Subjective cognitive complaints and its associations to response inhibition and neural activation in patients with stress-related exhaustion disorder

Abstract

Stress-related exhaustion is associated with cognitive deficits, measured subjectively using questionnaires targeting everyday slips and failures or more objectively as performance on cognitive tests. Yet, only weak associations between subjective and objective cognitive measures in this group has been presented, theorized to reflect recruitment of compensational resources during cognitive testing. This explorative study investigated how subjectively reported symptoms of cognitive functioning and burnout levels relate to performance as well as neural activation during a response inhibition task. To this end, 56 patients diagnosed with stress-related exhaustion disorder (ED; ICD-10 code F43.8A) completed functional magnetic resonance imaging (fMRI) using a Flanker paradigm. In order to investigate associations between neural activity and subjective cognitive complaints (SCCs) and burnout, respectively, scores on the Prospective and Retrospective Memory Questionnaire (PRMQ) and the Shirom-Melamed Burnout Questionnaire (SMBQ) were added as covariates of interest to a general linear model at the whole-brain level. In agreement with previous research, the results showed that SCCs and burnout levels were largely unrelated to task performance. Moreover, we did not see any correlations between these self-report measures and altered neural activity in frontal brain regions. Instead, we observed an association between the PRMQ and increased neural activity in an occipitally situated cluster. We propose that this finding may reflect compensational processes at the level of basic visual attention which could go unnoticed in cognitive testing but still be reflected in the experience of deficits in everyday cognitive functioning.

Keywords:

• Clinical burnout
• fMRI
• cognition
• exhaustion
• stress
• inhibition
• flanker

Additional information

Funding

This research was supported by grants from the Swedish research council for health, working life and welfare (2009-0772, 2020-01111), the Swedish social insurance agency (REHSAM), the Västerbotten county council and the Graduate school in population dynamics and public policy at Umeå University, AFA Insurance and Bank of Sweden tercentenary foundation, the Kempe foundation and Lars Hierta memorial foundation.

Notes on contributors

Andreas Nelson

Andreas Nelson is a licenced psychologist and PhD-student in psychology with a research interest in clinical neuropsychology and cognitive neuroscience.

Hanna Malmberg Gavelin

Hanna Malmberg Gavelin is a licensed psychologist and PhD in psychology with expertise in clinical neuropsychology and stress-related illness.

Micael Andersson

Micael Andersson is a research engineer at the Umeå Center for Functional Brain Imaging with expertise in brain imaging and data analysis.

Maria Josefsson

Maria Josefsson is an associate professor of statistics with expertise in developing methods for studying cognitive aging and risk factors.

Therese Eskilsson

Therese Eskilsson is a licensed physiotherapist and associate professor of physiotherapy with expertise in preventive health care and rehabilitation in stress-related illness.

Lisbeth Slunga Järvholm

Lisbeth Slunga Järvholm is a licenced senior consultant physician and professor with expertise in work-related health and stress-related illness.

Anna Stigsdotter Neely

Anna Stigsdotter Neely is a professor of psychology with expertise in clinical neuropsychology and cognitive neuroscience.

Carl-Johan Boraxbekk

Carl Johan Boraxbekk is a professor of neurology with expertise in cognitive neuroscience and brain imaging. All authors are associated with the RECO project, studying methods to improve cognitive functioning in stress-related exhaustion. The authors reported no potential conflict of interest.