and self-reported questionnaires at pre-test and post-test. Outcome measures were speed and accuracy of responses on the cognitive tests and self-reported work ability, subjective health complaints, and symptoms of depression and anxiety. RESULTS: In total, 35% of all invited participants agreed to take part and 93% of these also completed the second test. The mean gain scores in the intervention group were significantly higher than in the control group in response latency on simple and choice reaction time and errors in spatial working memory. CONCLUSION: The results of this study indicate that the motivation of participants to complete testing was high. Improvements in memory and attention were evident in rehabilitation participants indicating that rehabilitation may have an effect on cognitive functions.

Cognitive performance in a subclinical obsessive-compulsive sample 1: cognitive functions.

Individuals who are not clinically diagnosed with obsessive-compulsive disorder (OCD) but still display obsessive-compulsive (OC) tendencies may show cognitive impairments. The present study investigated whether there are subgroups within a healthy group showing characteristic cognitive and emotional performance levels similar to those found in OCD patients and whether they differ from OCD subgroups regarding performance levels. Of interest are those cases showing subclinical symptomatology. The results revealed no impairments in the subclinical OC participants on the neuropsychological tasks, while evidence suggests that there exist high and low scores on two standardised clinical instruments (Yale-Brown Obsessive Compulsive Scale and Cognitive Assessment Instrument of Obsessions and Compulsions) in a healthy sample. OC symptoms may diminish the quality of life and prolong sustainable return to work. It may be that occupational rehabilitation programmes are more effective in rectifying subclinical OC tendencies compared to the often complex symptoms of diagnosed OCD patients. The relationship between cognitive style and subclinical OC symptoms is discussed in terms of how materials and information might be processed. Although subclinical OC tendencies would not seem to constitute a diagnosis of OCD, the quality of treatment programmes such as cognitive behavioural therapy can be improved based on the current investigation.

Cognitive deficits of executive functions and decision-making in obsessive-compulsive disorder.

The nature of cognitive deficits in obsessive-compulsive disorder (OCD) is characterized by contradictory findings in terms of specific neuropsychological deficits. Selective impairments have been suggested to involve visuospatial memory, set shifting, decision-making and response inhibition. The aim of this study was to investigate cognitive deficits in decision-making and executive functioning in OCD. It was hypothesized that the OCD patients would be less accurate in their responses compared to the healthy controls in rational decision-making on a version of the Cambridge gambling task (CGT) and on the color-word interference test and on a version of the Tower of Hanoi test (tower test) of executive functioning. Thirteen participants with OCD were compared to a group of healthy controls (n = 13) matched for age, gender, education and verbal IQ. Results revealed significant differences between the OCD group and the healthy control group on quality of decision-making on the CGT and for achievement score on the tower test. On these two tasks the OCD group performed worse than the healthy control group. The symptom-dimension analysis revealed performance differences where safety checking patients were impaired on the tower test compared to contamination patients. Results are discussed in the framework of cognition and emotion processing and findings implicate that OCD models should address, specifically, the interaction between cognition and emotion. Here the emotional disruption hypothesis is forwarded to account for the dysfunctional behaviors in OCD. Further implications regarding methodological and inhibitory factors affecting cognitive information processing are highlighted.

Pointing and the interference effect in obsessive-compulsive disorder (OCD).

The interference effect in obsessive-compulsive disorder (OCD) was investigated in order to analyze cognitive aspects of motor stereotypy in OCD-related compulsions. So far, the domain of cognitive control in compulsive behavior has been under-investigated. Twelve participants (OCD patients and healthy controls) completed a newly created computer-based pointing task as well as standard clinical and psychological background measures. Findings showed that the patients displayed a larger visual interference effect compared to the controls and pointing paths were longer in time as well as distance when a distractor stimulus was present. It is concluded that, for compensation, patients would need to generate excessive amounts of attentional resources not available to overcome motor rigidity on the one side and visual distraction on the other side.

Cognitive Assessment Instrument of Obsessions and Compulsions (CAIOC-13) - a new 13-item scale for evaluating functional impairment associated with OCD.

The Cognitive Assessment Instrument of Obsessions and Compulsions (CAIOC) was designed as a novel instrument for clinicians to assess the main cognitive and executive impairments that are hypothesized to underpin the impact of obsessive-compulsive symptoms on functioning in patients with obsessive-compulsive disorder (OCD). Initially, 18 items were selected based upon observation in the laboratory and clinical research setting, then refined to a definitive 13-item scale after excluding items due to statistical criteria. In a study involving two raters, 50 patients diagnosed with OCD were assessed using the self-rated and clinician-rated versions of the new scale. OCD patients' scores fell in the region of moderate severity on both clinician and self-rated versions of the CAIOC-13. Inter-rater reliability and Cronbach's alpha scores were satisfactory. Factor analysis indicated a one factor solution confirming its unidimensionality. Significantly higher scores in the OCD group compared to a depression group (n=31) and a healthy control group (n=55) were revealed. Scores on the clinician and self-rated versions of the 13-item CAIOC appear valid and reliable measures of the severity of functional impairment associated with OCD. Further validation, including research into the relationship of the CAIOC-13 with laboratory measures of cognitive impairment and evaluation of its sensitivity is indicated.

Disgust and fear recognition in paraneoplastic limbic encephalitis.

Paraneoplastic limbic encephalitis (PNLE) affects limbic portions of the brain associated with recognition of social signals of emotions. Yet it is not known whether this perceptual ability is impaired in individuals with PNLE. We therefore conducted a single case study to explore possible impairments in recognising facially, vocally and bodily expressed emotions, using standardised emotion recognition tests. Facial expression recognition was tested with two forced-choice emotion-labelling tasks using static faces with either prototypical or morphed blends of basic emotions. Recognition of vocally and bodily expressed emotions was also tested with forced-choice labelling tasks, one based on prosodic cues, the other on whole-body movement cues. We found a deficit in fear and disgust recognition from both face and voice, while recognition of bodily expressed emotions was unaffected. These findings are consistent with data from previous studies demonstrating critical roles for certain brain regions - particularly the amygdala and insular cortex - in processing facially and vocally displayed basic emotions, and furthermore, suggest that recognition of bodily expressed emotions may not depend on neural structures involved in facial and vocal emotion recognition. Impaired facial and vocal emotion recognition may form a further neuropsychological marker of limbic encephalitis, in addition to the already well-described mnestic deficits.

Evidence for distinct contributions of form and motion information to the recognition of emotions from body gestures.

The importance of kinematics in emotion perception from body movement has been widely demonstrated. Evidence also suggests that the perception of biological motion relies to some extent on information about spatial and spatiotemporal form, yet the contribution of such form-related cues to emotion perception remains unclear. This study reports, for the first time, the relative effects on emotion recognition of inverting and motion-reversing patch-light compared to fully illuminated displays of whole-body emotion gestures. Inverting the gesture movies or playing them backwards significantly impaired emotion classification accuracy, but did so more for patch-light displays than for identical but fully illuminated movement sequences. This result suggests that inversion impairs the processing of form information related to the configuration of body parts, and reversal impairs the sequencing of form changes, more than these manipulations impair the processing of kinematic cues. This effect was strongest for inversion, suggesting an important role for configural information in emotion recognition. Nevertheless, even in combination these stimulus manipulations did not abolish above chance recognition of any of the emotions, suggesting that kinematics help distinguish emotions expressed by body gestures. Disproportionate impairments in recognition accuracy were observed for fear and disgust under inversion, and for fear under motion reversal, suggesting a greater role for form-related cues in the perception of these emotions.

Emotion perception from dynamic and static body expressions in point-light and full-light displays.

Research on emotion recognition has been dominated by studies of photographs of facial expressions. A full understanding of emotion perception and its neural substrate will require investigations that employ dynamic displays and means of expression other than the face. Our aims were: (i) to develop a set of dynamic and static whole-body expressions of basic emotions for systematic investigations of clinical populations, and for use in functional-imaging studies; (ii) to assess forced-choice emotion-classification performance with these stimuli relative to the results of previous studies; and (iii) to test the hypotheses that more exaggerated whole-body movements would produce (a) more accurate emotion classification and (b) higher ratings of emotional intensity. Ten actors portrayed 5 emotions (anger, disgust, fear, happiness, and sadness) at 3 levels of exaggeration, with their faces covered. Two identical sets of 150 emotion portrayals (full-light and point-light) were created from the same digital footage, along with corresponding static images of the 'peak' of each emotion portrayal. Recognition tasks confirmed previous findings that basic emotions are readily identifiable from body movements, even when static form information is minimised by use of point-light displays, and that full-light and even point-light displays can convey identifiable emotions, though rather less efficiently than dynamic displays. Recognition success differed for individual emotions, corroborating earlier results about the importance of distinguishing differences in movement characteristics for different emotional expressions. The patterns of misclassifications were in keeping with earlier findings on emotional clustering. Exaggeration of body movement (a) enhanced recognition accuracy, especially for the dynamic point-light displays, but notably not for sadness, and (b) produced higher emotional-intensity ratings, regardless of lighting condition, for movies but to a lesser extent for stills, indicating that intensity judgments of body gestures rely more on movement (or form-from-movement) than static form information.

Discrimination of intentional and random motion paths by pigeons.

Twelve pigeons ( Columba livia) were trained on a go/no-go schedule to discriminate between two kinds of movement patterns of dots, which to human observers appear to be "intentional" and "non-intentional" movements. In experiment 1, the intentional motion stimulus contained one dot (a "wolf") that moved systematically towards another dot as though stalking it, and three distractors ("sheep"). The non-intentional motion stimulus consisted of four distractors but no stalker. Birds showed some improvement of discrimination as the sessions progressed, but high levels of discrimination were not reached. In experiment 2, the same birds were tested with different stimuli. The same parameters were used but the number of intentionally moving dots in the intentional motion stimulus was altered, so that three wolves stalked one sheep. Despite the enhanced difference of movement patterns, the birds did not show any further improvement in discrimination. However, birds for which the non-intentional stimulus was associated with reward showed a decline in discrimination. These results indicated that pigeons can discriminate between stimuli that do and do not contain an element that human observer see as moving intentionally. However, as no feature-positive effect was found in experiment 1, it is assumed that pigeons did not perceive or discriminate these stimuli on the basis that the intentional stimuli contained a feature that the non-intentional stimuli lacked, though the convergence seen in experiment 2 may have been an effective feature for the pigeons. Pigeons seem to be able to recognise some form of multiple simultaneously goal-directed motions, compared to random motions, as a distinctive feature, but do not seem to use simple "intentional" motion paths of two geometrical figures, embedded in random motions, as a feature whose presence or absence differentiates motion displays.