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Survivors of critical illness have a high prevalence of long-term cognitive and psychiatric morbidity and poor quality of life years after hospital discharge. Data are lacking regarding whether cognitive screening tests predict which critically ill patients may be at risk to develop long-term cognitive sequelae and whether cognitive sequelae predict the patients everyday functioning. This study sought to determine whether cognitive screening tests, including the Mini-Mental State Examination (MMSE) and Mini-Cog, predict long-term cognitive sequelae and everyday functioning in survivors of critical illness 6-month post-hospital discharge. A second purpose was to investigate whether cognitive sequelae are associated with poor everyday functioning in critically ill survivors. Finally, the relationship between cognitive sequelae and quality of life was assessed. Survivors of critical illness had a high rate of cognitive impairments at hospital discharge, as well as long-term cognitive and psychiatric sequelae, deficits in everyday functioning, and reduced quality of life at 6-month follow-up. The MMSE and Mini- Cog did not predict long-term cognitive sequelae or everyday functioning at 6-months. Cognitive sequelae were not associated with poor everyday functioning; however, impaired attention, memory, and mental processing speed predicted problems with managing home/transportation, and impaired attention predicted problems in health and safety, social adjustment, and memory/orientation. Cognitive sequelae were associated with reduced quality of life in the role physical domain. Altogether, these findings lend additional knowledge to the literature regarding cognitive and psychiatric sequelae, everyday functioning, and reduced quality of life in critically ill patients, and may have clinical implications for the critical care providers, patients, and caregivers. Given the large population of survivors of critical illness each year, strategies aimed at recognizing, preventing and treating these morbidities are important research and public health concerns. Investigations into the clinical and economic burden of these morbidities and methods to mitigate them, including patient screening and referral to appropriate mental health and rehabilitation services, are warranted.

OBJECTIVE: Everyday tasks, such as meal preparation and bill paying, require the coordination of multiple cognitive processes and are essential for independent living. In dementia, cognitive impairment disrupts the ability to perform everyday tasks, though subtle difficulties occur prior to the onset of a frank dementia and predict risk of further decline. Current clinical methods of assessing everyday functioning fail to elucidate the reasons people experience mild functional difficulties, but new sensitive and objective measures of mild functional difficulties may advance our understanding of the cognitive mechanisms associated with very early functional decline. In separate paradigms, prior work has identified two markers of mild functional difficulties that distinguish healthy older adults from younger adults: (1) micro errors, inefficient reaching movements (e.g., reaching for but not using a distractor object) and (2) inefficient eye movements during verbal description of common everyday activities (e.g., making coffee). The present study used a novel single, streamlined paradigm that integrates analysis of inefficient eye movements with inefficient reaching to increase sensitivity for early detection and advance our understanding of mild functional difficulties. METHODS: Thirty-four older adults with healthy cognition (n = 28) or mild cognitive impairment (n = 6) completed a novel, non-immersive virtual reality (VR) test involving two everyday tasks (Breakfast and Lunch) during which both eye movements and reaching movements were measured. Participants also completed clinical questionnaires and a performance-based test (with real objects) of everyday functioning as well as cognitive testing. Analyses examined whether eye movements are (1) associated with precision of reaching movements during the VR task (Aim 1); (2) associated with clinical measures of everyday function (Aim 2); and (3) show meaningful patterns across the VR tasks (beginning vs. end; between vs. within subtask) that are differentially associated with cognitive measures (Aim 3). RESULTS: Within the VR task, participants spent the highest proportion of time viewing objects necessary for completion of the current task step (target objects) compared to distractor objects or objects not needed at the current task step. Relations between efficiency of eye movements and reaching movements during the VR task were not statistically significant (Aim1). Time spent viewing non-target objects in the VR task was moderately correlated with errors on the performance-based test, but not with clinical questionnaires of everyday functioning (Aim 2). Participants spent a greater proportion of time viewing non-target objects at the beginning of the task sequence compared to later in the task sequence, as well as between sub-tasks compared to within sub-tasks, but correlation coefficients between these viewing patterns and cognitive tests failed to reach statistical significance (Aim 3). CONCLUSIONS: Results provide preliminary evidence that eye movements during execution of a VR task of everyday functioning involving reaching movements may be a reliable and sensitive measure of subtle, real-world functional difficulties. Eye movement patterns suggest premature decay of task goals and interference from competing task goals are mechanisms that may contribute to early functional decline in older adults. Further study is required to demonstrate the utility of eye movements in predicting cognitive and functional decline in older adults. / Psychology

Objective: Grit is a noncognitive trait related to perseverance and consistent pursuit of long-term goals. Research on grit and aging provides evidence that grit increases with age and may be protective of cognitive and everyday functioning. However, no studies to date have examined relations between concurrently measured grit, cognitive abilities, and everyday functioning. This study tested two hypotheses: 1) that grit would predict cognitive performance and that this relation would be moderated by clinical diagnosis of cognitive status (i.e., healthy vs. mild cognitive impairment; MCI), and 2) that grit would predict everyday functioning and that this effect would be mediated by compensatory strategy use. Methods: Sixty-one older adults were recruited from the Penn Memory Center’s National Alzheimer’s Coordinating Center (NACC) cohort, including forty healthy controls with normal cognition and twenty-one individuals with mild cognitive impairment (MCI). Participants completed tests of verbal episodic memory, executive functioning, grit, compensatory strategy use, and everyday functioning. Results: Grit was not associated with cognitive functioning in either domain. Instead, memory performance was predicted only by clinical status (healthy vs. MCI), and executive functioning was predicted by clinical status, depressive symptoms, and years of education. Grit was negatively associated with everyday functional difficulties; however, there was no indirect effect of compensatory strategy use. Additionally, grit was moderately correlated with depression symptoms (r = -0.41). Conclusions: Grit is predictive of preserved everyday functioning, but not cognitive functioning, in a sample of healthy older adults and individuals with MCI. Mechanisms explaining the role of grit on everyday function remain elusive, though secondary analyses support that grit also influences affective well-being and may have a weaker role in the context of cognitive impairment. / Psychology

The overall aim of the thesis was to explore everyday functioning in six year-old children born preterm, from the children’s perspectives and from their parents’ perspectives. The relation between everyday functioning and neonatal risk factors, behavioural characteristics was studied with descriptive and correlational statistics, ANOVA and multiple linear regression (I). Patterns of everyday functioning were explored in a cluster analysis following a person-oriented approach (II). In a mixed method approach, the children’s and their parents’ perceptions on children’s competence in everyday activities were explored with a pictorial instrument and analysed with descriptive statistics and qualitative content analysis (III). The children’s perceptions of meaningful everyday life situations were explored in a photo voice study, analysed with qualitative content analysis. In total, 144 children born preterm and 222 children born at term and their parents were involved. The results indicated that from the parents’ perspective most children born preterm and full-term were perceived with strong everyday functioning featuring strong motor, process and communication skills, a positive interaction pattern and low levels of behaviour problems. As a group, the children born very preterm were perceived weaker in their everyday functioning than the full-term group but the pattern of performance skills, interaction and behaviour varied similar to that of children born full-term. Further, it was found that preterm birth was not the main predictor, instead hyperactivity had most influence on everyday functioning. Moreover, the children born preterm perceived themselves to be overall strong performers of everyday activities. They wanted to be active and do things and for that they wanted to have skills and significant others i.e. siblings, parents, friends and pets to interact with and to feel safe and loved. Further, the children born preterm expressed a will to develop, improve and gain new skills and to have more opportunities to do meaningful things. In conclusion, the results in this thesis indicate that young children born preterm are able to reflect on their everyday functioning, and express needs and desires for their participation in meaningful everyday life situations. Moreover, preterm birth is not the sole predictor of everyday functioning more critical is the interaction of individual, behavioural and contextual factors.

With the growing older adult population, neurodegenerative diseases common in old age such as mild cognitive impairment (MCI) or Parkinson’s disease (PD) are becoming increasingly germane areas of research. Pharmacological treatments have thus far been unsuccessful in treating cognitive decline associated with these neurodegenerative disorders. Alternative interventions, such as cognitive training programs, have shown promise. The current dissertation contains three papers examining cognitive interventions in neurodegenerative diseases. The first paper examined the longitudinal effects of cognitive speed of processing training (SPT) among those with PD. Results showed that training gains seen at initial post-test were maintained three months later. The second paper examined the effects of SPT among those with psychometrically-defined MCI and found small to medium effect sizes for improvements in everyday functional performance among those trained. The third paper examined the effects of auditory cognitive training among cognitively healthy older adults and those with psychometrically-defined MCI and found that effects may differ between those with and with MCI. Overall, these papers show that training effects can be maintained longitudinally and may potentially transfer to everyday functioning in those with neurodegenerative diseases. However, not all cognitive training programs show benefits in all areas, and individuals with differing cognitive statuses may benefit differentially from cognitive training. Future research should further explore the longitudinal effects of these training programs as well as the possibility of transfer to untrained abilities.

Primärvården står i dagsläget inför utmaningar gällande omhändertagandet av psykisk ohälsa. Integrerad beteendehälsa (IBH) är en organisatorisk modell med potential att underlätta för hur evidensbaserad psykologisk behandling kan bedrivas i en primärvårdskontext. Syftet med föreliggande studie var att utvärdera en sedvanlig IBH-vårdmodell, kontextuell bedömning följt av fokuserade insatser, med en utökad bedömningsprocedur följt av valet att inleda fokuserade insatser eller vägledd självhjälp, samt de två behandlingsuppläggen fokuserade insatser (oavsett bedömningsförfarande) och vägledd självhjälp efter utökad bedömning. Effekter på vardaglig funktionsnivå, betydelsen av antal behandlingskontakter samt den kontinuerliga upplevelsen av problemets svårighetsgrad, tilltro till den egna förmågan att förändras och besökens hjälpsamhet undersöktes. 69 primärvårdspatienter randomiserades mellan de två vårdmodellerna. Resultaten indikerade på en signifikant förbättring i vardaglig funktionsnivå för samtliga patienter oavsett vårdmodell och behandlingsupplägg. Inget samband mellan antal sessioner och förbättring upptäcktes. Skillnader i utfall och patienternas kontinuerliga upplevelser av behandlingsinterventionerna diskuteras. / The primary healthcare system faces challenges concerning the treatment of mental health. Integrated behavioral health (IBH) is an organizational model with the potential to implement evidence-based psychological treatment in a primary care setting. The aim of this study was to compare a standard IBH treatment model, contextual assessment followed by brief interventions, with an extended assessment procedure followed by brief interventions or guided self-help, as well as the two different treatment plans brief interventions (regardless of assessment procedure) and guided self-help post an extended assessment procedure. Effects on everyday functioning and correlations between number of sessions and treatment effect are evaluated along with the continuous patient experience regarding the severity of the problem, confidence in ability to change and session helpfulness. 69 primary care patients were randomized between the two treatment models. The results indicated a significant improvement in everyday functioning regardless of treatment model or treatment plan. No significant correlation between number of sessions and improvement was found. Differences in treatment outcome and patient experience are discussed.