Psychosocial working conditions play a significant role for health during working age, as well as in post-retirement life. However, little is known about the impact of work stressors on cognitive and physical impairment assessed in combination. The aim was to study associations between midlife work stressors and physical and cognitive impairment in older age for women and men separately. The data were derived from two Swedish nationally representative surveys. The same participants were followed through three waves at the mean ages of 54, 61, and 81 (n=360). Multinomial logistic regression was used to assess the association between work stressors, and test of cognitive and physical function. Low control and passive jobs were associated with higher odds of cognitive impairment, and cognitive and physical impairment when assessed in combination. These findings were driven by associations found among men. Accumulated low control and passive jobs across midlife were associated with physical impairment in older age among men, but not among women. These results highlight the importance of work stressors for physical and cognitive impairment in older age. Improving psychosocial working conditions in midlife, in particular increasing the level of control among employees, may promote healthy aging.

Dans le contexte du diagnostic précoce de la maladie d’Alzheimer, une direction de la recherche émerge autour de l’informatisation de tests cognitifs. Nous avons conçu un test de barrage informatisé sur tablette (test e-CT), développé à partir d’un test de barrage papier-crayon. Nous avons étudié les variables influençant les performances au test e-CT et ses propriétés psychométriques. Nous avons observé que chez les sujets âgés sains, la seule variable influençant était l’âge. Les performances au test e-CT n’étaient pas influencées par l’expérience avec un appareil informatique. Cependant, chez les patients présentant des troubles cognitifs, ceux qui utilisaient quotidiennement un appareil informatique avaient une meilleure performance que ceux qui n’avaient pas un usage quotidien. En effet, les patients utilisant quotidiennement un appareil informatique présentaient de meilleures capacités cognitives. Le test e-CT était corrélé avec plusieurs tests des fonctions exécutives (validité convergente), mais pas avec le test de la mémoire épisodique (validité divergente). Il présente aussi une bonne fidélité test-retest. Le test e-CT présente des bonnes performances diagnostiques, permettant de différencier les personnes âgées saines des patients présentant des troubles cognitifs. En conclusion, le test e-CT présente des propriétés psychométriques satisfaisantes et peut être utilisé pour l’évaluation cognitive chez le sujet âgé. / In the context of early detection of cognitive impairment associated with dementia, an area of research focus concerns development and validation of computerized tests. We have developed a tablet-based cancellation test (e-CT), based on an existing paper-and-pencil cancellation test (K-T test). We studied the variables influencing performance on the e-CT and its psychometric properties. Among healthy older adults, only age was found to be an influencing variable. The performance on the e-CT was not influenced by experience with a computer-based device. However, for patients suffering from cognitive impairment, those using a computer-based device daily outperformed those who were not daily users. Further analyses showed that daily users conserved better cognitive capacities than non-daily users. The e-CT showed significant correlations with several measures of executive functions (convergent validity), but there was no relationship between the e-CT and the episodic memory test (divergent validity). It showed good test-retest reliability. The e-CT had good diagnostic accuracy in differentiating between healthy elderly subjects and patients with cognitive impairment. In conclusion, the e-CT test shows satisfying psychometric properties and is a promising tool for neuropsychological assessment in older adults

Les hypersignaux de la substance blanche (HSB) ont été associés à des déficits exécutifs et mnésiques et à une atteinte des circuits corticaux et sous-corticaux frontaux. Leur présence, en plus du dépôt ß-amyloïde chez de nombreux patients avec un MCI (Mild Cognitive Impairment ou trouble cognitif léger) augmenterait le risque de conversion vers une maladie d'Alzheimer (MA). Un des enjeux importants dans la phase préclinique de la maladie est d'explorer le potentiel des interventions cognitives pour prévenir le déclin cognitif et la progression vers une MA. Alors que les HSB sont de plus en plus considérés comme un des facteurs déterminant l'hétérogénéité des patients MCI, peu d'étude ont pris en compte leur présence dans les interventions cognitives. L'hypothèse qu'une intervention pourrait induire des effets différentiels selon l'existence ou non d'hypersignaux dans le MCI reste inexplorée à notre connaissance, et est au cœur de ce travail de thèse. / White matter hyper signals (WMH) were associated with executive and memory deficits and impairment of the cortical and subcortical frontal circuits. Their presence, in addition to amyloid deposition in many patients with Mild Cognitive Impairment (MCI), would increase the risk of conversion to Alzheimer's disease (AD). An important issues in the preclinical phase of MCI is to explore the potential of cognitive interventions to prevent cognitive decline and progression to AD. While WMH are increasingly considered as one of factors determining the heterogeneity of MCI patients, few studies have take into account their presence in cognitive interventions. The hypothesis that an intervention could induce differential effects according to the existence or not of WMH in MCI remains unexplored to our knowledge, and is at the heart of this work of thesis.

No description available.

Mental health problems are associated with significant losses in work productivity and, consequently, have significant ramifications for business entities and the general economy. Several instruments have been developed to measure productivity-related constructs such as absenteeism and presenteeism. The current study examines the utility of the Outcome Questionnaire-45 (OQ), a commonly used mental health questionnaire, in predicting work productivity. This relationship is explored as a preliminary step in assessing the degree to which changes in mental health brought about by psychotherapy will improve work productivity. Forty-nine participants were recruited from a call center in a small market research firm based in the Western United States. Work productivity was measured using four subscales of the Work Productivity and Activity Impairment (WPAI) questionnaire as well as an objective measure. The OQ and WPAI were administered on a weekly basis over the course of five weeks. Participant characteristic variables and work-time variables were also measured. A mixed models analysis of covariance (ANCOVA) with repeated measures showed that the Social Role (SR) Scale, a subscale of the OQ, was a significant predictor of Presenteeism, Overall Work Impairment, and Activity Impairment subscales. Latent growth modeling (LGM) was used to examine the relationship between the variables while accounting for individual trajectory differences. Although the results suggested that an unconditional model of Overall Work Impairment with SR as a time-varying covariate provided a good fit for the data, standardized regression weights between the variables were not significant. Implications of findings, limitations, and recommendations for future research are discussed.

Separation anxiety is highly prevalent among intellectually and visually impaired individuals, yet little research has been done into its treatment in this population. Due to delayed cognitive skills, these individuals struggle to develop the abstract concept of person permanence, which is necessary to diminish separation anxiety. The first aim of this study was to investigate whether using technology alone or including caregivers was the most beneficial approach to developing person permanence using technology-assisted therapy. The caregivers received training in advance in an attachment-based protocol about securing attachment relationships with the participant. It was hypothesised that the inclusion of attachment figures in technology-assisted therapy would enhance the acquisition of the person permanence concept. The second aim of this study was to determine whether technology-assisted therapy in tandem with the participation of caregivers consequently decreased separation anxiety and challenging behaviour in an adult with intellectual and visual impairment. It was hypothesised that the subject’s anxiety and challenging behaviour levels would significantly decrease due to the intervention. The final aim was to determine how the caregivers and the participant experienced this intervention. It was hypothesised that they would regard it as a positive experience. This single-subject design used a pre-experimental quantitative approach. It was based on the familiar ABAB design and comprised six phases. Phase A served as baseline, giving the participants time to become acquainted with the technology. Phase B consisted of automated responses to the participant’s messages. In phase C caregivers directed the active reply. The daily messages were discussed when the participant and caregiver reunited, incorporating the attachment-based protocol. Phase B and C were repeated. Phase D followed after the devices were handed in. The technology was a specially adapted touch iPhone with an application comprising coloured emoticons. When the participant was physically separated from the caregiver, he could send happy, sad, angry or scared emoticons, or request help. The caregiver, who had a similar device, responded by sending a pre-determined response such as acknowledging the participant’s “I am angry” message with a “You are angry” message. Due to the association between anxiety and challenging behaviour in this population, standardised instruments were used to measure changes in these behaviours. Repeated measure ANOVA and a non-parametric Friedman test were used to analyse the data, specifically comparing phase B and C. Overall, the results showed that behaviour did significantly change over the course of the intervention. The frequency of the various iPhone messages sent by the participant was recorded daily. ANOVA contracts results demonstrated significantly fewer anxious and angry messages sent during the C phases compared with the B phases. The professional caregivers recorded the frequency and intensity of anxiety and challenging behaviours. The ANOVA contrast results showed a significantly lower frequency and intensity of these behaviours in the C phases compared with the B phases. A questionnaire was developed to evaluate the social validity of the intervention. The independent samples t-test demonstrated a significant difference between the mean scores rated by the caregivers at the beginning and the end of the invention. The participant and caregivers were positive about the intervention. Although the results cannot be generalised, it can be concluded that the inclusion of caregivers in technology-assisted therapy can serve as an invaluable aid to developing the person permanence concept. The findings also indicate that the anxiety and challenging behaviour levels shown by the adult with ID and visual impairment decreased due to technology-assisted therapy applied by caregivers, while responses to the social validity of the intervention were positive. / MSc (Research Psychology), North-West University, Potchefstroom Campus, 2015

Separation anxiety is highly prevalent among intellectually and visually impaired individuals, yet little research has been done into its treatment in this population. Due to delayed cognitive skills, these individuals struggle to develop the abstract concept of person permanence, which is necessary to diminish separation anxiety. The first aim of this study was to investigate whether using technology alone or including caregivers was the most beneficial approach to developing person permanence using technology-assisted therapy. The caregivers received training in advance in an attachment-based protocol about securing attachment relationships with the participant. It was hypothesised that the inclusion of attachment figures in technology-assisted therapy would enhance the acquisition of the person permanence concept. The second aim of this study was to determine whether technology-assisted therapy in tandem with the participation of caregivers consequently decreased separation anxiety and challenging behaviour in an adult with intellectual and visual impairment. It was hypothesised that the subject’s anxiety and challenging behaviour levels would significantly decrease due to the intervention. The final aim was to determine how the caregivers and the participant experienced this intervention. It was hypothesised that they would regard it as a positive experience. This single-subject design used a pre-experimental quantitative approach. It was based on the familiar ABAB design and comprised six phases. Phase A served as baseline, giving the participants time to become acquainted with the technology. Phase B consisted of automated responses to the participant’s messages. In phase C caregivers directed the active reply. The daily messages were discussed when the participant and caregiver reunited, incorporating the attachment-based protocol. Phase B and C were repeated. Phase D followed after the devices were handed in. The technology was a specially adapted touch iPhone with an application comprising coloured emoticons. When the participant was physically separated from the caregiver, he could send happy, sad, angry or scared emoticons, or request help. The caregiver, who had a similar device, responded by sending a pre-determined response such as acknowledging the participant’s “I am angry” message with a “You are angry” message. Due to the association between anxiety and challenging behaviour in this population, standardised instruments were used to measure changes in these behaviours. Repeated measure ANOVA and a non-parametric Friedman test were used to analyse the data, specifically comparing phase B and C. Overall, the results showed that behaviour did significantly change over the course of the intervention. The frequency of the various iPhone messages sent by the participant was recorded daily. ANOVA contracts results demonstrated significantly fewer anxious and angry messages sent during the C phases compared with the B phases. The professional caregivers recorded the frequency and intensity of anxiety and challenging behaviours. The ANOVA contrast results showed a significantly lower frequency and intensity of these behaviours in the C phases compared with the B phases. A questionnaire was developed to evaluate the social validity of the intervention. The independent samples t-test demonstrated a significant difference between the mean scores rated by the caregivers at the beginning and the end of the invention. The participant and caregivers were positive about the intervention. Although the results cannot be generalised, it can be concluded that the inclusion of caregivers in technology-assisted therapy can serve as an invaluable aid to developing the person permanence concept. The findings also indicate that the anxiety and challenging behaviour levels shown by the adult with ID and visual impairment decreased due to technology-assisted therapy applied by caregivers, while responses to the social validity of the intervention were positive. / MSc (Research Psychology), North-West University, Potchefstroom Campus, 2015

The overall aim was to improve knowledge of the consequences of cognitive dysfunction in everyday life and of instruments to make these assessments. The thesis contains four studies each of different design using different populations. In study I, the relationship between cognitive function, ability to perform activities of daily living and perceived health-related quality of life were investigated in a population of 85-year-old individuals in the community of Linköping (n = 373). The study was part of the Elderly in Linköping Screening Assessment 85 (ELSA 85). Even mild cognitive dysfunction correlated with impaired ability to perform activities of daily living and lower health-related quality of life. In study II, the diagnostic accuracy and clinical utility of Cognistat, a cognitive screening instrument, were evaluated for identifying individuals with cognitive impairment in a primary care population. Cognistat has relatively good diagnostic accuracy with a sensitivity of 0.85, a specificity of 0.79 and a Clinical Utility Index (CUI) of 0.72. The corresponding values were 0.59, 0.91 and 0.53 for the Mini Mental State Examination (MMSE), and 0.26, 0.88 and 0.20 for the Clock Drawing Test (CDT). In study III, the aim was to develop an instrument measuring self-perceived or caregiver reported ability to perform everyday life activities in persons with suspected cognitive impairment or dementia and to perform psychometric testing of this instrument, named the Cognitive Impairment in Daily Life (CID). The CID was found to have good content validity. In study IV, experiences of cognitive impairment, its consequences in everyday life and the need for support in persons with mild cognitive impairment (MCI) or mild dementia and their relatives were explored. Interviews were performed with five people with MCI, eight people with mild dementia and their relatives (n = 13). The main finding was that persons with MCI and dementia experienced cognitive changes that could be burdensome and result in changed activity patterns. In conclusion, the findings support earlier research and show that cognitive dysfunction even at mild stages has an impact on everyday life and reduces perceived quality of life. To improve interventions for persons with cognitive impairment, it is important to assess not only cognitive function but also its consequences in everyday life activities.

Introduction: Dementia is a syndrome due to disease of the brain, usually of a chronic nature, in which there is disturbance of multiple higher cortical functions including Memory, Comprehension, Thinking, Judgment, Orientation, language and communication skills and abstract thinking. It is one of the most challenging disorders both in terms of prevalence and economic burden. There are currently approximately 800,000 people with dementia in UK and national cost is 17 billion per year. It is estimated that in next thirty years, number of people with dementia will increase to 1.4 million and the national cost will be over 50 billion. The exceptional advances in modern medicine in terms of prolonging life expectancy do not necessarily improve the care delivered to people with dementia. Dementia is a progressive condition where clinical recovery is not possible despite the discovery of cognition enhancing drugs. This belief leads to low expectations that tend to erode hope and foster indignity. Advances in treatment of Alzheimer’s disease have, however, stimulated new thinking and methods of service delivery. At certain stage of their illness, if not from the very beginning, personal, and social recovery becomes more meaningful for service users than their clinical recovery. Objective: To investigate whether recovery-orientated psychiatric assessment and therapeutic intervention enhances the wellbeing of people with memory problems and their family carers. Method: This study was a preliminary randomised control study. Patients were randomly allocated to recovery focus group or treatment as usual group acting as the control. Participants in the recovery focus group received a recovery-focused pre-diagnostic wellbeing assessment and counselling, diagnostic consultation with written feedback and post-diagnostic support over a period of six months. Participants in both groups were assessed using the WHO Wellbeing Index (WHO-5) as the primary outcome measure. The Mini Mental State Examination, Cornell Scale for Depression in Dementia, EuroQol-5D and Zarit Burden Interview were used as secondary outcome measures. Written records of the narrative accounts of participants in the recovery focus group were also obtained. Results: 48 patients with early dementia were recruited and agreed to take part in the study. Out of these, 34 patients completed the study, of which 17 patients were in the recovery focus group and 17 patients were in the treatment as usual group (control).There was a significant difference between the groups in terms of greater improvement in wellbeing as rated by the WHO – 5 Wellbeing Index in the recovery focus group compared to the control group. The secondary outcome measures in the areas of cognition, quality of life and caregiver burden showed no differences between the groups. However, case histories from the recovery focus group identified the main areas of improvement in improved mood, increased social interaction, reduction in carer strain and/or burden and improved self-worth and/or confidence. Conclusions: This study shows that recovery focused care can enhance the wellbeing of people with mild to moderate dementia. The additional benefits perceived by the patients and their relatives /carers include improvement in mood symptoms, social interaction and confidence as well as reduction in carer burden and strain.

Enligt “Teorin om planerat beteende” så finns det tre orsaker till beteendet. Denna teori handlar om vad som påverkar en persons förväntningar och beteende innan de ska utföra en uppgift på en webbplats. Tidigare forskning har visat att tillgängligheten på webbplatser fortfarande är bristfälliga för personer med synnedsättning, eftersom de har olika behov och det spelar en viktig roll hur webbplatserna är uppbyggda och anpassade för personer med synnedsättning. Det ska vara lätt för användaren att hitta, förstå och kunna ta del av informationen på webbplatsen. För att kunna anpassa en webbplats på bästa sätt för personer med synnedsättning, bör en designer ta hjälp av olika riktlinjer för att kunna designa webbplatsen mer tillgänglig med bra och användbar information för personer med synnedsättningar. Men dessa riklinjer hjälper inte alltid användare med svår synnedsättning, eftersom de är i behov av olika hjälpmedel. Forskningsområdet berör områdena universell design, tillgänglighet, användarupplevelse, tillgänglighet och förväntningar på webben. Syftet med denna studie var att undersöka tillgängligheten för personer med synnedsättning på Linnéuniversitets webbplats och studera om webbplatsen är tillgänglig för dem, och studera om webbplatsen uppfyller deras förväntningar och upplevelse till att använda webbplatsen. Studien har studerat hur tillgängligheten påverkar användarupplevelsen för människor med synnedsättning på en webbplats och vilka förväntningar som användaren har på webbplatser. En empirisk studie genomfördes utifrån användartest med uppgifter och intervjuer på den befintliga webbplatsen med hjälp av personer med synnedsättning. I detta arbete har fullständig blindhet uteslutits, eftersom det är helt annan inriktning. Resultatet av intervjuerna sammanställdes och kategoriserades inom tillgänglighet, upplevelse och förväntningar av webbplatsen utifrån de mönster där testpersonerna hade angett liknande svar. Resultatet av sammanställningen av användartestet och intervjuerna på Linnéuniversitetets webbplats visade att testpersonerna anser att webbplatsen är tillgänglig för personer med synnedsättning och att deras förväntningar på webbplatsen uppfylldes. Resultatet visade att det som påverkar tillgängligheten på en webbplats är dåligt utformade med dåliga kontraster som till exempel ljus blått på vit bakgrund. På grund av dålig utformade webbplatser så kan inte personer med synnedsättning använda sina eventuella hjälpmedel, till exempel talsyntes, för att läsa upp innehållet på webbplatsen åt dem. Rörliga bilder, placering av objekt, otydliga menyer och rubriker, dåliga typsnitt eller att texten är för liten så att den blir svår att läsa. Det som personer med synnedsättning förväntar sig ska finnas på en tillgänglig webbplats: bra kontraster, bra typsnitt och tydliga rubriker. Bra placering av element så att det blir lätt att navigera sig, inga rörliga bilder, kunna lyssna på innehållet och att kunna använda sina eventuella hjälpmedel på webbplatsen. Genom detta får användaren en positiv upplevelse av webbplatsen. / According to “Theory of planned behavior", there are three reasons for the behavior. This theory is about what affect a person ́s expectations and behavior before they need to perform a task on a website. Previous research has shown that the availability of websites is still inadequate for people with visual impairment, because they have different needs and it plays an important role in how sites are built and adapted for people with visual impairment. It should be easy for users to find, understand and be able to take note of the information provided on the site. To be able to customize a site in the best way for people with visual impairment, a designer should take the help of various guidelines to design a website more accessible with useful information for people with visual impairment. But these guidelines don't always help users with severe visual impairment, because they are in need of different means. The research area relevant to the fields of universal design, accessibility, user experience, availability and expectations on the websites. The purpose of this study is to investigate the availability of people with visual impairment on Linnaeus University website and learn about how the site is available to them, and to study their expectations and experience of using the website. This study has studied how accessibility affects the user experience for people with visual impairment on a website and the expectations that the user has on websites. To be able to examine, I conducted an empirical study based on user tests with data and interviews on the existing site with the help of people with visual impairment. In this work I have excluded complete blindness, because it is quite a different focus. The results of the interviews were compiled and were categorised in availability, experience and expectations of the website based on the pattern in which subjects had stated similar answers. The result of the compilation of user test and interviews at Linnaeus University website showed that subjects think that the website is accessible to people with visual impairment, and that their expectations of the website were satisfied. The results showed that what affects the accessibility of a website is poorly designed interfaces with poor contrasts such as light blue on a white background. Because of badly designed websites, persons with visual impairment cannot use any assistive devices such as speech synthesizers to read out the contents of the site for them, pictures that moves, position of objects, obscure menus and headlines, bad fonts or that the text is to small, making it difficult to read. What person with visual impairment expects to find on an accessible website: good contrast, good fonts and clear titles. Good placement of the elements so that it will be easy to navigate, no pictures that moves, ability to listen to the content and to use any means at the site. Through this, the user receives a positive experience of the website.