While the physical health benefits of exercise are well established, mental health benefits remain unclear. The literature reports reduced stress and improved cognitive function in rodent exercise studies, and improved mood scores in humans. However, though mood disorders are characterized by poor response to treatment, studies rarely evaluate difficult-to-treat patients or functional outcomes. Therefore, we evaluated the impact of 12-week, group-based exercise programs (running or yoga) on mood and functional outcomes including health-related quality of life (HRQOL) and social and cognitive functioning. Methods: Study 1 was a retrospective review of mood and stress outcomes in participants with difficult-to-treat mood disorders. In Study 2, we measured functional outcomes before and after the running program in a subsample from Study 1. Improved friendship and high injury rates in the running group inspired Study 3, a randomized control trial to evaluate mood and functional outcomes in a non-clinical sample using yoga, a low-impact exercise program that included cognitive control. Results: In Study 1 (n=46), depression (p<0.0001) and stress (p=0.01) scores improved over time, and improved friendship levels were predictive of improved mood scores (p<0.04). In Study 2 (n=18), we found improved scores on several HRQOL subscales, including social functioning (p-values<0.01) and weak improvements in working memory and processing speed (p-values<0.04). In Study 3, yoga participants (n=20) had improved stress (p=0.02), loneliness (p=0.002), and HRQOL (p-values<0.03) scores, compared to wait-list controls (n=8). Yoga participants improved on tasks reflecting hippocampal memory (p-values<0.006) and attention and inhibitory control (p=0.03). Regression and mediation analyses suggest that social support mediates the stress-reducing impact of yoga (p-values<0.0005). Discussion: Group-based exercise programs impart benefits across mental health and functional outcomes for participants with and without mood disorders. Exercise may be an effective adjunctive treatment for mood disorders, and more data is needed on how social support impacts clinical outcomes. / Thesis / Doctor of Philosophy (PhD) / This dissertation examines the impact of exercise across multiple indications of mental health and functioning including mood scores, stress, cognitive function, social function and health-related quality of life (HRQOL) in participants with and without mood disorders. Youth and adults engaged in 12-week group-based exercise interventions of running or yoga and completed comprehensive mental health and neurocognitive assessments. Results: Participation in a structured exercise program was associated with improved stress and depression, social functioning, physical and mental HRQOL domains and limited improvements in cognitive function. Results also support therapeutic benefits of structured high- and low-intensity exercise programs across multiple symptoms in patients with difficult-to-treat mood disorders, and further suggest that reduced stress and increased social functioning play key roles in the mental health benefits observed. These results represent a new standard for mood disorders research, to better understand the how lifestyle strategies are effective for the treatment of mental illness.

Concussion, defined as a functional injury with complex symptomatology, affects millions annually and has been classified as a serious public health concern. Clinical tools currently available for concussion assessment fail to objectively measure cognitive function and thus, are inadequate for proper evaluation of the cognitive dysfunctions associated with the injury. As a result, investigation into the neurological consequences associated with concussion has become a prominent focus in neuroscience research. Traditionally, neuroimaging methods have been used primarily on concussion detection, while behavioural and neuropsychological assessments have been used for both concussion detection and cognitive-performance tracking. However, to date, minimal work has explored the use of neuroimaging to track the consequences of concussion at the neurophysiological level. Accordingly, the present thesis sought to investigate the clinical applicability of electroencephalography (EEG) as an effective neuroimaging tool capable of concussion detection, as well as its ability to objectively track neurophysiological changes over time. Event-related potentials (ERPs) were used to assess specific functions, or more accurately, dysfunctions of select cognitive processes as reflected by electrophysiological changes in the brain. Specifically, the Mismatch Negativity (MMN), N2b, and P300 were investigated to evaluate memory, attention, and executive control in concussed populations. The results of this thesis demonstrated alterations in each of the aforementioned ERPs, signifying cognitive dysfunctions linked to neurophysiological abnormalities in concussed populations. Of particular importance, Chapter 2 revealed the first instance of MMN abnormalities in a concussed population, Chapter 3 was the first to assess concussed adolescents at the acute stage of their injury, and Chapter 4 demonstrates the potential of ERPs to track neurophysiological changes from the acute to post-acute stages of the injury. Ultimately, the findings presented in this dissertation support the clinical viability of using ERPs to not only detect cognitive dysfunctions associated with concussion, but also to objectively track neurophysiological changes on the path to recovery. / Dissertation / Doctor of Philosophy (PhD)

The American Dream which boasts equal opportunity, meritocracy, and prosperity in accordance with an individual's hard work and dedication continues to instill hope in upward social mobility. Understanding social mobility necessitates an examination of individuals' or groups' ability to move upward or downward in status based on wealth, occupation, education, or some other social variable ("Social mobility," n.d.). Accordingly, social mobility within a hierarchical status system like the United States parallels inequality and presents challenges for underrepresented populations. More specifically, there is a gap that exists in the perceptions, generalizations, and realizations of social mobility for Black men in America resulting in a dichotomous disparity that is perplexing and adds to some of the greatest challenges and barriers to social mobility facing Black men. The purpose of this phenomenological study was to employ a cognitive lens to examine factors affecting the social mobility experiences of Black men throughout their educational and occupational pursuits, and/or community involvement; ultimately giving voice to a traditionally marginalized group. Cognitive problem solving styles, decision making, performed behaviors, and diverse social interactions were explored within the context of negotiating overarching stereotypes, overcoming barriers, making good decisions, and persisting towards social mobility. The conceptual framework for the study took into account cognitive function, race, and resilience by way of Kirton's Adaption-Innovation Theory, Critical Race Theory, and Resilience Theory, respectively. The study findings offer counter-narratives to rebuff dominant ideology about Black men in society, facilitate an understanding of values and motivators, introduce characteristics that aid social mobility, and may inform strategies, policies, and programing that affect Black men. Recommendations for further research are also offered. / Ph. D.

Introduction: After a brain injury there are often long term consequences impacting on QoL. However, this is a complex issue influenced by many factors. As someone recovers and adjusts it is likely that the way in which they evaluate QoL will also change. The theory of response shift suggests people will change the way they evaluate QoL in the face of changes in their life. The aim of this thesis is to investigate what influences a QoL judgement; examining the possibility of response shift. Methods: Quantitative and qualitative methods were used in 4 studies. These were a cross-sectional design utilising an individualised QoL measure (SEIQoL-DW); a longitudinal study utilising a ‘then-test’ approach; a cross-sectional questionnaire study; and a qualitative study using Interpretative Phenomenological Analysis. Study 1 (Ch.3) Results: Correlations between the QoL measures confirm the validity of the SEIQoL-DW; however, correlations were generally stronger for the simpler Hadorn Scale. There was little overall change in mean QoL when current and retrospective judgements were compared. There was evidence for a change in what areas of life were considered most important to QoL following injury. Study 2 (Ch.4) Results: Improvements in reported QoL between baseline and follow-up were small. A then-test indicates that any effect of response shift is small, and non-significant in the current research. There was also little evidence for reprioritisation or re-conceptualisation. Examination of other factors associated with QoL suggest that brain-injury specific factors (BIGI, RBANS) play a role in predicting QoL. Study 3 (Ch.5) Results: QoL was reported as worse post-injury on both Hadorn’s scale and the QOLIBRI-OS; a difference that was more pronounced on the QOLIBRI-OS. Differences were also reported in the importance of different areas of functioning. Change in QoL as measured by the QOLIBRI-OS was significantly influenced by disability as measured by the GOSE, emotional and informational support, and upwards social comparison. Optimism as measured by the LOT, but not upwards social comparison was a significant predictor of change on Hadorn’s scale; GOSE and emotional and informational support remain significant predictors. The GOSE, emotional and informational support, emotional coping styles and optimism were significant predictors of current QoL on the QOLIBRI-OS; and emotional and informational support and optimism were significant predictors of QoL on Hadorn’s scale. Little evidence was found to suggest that the factors proposed in Sprangers and Schwartz’s (1999) model of response shift have predicted relationships with QoL. Two candidate variables were studied: optimism and social support. However neither showed the predicted pattern of relationships. Nonetheless the study supports previous work indicating an influence of optimism and social support on QoL, and indicates that these warrant further study. There were systematic difference between current and retrospective ratings of importance of domains. The level of importance given to the areas of life defined by the QOLIBRI-OS is higher after injury than before, with the exception of “personal and social life” for which there is no significant difference. The areas of life chosen to reflect that which is measured by the GOSE (“work”, “close relationships”, and “social and leisure activities”) are rated as less important with the exception of “close relationships”. These findings provide further support for the idea that QoL domains are re-evaluated after brain injury. Study 4: This was an in depth qualitative investigation of the experience of recovery and adjustment following TBI. Semi-structured interviews and Interpretative Phenomenological Analysis (IPA) were used. Interviews were conducted with 4 men who were 3, 7, 12, and 18 years post injury. Main Outcome and Results: Themes emerging from the analysis were ‘Change: In Self and World’; ‘Reaching a point of realisation’; ‘Support’; ‘Adjusting to change/Coping with day to day life’; and ‘Participation, Goals and Focus’. These themes cover how participants felt both they and their lives had changed as a consequence of their injury; ways they went about coping and adjusting to changes; the importance of support; and the significance of social integration and participation in feeling satisfied with life. Summary and Conclusions: These studies provide evidence for response shift in different ways. There is little evidence for recalibration but there is some indication that reprioritization or reconceptualization may take place. Changes in how important different areas of life are before and after injury suggest that participants are changing the way they view and make evaluations of QoL. Factors identified as being important to QoL judgements were disability, social support (emotional and informational support identified in the questionnaire study and support in the IPA), upwards social comparison, and optimism. The IPA study suggests that functional outcome and participation are important after TBI; while also identifying ways of coping and providing an insight into the experience of recovery from brain injury. The different QoL measures used provides both evidence for their validity, but also evidence for the different conceptualisations of QoL that are measured by different instruments. The findings have implications both for understanding the QoL of the individual and for research on QoL after TBI.

BACKGROUND. Breast cancer is the most common type of cancer in women in the UK and is often treated with chemotherapy. Psychosocial side effects (anxiety, depression and fatigue) and cognitive side effects (memory and concentration difficulties) are frequently reported by breast cancer patients. Following recent advances in screening and treatment technology for the disease, survivorship rates have increased. Therefore, women are able to continue or resume their daily tasks during and following treatment. The impact of chemotherapy-related psychological side effects on quality of life and work ability are documented, however the impact on safety outcomes has currently been overlooked in this patient population. Evidence from other research fields suggests that anxiety, depression, fatigue and cognitive difficulties are associated with increased risk of accidents and injuries. OBJECTIVES. This research provides longitudinal self-report data on psychosocial well-being, cognitive function, quality of life, work ability and accident frequency outcomes. METHOD. A mixed-methods, prospective, longitudinal approach was employed. Breast cancer patients about to undergo chemotherapy treatment (n = 60) completed questionnaires at pre-treatment baseline, and again four months (follow-up time 1), eight months (follow-up time 2), and twelve months (follow-up time 3) later. A treatment control group of breast cancer patients receiving radiotherapy (n = 56), and an age-matched healthy control group (n = 58) were assessed at comparable intervals. In addition, a subsample of participants from the chemotherapy group (n = 11), radiotherapy group (n = 6), and healthy control group (n = 15) kept personal solicited diaries for a four-month period to capture the lived experience of managing daily tasks. The diary data were examined using thematic analysis. The combination of the quantitative and qualitative approaches added breadth and depth to the study with the aim of obtaining a realistic and comprehensive understanding of the impact of chemotherapy for breast cancer on patients daily lives. RESULTS. Chemotherapy patients reported a subtle decline in psychosocial well-being, cognitive function and quality of life, and encountered more accidents, particularly at mid-chemotherapy. CONCLUSION. It is important that healthcare professionals, breast cancer patients, relatives and employers are aware of the temporal fluctuations associated with chemotherapy-related side effects, particularly potential safety outcomes. Interventions could be developed to help patients manage their daily tasks in the home and in the workplace safely.

Tyrimo objektas: kognityvinės funkcijos. Tyrimo tikslas: nustatyti ir palyginti 15-18 metų šokėjų ir šokių nelankančių merginų kognityvines funkcijas. 1. Tyrimo uždaviniai: 1 - Nustatyti ir palyginti 15-18 metų šokėjų ir šokių nelankančių merginų darbinės ir verbalinės atminties rodikliai. 2 - Nustatyti ir palyginti 15-18 metų šokėjų ir šokių nelankančių merginų paprastosios ir sudėtingosios reakcijos rodikliai. 3 - Nustatyti ir palyginti 15-18 metų šokėjų ir šokių nelankančių merginų erdvinį suvokimą, strategijų plėtojimo ir vykdomųjų funkcijų rodiklius. Išvados. 1 - Nustatyta, kad verbalinės ir darbinės atminties testų rodikliai tiek šokių nelankančių merginų tiek šokėjų buvo panašūs. 2 - Paprastosios reakcijos rodikliai buvo geresni šokių nelankančių merginų, tuo tarpu sudėtingosios reakcijos rodikliai buvo geresni šokančių merginų. 3 - Šokių nelankančių merginų erdvinio suvokimo ir vykdomosios funkcijos testų rezultatai buvo geresni, tačiau strategijų plėtojimo rodikliai geresni šokėjų. Rekomendacijos ir pasiūlymai. Siekiant objektyviai įvertinti šokio įtaka kognityvinių funkcijų rodikliams yra tikslinga testuoti ir palyginti ne tik šokėjų ir šokių nelankančių 15 – 18 m. merginų grupes, tačiau nustatyti šokio poveikį, kai tiriamosios grupės testavimai vyktų prieš pradedant lankyti šokių užsiėmimus ir po numatyto intervencijos laikotarpio. / The object: of the cognitive functions. The aim: to identify and compare the 15-18 dancers and not dancing girls cognitive functions. Objectives: 1 - To identify and compare the 15-18 dancers and not dancing girls and verbal working memory performance. 2 - Identify and compare the 15-18 dancers and not dancing girls ordinary and difficult reaction rates. 3 - Identify and compare the 15-18 dancers and not dancing girls a three-dimensional understanding of the strategies and the development of executive function tests. Conclusions: 1 - It was found not dancing girls and dancers verbal and working memory test indicators were similar. 2 - Ordinary reactions were higher for not dancing girls, while difficult reaction was superior dancing girls. 3 – Not dancing girls a three-dimensional perception and executive function test results were better, but the development of strategies to perform was better of dancers. Recommendations and suggestions. In order to objectively evaluate the dance influence cognitive variables, it is appropriate to test and compare not only the dancers and the non dancing girls, 15 - 18 years groups of girls, but to determine the impact of the dance, when the research team testing conducted prior to attending dance classes and after the intervention period provided.

The purpose of the present study was to investigate cognitive functioning in a group of 30 chronic pain patients (CPG) as compared to a group of 39 acute pain patients (APG). In order to assess cognitive performance, certain subtests were selected from the McCarron-Dial System (MDS) of Neuropsychological Evaluation. Specifically, a measure of haptic discrimination was used along with the Bender Visual Motor Gestalt Test. As such, completion of these subtests required a cortically mediated, central nervous system processing of sensory information. This particular method of assessment was chosen because it provided a nonverbal measure of higher-order cognitive performance. Additionally, the haptic measure provided separate scores for right and left hemispheric functioning. Data analysis revealed significantly poorer Bender performance among CPG members (t(69) = -5.09, E - •0004, two tailed). Further data analysis revealed that the CPG performed significantly poorer on certain of the haptic discrimination subtests. Specifically, both texture and configuration scores for the right hemisphere were significantly lower among CPG members (texture, p = -042 and configuration, p = .002). Subsequent analyses were conducted to determine predictive relationships between important variables. These data are discussed in terms of their clinical significance and importance for future research.

The purpose of this study was to examine whether exposure to a 6-week piano class would have an impact on specific cognitive functions (attention, short-term memory, and planning) in senior adults. In addition, I aimed to determine whether the cognitive function of participants who studied piano as children would differ from those who did not. Twelve 30-minute sessions were offered to residents of a rural, southern Missouri county using the Yamaha Music in Education (MIE) piano laboratory in a local elementary school. The on-line version of the Cambridge Neurological Test Automated Battery (CANTAB) was used to measure attention, short-term memory and planning. Thirty-six (N = 36) older adults completed the study. Four groups of 8 to 10 participants were randomly assigned. One treatment (Group A) and one control (Group C) received the CANTAB pretest, and posttest, and one treatment (Group B) and one control (Group D) received only the CANTAB posttest. I performed an ANCOVA and discovered no significant difference between CANTAB posttest scores for treatment groups and control groups. Additionally, no significant difference was found between CANTAB scores for those who had piano lessons as a child and those who did not. Evidence from the CANTAB scores support the null hypothesis that there was no evidence of a relationship between twelve 30-minute piano lessons and improved cognitive function in senior adult students. There was also no evidence of a relationship between studying piano before the age of 18 and improved cognitive function as measured by CANTAB.

Cette thèse s’intéresse à la contribution des expositions professionnelles —chimiques, biomécaniques, et psychosociaux—tout au long de la vie dans les inégalités sociales de santé liés au vieillissement. Les trois papiers de la thèse essaient de combler les lacunes dans les connaissances sur les effets à long terme des expositions professionnelles et la contribution des expositions individuelles et conjointes dans ces inégalités. Le premier papier cherche à savoir si le niveau d’éducation atteint dans l’enfance modifie l’effet de l’exposition professionnelle aux solvants au cours de la carrière sur la fonction cognitive après 55 ans.. Nous avons trouvé que l’effet de l’exposition aux solvants sur la fonction cognitive était différent selon le niveau d’éducation.. Le deuxième papier discute les effets combinés des expositions biomécaniques et psychosociaux au cours de la vie professionnelle sur la santé physique et fonctionnelle après la retraite. Nous avons trouvé qu’une forte exposition à la fois aux risques physiques et psychosociaux au cours de la vie active est associée à une capacité fonctionnelle bien plus faible après la retraite que l’exposition à un seul type de risques. Aussi, l’effet était différent chez les hommes et chez les femmes. Le troisième papier est un papier méthodologique qui discute des alternatives aux formes longues des échelles généralement utilisées pour évaluer les expositions biomécaniques au travail. Nous avons cherché à vérifier si la question « Trouvez-vous votre travail fatiguant physiquement?» pourrait être une mesure de substitution acceptable pour évaluer des expositions détaillées.. Nous avons comparé la mesure à un item à une mesure plus complète de 38 expositions spécifiques dans huit domaines. Nous avons trouvé que la mesure à un item était plus valide chez les participants fortement exposés à des contraintes biomécaniques de travail. En somme, cette thèse a montré que les expositions professionnelles peuvent à la fois exacerber les disparités existantes en matière de santé et les perpétuer au delà de la retraite. / This dissertation focuses on how occupational exposures throughout the lifecourse—chemical, physical, and psychosocial—contribute to social patterns in aging outcomes, addressing the gap in knowledge about lasting effects of occupational exposures and the contribution of individual and combined exposures to social patterns in aging. The first paper explores whether childhood educational attainment modifies effects of occupational solvent exposure during the career on cognitive function after age 55. We found differential effects of solvent exposure on cognition by educational attainment. The second paper looks at combined physical and psychosocial exposures during working life and effects on physical health and functioning after retirement. This paper finds that high exposure to both physical and psychosocial hazards at work is associated with worse functional capacity in retirement than exposure to either one separately; the pattern of this relationship differs for men and women. The third paper is a methodology paper exploring alternatives to extensive testing batteries often used to evaluate physical workplace exposures. We tested whether the question “Do you find your work physically strenuous?” was an acceptable proxy measure for more detailed exposure assessments by comparing the measure to a comprehensive self-report measure of 38 specific biomechanical strains across eight domains. We found that the measure was most valid in the populations that were most highly exposed to physical strains at work. In general, this dissertation found that occupational exposures can exacerbate existing disparities in health and perpetuate disparities into and beyond retirement.

Bakgrund: Demenssjukdomar är en växande sjukdomsgrupp i samhället. I Sverige beräknas att mellan 130–150 tusen personer lever med en demenssjukdom. Demens går inte att bota utan det går enbart att bromsa upp förloppet med hjälp av läkemedel. Personer som drabbas av demenssjukdomar får oftast många följdsjukdomar som i förlängningen leder till döden. Med hjälp av dator och tv-spelsanvändning kan demenssjukdomen bromsas med kognitiv träning. Syfte: Syftet har varit att undersöka nyttan av dator och tv-spelsanvändningsområden inom demensvården. Metod: Studien genomfördes som en litteraturöversikt där fjorton vetenskapliga artiklar inkluderades. Sökningar har gjordes via databaserna Pubmed, Cinahl och Psycinfo. De inkluderade artiklarna har analyserats där likheter och skillnader har jämförts. Resultat: Resultatet visade att teknologin kan påverka personers kognitiva funktion, fysiska hälsa samt psykiska hälsa. Dator och tv-spelsanvändning har flera positiva effekter så som förbättrad kognitiv förmåga, ökad självständighet och bevarande av egna intressen. Slutsats: Datorer och tv-spel har fördelaktiga effekter hos personer som lider av en demenssjukdom. Bland annat upptäcktes förbättringar i den psykiska, fysiska och kognitiva förmågan i de granskade studierna. Då ämnet är nytt krävs ytterligare forskning inom ämnet. / Background: Dementia is a growing disease in the society. In Sweden there are approximately 130-150 thousand people living with dementia. There is no cure for dementia, and with pharmaceuticals you can only prolong the decease. People who suffer from dementia tend to have other illnesses prior to the main dementia. These complications often lead to death. With the usage of videogames and computergames where the user is utilizing the body and bodymovement as a tool for progress there are beneficial effects to the motor skills and cognitive functions for the elderly living with dementia and cognitive decline. Aim: The purpose of this study was to investigate the utilization of computers and video games in the dementia care. Method: Done as a literature review where 14 articles was included. Searches have been made through databases Pubmed, Cinahl and Psycinfo. The 14 articles where systematically analyzed and differences and similarities were compared between the articles Results: Four categories were made, physical health, psychological health, cognitive function and usability of technology by the dementia suffers. Conclusions: Computer and videogames utilization have beneficial effects for the people who suffers from dementia. Enhanced physical, psychological and cognitive function were found in the studies. Due to the relatively new subject further research is required in the area.