Stress-related conditions like clinical burnout and exhaustion disorder (ED) are associated with enduring cognitive problems. We have previously demonstrated that the addition of computerised cognitive training (CCT) and aerobic training (AT) to a multimodal rehabilitation programme (MMR) yielded greater improvements in cognitive function compared to MMR alone in patients with ED. These effects were maintained at the 1-year follow-up for CCT, but not for AT. Building on these findings, the present study examined the extended long-term effects of CCT and AT on cognitive function, psychological health, and work ability, 4.5 years after the interventions. Participants were recruited from a stress-rehabilitation clinic and 56 of the initial 132 participants returned for the 4.5-year follow-up. Assessments were conducted before (T1), immediately after (T2), 1-year after (T3) and 4.5-years after (T4) the interventions. Mixed model analyses assessed changes in the intervention groups relative to the control group from T1 to T4, with follow-up comparisons examining within-group stability of outcomes between T3 to T4. The primary outcome was cognitive performance on a global cognitive score. Secondary outcomes included domain-specific cognitive functioning, self-reported cognitive function, psychological health (burnout, depression, anxiety, and fatigue), and work ability. The analysis revealed sustained long-term effects on the global cognitive score, a trained updating task and episodic memory in the CCT group, with stable performance between one- and 4.5-year follow-up. The addition of AT did not yield any extended long-term effects on cognitive performance. Both groups showed extended long-term improvements in self-reported memory problems, although findings were mixed. Extended long-term improvements were observed on burnout for both groups, with additional effects on anxiety and work ability in the AT group. Notably, these effects were not present at the 1-year follow-up and are more plausibly explained by selective attrition rather than a delayed intervention effect. In conclusion, the result indicates that cognitive interventions such as CCT can have lasting positive effects on cognitive function in patients with ED, whereas the long-term psychological effects should be interpreted with caution. Trial Registration: ClinicalTrials.gov: NCT0073772. 

Objective Given the clinical heterogeneity of Parkinson's disease (PD), identification of early -stage subgroups with shared non-motor symptom (NMS) profiles may clarify its pathophysiology. This study used latent-profile analyses (LPA) to define subgroups based on sleep disturbances, cognitive performance and neuropsychiatric symptoms, and examined dopaminergic function and brain volume differences between them.<br /> Methods We analyzed data from 51 cognitively normal non-PD older adults and 105 early-stage PD participants from the iPARK trial, including 19 who underwent [11C]-raclopride PET/MR. Participants completed the Hospital Anxiety and Depression Scale, the short version of the Karolinska Sleep Questionnaire and a battery of neuropsychological tests. LPA were used in PD to identify subgroups based on NMS profiles, which were then characterized and examined in relation to dopaminergic integrity and brain morphology.<br /> Results LPA identified a two-cluster solution as the best fit. Group 1 (N = 49) showed poorer working memory, executive function and processing speed along with greater daytime sleepiness, depression and anxiety. Group 2 (N = 56) exhibited less affected cognitive function and minimal NMS. Groups were similar in demographics, disease duration, motor symptom severity and medication, but differed on UPDRS-1 NMS. Group 1 demonstrated significantly reduced [11C]-raclopride binding potential compared to Group 2 in the left putamen at both ROI- and voxel-wise analysis.<br /> Conclusion These findings indicate clinically distinct subgroups in early-stage PD. Greater NMS burden is linked to impaired dopaminergic integrity, suggesting a potential neurobiological signature. Early identification of such subgroups may improve understanding of disease heterogeneity and support personalized management and interventions.

Clinical trial registration https://clinicaltrials.gov/study/NCT03680170?id=NCT03680170&rank=1, identifier (NCT03680170).

The Shirom-Melamed Burnout Questionnaire/Measure (SMBQ/SMBM) is a self-report instrument frequently used for assessing degree of burnout and screening for stress-related exhaustion disorder. The aim of the present study was three-fold. First, to examine reliability and construct validity of different versions of SMBM with 6-22 items in a clinical context. Second, to examine the criterion validity by assessing sensitivity and specificity and determining clinical cut-offs for these versions of the SMBM, and third to examine the prevalence of burnout in a general population and primary care sample using the proposed cut-offs. Two Swedish samples were used for the first two purposes: a clinical sample of patients diagnosed with exhaustion disorder (n = 149), and a matched sample of healthy controls (n = 60). For the third purpose a sample from the general population (n = 3406), and a primary care clinical sample (n = 326) was used. The modified versions of the SMBM showed good internal consistency, construct validity, dimensionality and model fit on the clinical exhaustion disorder sample, as well as configural measurement invariance across clinical and non-clinical samples. The sensitivity (94.6%-95.3%) and specificity (93.3%-95.0%) in identifying cases with exhaustion disorder based on the cut-off of 4.0 for the 19-, 16- and 11-items versions, and on the cut-off of 3.75 for the 6-item version was high. The prevalence of burnout was 81.2% in the primary care sample and 16.6% in the general population sample. The findings indicate that the SMBM is a useful instrument for screening for exhaustion disorder and burnout.

Background

People diagnosed with stress-related exhaustion disorder report high levels of cognitive symptoms. This study aimed to explore how persons diagnosed with Exhaustion disorder (ED) experienced cognitive functioning and recovery 6-10 years after participating in a rehabilitation programme. Specifically, it investigated the experiences of current functioning, change over time, and what had been barriers or facilitators for cognitive recovery.

Methods

Semi‐structured interviews were conducted for 38 persons previously diagnosed with ED (Mean age: 52; Females: 32) and explored using thematic analysis.

Results

The analysis resulted in four themes: “’It’s different now’: Remaining cognitive symptoms”, “The bigger picture: Cognitive recovery in context”, “Overcoming challenges: Strategies for coping with cognitive symptoms”, and “The approach towards cognition matters”. The participants’ experiences varied but included descriptions on how cognitive functioning had become better with some remaining symptoms. These difficulties were reported across cognitive domains, yet often centred around upholding executive control. Cognitive recovery was seen in the context of overall well-being and recovery which differed between the participants. Facilitators and barriers thus varied between persons, and included both restorative and compensatory strategies, external conditions, the degree of worry, and development of a more acceptant or self-compassionate view on cognition and oneself.

Conclusions

The results show that cognitive recovery in ED is multifaceted. 6-10 years after rehabilitation, experiences included improvement of everyday cognitive functioning, but also lingering challenges, often related to maintenance of executive control. Recovery was influenced by factors such as general well-being, restorative or compensatory strategies, worrying, or the adaptation of more accepting or self-compassionate perspectives. The findings indicate a need for tailored, person-centred approaches to supporting cognitive recovery.

Background: Combining multimodal lifestyle interventions and disease-modifying drugs (novel or repurposed) could provide novel precision approaches to prevent cognitive impairment. Metformin is a promising candidate in view of the well-established link between type 2 diabetes (T2D) and Alzheimer’s Disease and emerging evidence of its potential neuro-protective effects (e.g. vascular, metabolic, anti-senescence). MET-FINGER aims to test a FINGER 2.0 multimodal intervention, combining an updated FINGER multidomain lifestyle intervention with metformin, where appropriate, in an APOE ε4-enriched population of older adults (60–79 years) at increased risk of dementia. Methods: MET-FINGER is an international randomised, controlled, parallel-group, phase-IIb proof-of-concept clinical trial, where metformin is included through a trial-within-trial design. 600 participants will be recruited at three sites (UK, Finland, Sweden). Participants at increased risk of dementia based on vascular risk factors and cognitive screening, will be first randomised to the FINGER 2.0 intervention (lifestyle + metformin if eligible; active arm) or to receive regular health advice (control arm). Participants allocated to the FINGER 2.0 intervention group at risk indicators of T2D will be additionally randomised to receive metformin (2000 mg/day or 1000 mg/day) or placebo. The study duration is 2 years. The changes in global cognition (primary outcome, using a Neuropsychological Test Battery), memory, executive function, and processing speed cognitive domains; functional status; lifestyle, vascular, metabolic, and other dementia-related risk factors (secondary outcomes), will be compared between the FINGER 2.0 intervention and the control arm. The feasibility, potential interaction (between-groups differences in healthy lifestyle changes), and disease-modifying effects of the lifestyle-metformin combination will be exploratory outcomes. The lifestyle intervention is adapted from the original FINGER trial (diet, physical activity, cognitive training, monitoring of cardiovascular/metabolic risk factors, social interaction) to be consistently delivered in three countries. Metformin is administered as Glucophage®XR/SR 500, (500 mg oral tablets). The metformin/placebo treatment will be double blinded. Conclusion: MET-FINGER is the first trial combining a multimodal lifestyle intervention with a putative repurposed disease-modifying drug for cognitive impairment prevention. Although preliminary, its findings will provide crucial information for innovative precision prevention strategies and form the basis for a larger phase-III trial design and future research in this field. Trial registration: ClinicalTrials.gov (NCT05109169).

Background: Evidence for the beneficial effects of cognitive training on cognitive function and daily living activities is inconclusive. Variable study quality and design does not allow for robust comparisons/meta-analyses of different cognitive training programmes. Fairly low adherence to extended cognitive training interventions in clinical trials has been reported. Aims: The aim of further developing a Cognitive Training Support Programme (CTSP) is to supplement the Computerised Cognitive Training (CCT) intervention component of the multimodal Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER), which is adapted to different cultural, regional and economic settings within the Word-Wide FINGERS (WW-FINGERS) Network. The main objectives are to improve adherence to cognitive training through a behaviour change framework and provide information about cognitive stimulation, social engagement and lifestyle risk factors for dementia. Methods: Six CTSP sessions were re-designed covering topics including (1) CCT instructions and tasks, (2) Cognitive domains: episodic memory, executive function and processing speed, (3) Successful ageing and compensatory strategies, (4) Cognitive stimulation and engagement, (5) Wellbeing factors affecting cognition (e.g., sleep and mood), (6) Sensory factors. Session content will be related to everyday life, with participant reflection and behaviour change techniques incorporated, e.g., strategies, goal-setting, active planning to enhance motivation, and adherence to the CCT and in relevant lifestyle changes. Conclusions: Through interactive presentations promoting brain health, the programme provides for personal reflection that may enhance capability, opportunity and motivation for behaviour change. This will support adherence to the CCT within multidomain intervention trials. Efficacy of the programme will be evaluated through participant feedback and adherence metrics. 

Background: The Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) showed cognitive benefits from a multidomain lifestyle intervention in at-risk older people. The LipiDiDiet trial highlighted benefits of medical food in prodromal Alzheimer’s disease (AD). However, the feasibility and impact of multimodal interventions combining lifestyle with medical food in prodromal AD is unclear. Methods: MIND-ADmini was a 6-month multinational (Sweden, Finland, Germany, France) proof-of-concept randomized controlled trial (RCT). Participants were 60–85 years old, had prodromal AD (International Working Group-1 criteria), and vascular/lifestyle risk factors. The parallel-group RCT had three arms: multimodal lifestyle intervention (nutritional guidance, exercise, cognitive training, vascular/metabolic risk management and social stimulation); multimodal lifestyle intervention + medical food (Fortasyn Connect); and regular health advice/care (control). Participants were randomized 1:1:1 (computer-generated allocation at each site). Outcome evaluators were blinded to randomization. Primary outcome was feasibility of the multimodal intervention, evaluated by recruitment rate during a 6-month recruitment phase, overall adherence in each intervention arm, and 6-month retention rate. Successful adherence was pre-specified as attending ≥ 40% of sessions/domain in ≥ 2/4 domains (lifestyle intervention), and consuming ≥ 60% of the medical food (lifestyle intervention + medical food). The secondary outcomes included adherence/participation to each intervention component and overall adherence to healthy lifestyle changes, measured using a composite score for healthy lifestyle. Cognitive assessments were included as exploratory outcomes, e.g. Clinical Dementia Rating scale. Results: During September 2017-May 2019, 93 individuals were randomized (32 lifestyle intervention, 31 lifestyle + medical food, and 30 control group). Overall recruitment rate was 76.2% (64.8% during the first 6 months). Overall 6-month retention rate was 91.4% (lifestyle intervention 87.5%; lifestyle + medical food 90.3%; control 96.7%). Domain-specific adherence in the lifestyle intervention group was 71.9% to cognitive training, 78.1% exercise, 68.8% nutritional guidance, and 81.3% vascular risk management; and in the lifestyle + medical food group, 90.3% to cognitive training, 87.1% exercise, 80.7% nutritional guidance, 87.1% vascular risk management, and 87.1% medical food. Compared with control, both intervention arms showed healthy diet improvements (βLifestyle×Time = 1.11, P = 0.038; βLifestyle+medical food×Time = 1.43, P = 0.007); the lifestyle + medical food group also showed vascular risk reduction (P = 0.043) and less cognitive-functional decline (P < 0.05, exploratory analysis). There were 5 serious adverse events (control group: 1; lifestyle intervention: 3; lifestyle + medical food: 1) unrelated to interventions. Conclusions: The multidomain lifestyle intervention, alone or combined with medical food, had good feasibility and adherence in prodromal AD. Longer-term cognitive and other health benefits should be further investigated in a larger-scale trial. Trial registration: ClinicalTrials.gov NCT03249688. 

Background Sick-leave rates are high due to stress-related illnesses, but little is still known about the process of recovery from these conditions. The aim of this study was to explore the experiences of the recovery process, 6 to 10 years after treatment in people previously diagnosed with exhaustion disorder (ED), focusing on facilitators and barriers for the process of recovery from ED, and recovery activities experienced as helpful during the recovery process.Method Thirty-eight participants (average age: 52 years, 32 females) previously diagnosed with ED were interviewed with semi-structured interviews 6-10 years after undergoing treatment. The interviews were analyzed with thematic analysis.Results Three themes resulted from the analysis. The first theme, "A long and rocky road", summarizes the fluctuating path to feeling better and emphasizes barriers and facilitators that affected the process of recovery, with a focus on external life events and the participants' own behaviors. Facilitators were changing workplace, receiving support, a reduction in stressors, and changed behaviors. Barriers were a poor work environment, caregiver responsibilities, negative life events and lack of support. The second theme "Recovery activities are needed every step of the way" describes how both the need for recovery activities and the types of activities experienced as helpful changed during the recovery process, from low-effort recovery activities for long periods of time to shorter and more active recovery activities. Recovery activities were described as important for self-care but hard to prioritize in everyday life. The last theme, "Reorienting to a new place", captures the struggle to cope with the remaining impact of ED, and how internal facilitators in terms of understanding and acceptance were important to reorient and adjust to a new way of functioning.Conclusions Recovering from ED is a long and ongoing process where recovery activities are needed every step of the way. Our results highlight the importance of supporting personal recovery and long-term behavioral change, addressing individual stressors that may perpetuate the condition, and adjusting recovery activities according to where the person is in the recovery process.Trial registration ClinicalTrials.gov: NCT0073772. Registered on March 8, 2017. This study was pre-registered on Open Science Framework (osf.io).

Objectives Older people reporting subjective memory complaints (SMCs) may have a greater risk of cognitive decline. Multidomain lifestyle interventions are a promising strategy for the prevention of cognitive decline. The aim of this study was to investigate whether the presence of SMCs affects the efficacy of a 2-year multidomain lifestyle intervention on cognition.Methods This study is part of the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) project. Participants (a subsample of 568 individuals, baseline age 60-77 years) were randomized (1:1) to receive a 2-year multidomain lifestyle intervention group including dietary advice, exercise, cognitive training, and vascular risk management, or regular health advice control group. Cognitive performance was assessed at baseline and at 1- and 2-year visits, using a neuropsychological test battery, including tests assessing memory, executive functions, and processing speed. Participants rated the frequency of SMCs using the Prospective and Retrospective Memory Questionnaire.Results Having more retrospective SMCs was linked to a less favorable cognitive trajectory over 2 years. The difference between the intervention and control groups in annual change in tested memory performance was 0.077 (95% CI, 0.008-0.146) among those reporting more retrospective SMCs and -0.011 (-0.074 to 0.053) among those with less SMCs; interaction effect p = .019. No other interactions between SMCs and intervention allocation were observed.Discussion A lifestyle intervention may be beneficial for older adults with and without SMCs. Persons having more retrospective SMCs may benefit more from the intervention regarding memory functioning. Clinical Trials Registration Number: NCT01041989Discussion A lifestyle intervention may be beneficial for older adults with and without SMCs. Persons having more retrospective SMCs may benefit more from the intervention regarding memory functioning. Clinical Trials Registration Number: NCT01041989

Physical exercise has been considered to be an efficient mean of preserving cognitive function and it influences both the structural and functional characteristics of the brain. It has especially been shown to increase brain plasticity, the capacity to re-structure brain properties in response to interaction, such as cognitive practice. Studies have also examined the potential additive effect of cognitive training on the documented benefit of physical exercise, commonly, however, not at the neural level. We monitored, using magnetoencephalography (MEG), the brain processes associated with executive functions in older individuals who participated in a 12-month randomized controlled trial including two research arms: physical and cognitive training vs physical training alone. Measurements were conducted at 0 months, 6 months, and 12 months. The addition of cognitive training was associated with better performance in the Stroop test that reflects executive control. The extra benefit of cognitive training was also manifested as decreased modulation of beta frequency band (15-25 Hz) especially to difficult distractors. As beta band activity is associated with attentional control, this indicates fewer resources needed to inhibit irrelevant sensory inputs. These results imply an enhancing role of cognitive elements integrated with physical training in improving or maintaining executive functions in older individuals.