Performance on an Everyday Life Activity in Persons Diagnosed with Alcohol Dependency Compared to Healthy Controls: Relations between a Computerized Shopping Task and Cognitive and Clinical Variables†

Aim: Persons diagnosed with alcohol dependency often suffer from cognitive impairments. Little is known, however, concerning how these cognitive deficits impact complex, everyday life activities. We set out to better characterize the nature of everyday life difficulties in patients with alcohol dependency using a computerized shopping task. Methods: A computerized real-life activity task (shopping task) required participants to shop for a list of eight grocery store items. Twenty individuals diagnosed with alcohol dependency and 20 healthy controls were administered a battery of cognitive tests, clinical scales and the shopping task. Results: Performance on the shopping task significantly differentiated patients and healthy controls for several variables and, in particular, for total time. Total time to complete the task correlated significantly with poor performance on measures of processing speed, verbal episodic memory, cognitive flexibility and inhibition. Total time was significantly correlated with poorer everyday life functioning and longer duration of illness. Conclusion: This computerized task is a good proxy measure of the level of everyday life and cognitive functioning of persons diagnosed with alcohol dependenc

Multitasking capacities in persons diagnosed with schizophrenia: A preliminary examination of their neurocognitive underpinnings and ability to predict real world functioning

peer reviewedBackground: Difficulties in everyday life activities are core features of persons diagnosed with schizophrenia. Moreover, patients seem to demonstrate particular difficulties during complex and multitasking activities, such as cooking a meal (Semkovska et al., 2004). Multitasking refers to activities where the person has to: carry out and alternate between different tasks that vary in terms of priority, difficulty and duration; define the tasks’ targets; and where the person is faced with unexpected problems during the realization of these tasks (Burgess, 2000). However, at present, patients’ multitasking capacities have not been adequately examined in the literature due to an absence of suitable assessment strategies. We thus recently developed a computerized real-life activity task designed to take into account the complex and multitasking nature of certain everyday life activities where participants are required to prepare a room for a meeting – the Computerized Meeting Preparation Task (CMPT) Methods: Twenty-one individuals diagnosed with schizophrenia and 20 matched healthy controls completed the CMPT. During the CMPT, participants found themselves in a virtual room that they had to prepare for a meeting while respecting a list of instructions (the placement of the guests, the needed objects, the desired drinks, etc.). Patients were also evaluated with an extensive cognitive battery (assessing executive functions, attention, processing speed and memory), measures of symptomatology and real world functioning. To examine the ecological validity of the CMPT, 14 others patients were recruited and were given the computerized version and a real version of the meeting preparation task. Results: Results demonstrated that performance on the CMPT significantly differentiated patients and healthy controls for the total time to complete task, planning efficiency, and the respect of the instructions. Moreover, these variables were significantly correlated with executive functioning (i.e. cognitive flexibility and planning), suggesting the major implication of these cognitive processes in multitasking activities. Performance on the CMPT also significantly predicted up to 50% of real world functioning. Finally, performances on the computerized version and the real version of the meeting preparation task were highly correlated, suggesting good ecological validity. Discussion: In this study, we created a novel task involving the multitasking nature of real world activities. The results demonstrated that this approach provides a good indication of the real world functioning in patients diagnosed with schizophrenia. Moreover, results suggest a particular implication of executive functioning in multitasking activities. These findings suggest the importance of evaluating multitasking capacities in patients diagnosed with schizophrenia in order to predict real world functioning

Streven naar remissie van depressie door een betere en bredere aanpak van de symptomen

The first part of this paper outlines the scale, impact and current management of major depressive disorder. Major depressive disorder is a huge public health problem, and despite the availability of a range of effective antidepressants and approaches to therapy, many patients fail to achieve remission, or if they do, they go on to suffer relapse or recurrence. Partial remission leaves patients experiencing residual symptoms, with a greater risk of relapse, more severe, chronic disease, impaired psychosocial functioning, a lower health-related quality of life, and an increased risk of mortality. This background provides the context for exploration of the traditional definition of remission, and it is suggested that a broader definition of remission would be a better guide to therapy. The main point of this paper is the proposal for an alternative definition of remission that incorporates positive therapeutic outcomes in four perspectives; psychodynamic, cognitive, biological and functional. Barriers to the application of a broader definition of remission in the clinic are explored briefly, and the need for specific, practical multi-axial instruments for use in MDD is acknowledged. Broad remission is more likely to be achieved using antidepressants that address a wider range of symptoms. It is also important to continue therapy beyond the acute stage into continuation, and possibly maintenance therapy, if complete remission is to be achieved and maintained in the long term

A new way of predicting everyday life functioning: Validation of a Computerized Meeting Preparation Task with persons diagnosed with schizophrenia

Deficits in everyday life functioning are a core feature of persons diagnosed with schizophrenia. However, functional outcome is usually evaluated with questionnaires and performance-based assessments, all of which contain a number of limits. We developed a computerized real-life activity task (meeting preparation task) where participants are required to prepare a meeting room. Twenty-one individuals diagnosed with schizophrenia and 21 matched healthy controls completed the task. Patients were also evaluated with a cognitive battery and measures of symptomatology and functional outcome. Results showed that performance on the computerized task significantly differentiated patients and controls for a certain number of variables. These variables, combined into a composite score, were significantly correlated with both cognitive functioning and functional outcome. Moreover, this composite score significantly predicted 39% of functional outcome, whereas a cognitive composite score did not reach significance. In addition, when the meeting task composite score was combined with symptomatology and the cognitive composite score, these measures significantly predicted 70% of functional outcome. These findings suggest that the meeting preparation task provides a valid and significant indication of the level of everyday life functioning in patients with schizophrenia, and may be viewed as a valuable instrument in both an evaluation and remediation context

Relations between a computerized shopping task and cognitive and clinical variables in patients diagnosed with bipolar disorder and alcohol dependency compared with healthy controls.

Persons diagnosed with bipolar disorder and alcohol dependency are frequently subject to poor everyday life functioning. However, previous studies have primarily used questionnaires or observational methods to assess everyday life functioning, both of which contain a number of limits. In order to address some of these limits, we developed a computerised real-life activity task, in particular, a shopping task where participants are required to shop for a list of 8 grocery store items. Twenty individuals diagnosed with alcoholic dependence and 21 patients diagnosed with bipolar disorder were compared with 20 and 21 matched healthy controls, respectively. All participants completed the shopping task, and both clinical groups were evaluated with an extensive battery of neuropsychological tests and a measure of global functioning. Results showed that, for both clinical groups, performance on the computerised shopping task significantly differentiated patients and healthy controls for a number of variables, especially total time and mean time to consult the shopping list. Performances on shopping task variables, in both clinical groups, were also significantly correlated with neuropsychological tests measuring verbal episodic memory, processing speed and selective attention. Finally, performances on the computerised shopping task were significantly correlated with various clinical variables and with global functioning in both patient groups. These findings suggest that the computerised task used in the present study provides a valid indication of the level of everyday life functioning for these clinical populations, and therefore may be viewed as a valuable instrument in both an evaluation and remediation context

Performance on a Computerized Shopping Task in Bipolar Disorder and Alcohol Dependency

Persons diagnosed with bipolar disorder and alcohol dependency are frequently subject to cognitive impairments and encounter difficulties during everyday life activities. However, little is known how these deficits interact in real life. Moreover, previous studies have primarily used questionnaires or observational methods to assess everyday life functioning, both of which contain a number of limits. In order to address some of these limits, we developed a computerized real-life activity task, in particular, a shopping task where participants are required to shop for a list of 8 grocery store items in a virtual supermarket. Twenty individuals diagnosed with alcoholic dependence and 21 patients diagnosed with bipolar disorder were compared with healthy controls (20 and 21, respectively), matched for age, sex and educational level. All participants completed the shopping task, and both clinical groups were evaluated with an extensive battery of cognitive tests (assessing executive functioning, attention, processing speed and memory), clinical scales and a measure of real world functioning. Results showed that, for both clinical groups, performance on the computerized shopping task significantly differentiated patients and healthy controls for a number of variables, especially total time to complete the shopping task. Performances on shopping task variables, in both clinical groups, were also significantly correlated with cognitive tests measuring processing speed, episodic memory, cognitive flexibility and inhibition. Finally, performances on the computerized shopping task were significantly correlated with real world functioning in both patient groups. These findings suggest that the computerized task used in the present study provides a valid indication of the level of real world functioning for these clinical populations, and therefore may be viewed as a valuable instrument in both an evaluation and remediation context

The Neurocognitive Underpinnings of Multitasking Capacities in Persons Diagnosed with Schizophrenia

Difficulties in everyday life activities are core features of persons diagnosed with schizophrenia, and in particular during multitasking activities. Multitasking refers to activities where the person has to: carry out and alternate between different tasks that vary in terms of priority, difficulty and duration; define the tasks’ targets; and where the person is faced with unexpected problems during the realization of these tasks (Burgess, 2000). However, the neurocognitive underpinnings of multitasking have never been explored in schizophrenia. Further, only two cognitive models exist in the literature, based on a student sample (Logie et al., 2011) and a neurological sample (Burgess et al., 2000). Both of these models suggest three primary constructs including Memory, Planning and Intent. However, there are several limitations related to the way multitasking was evaluated in these studies. We thus developed a computerized real-life activity task designed to take into account the multitasking nature of certain everyday life activities where participants are required to prepare a room for a meeting – the Computerized Meeting Preparation Task (CMPT). Using this new task, and based on previous studies (Burgess et al., 2000; Logie et al., 2011), the aim of the present study was to evaluate a new cognitive model of multitasking ability and that takes into account certain cognitive processes that are not integrated in existing models. Fifty-seven individuals diagnosed with schizophrenia and 41 matched healthy controls completed the CMPT. Participants were also evaluated with a battery of cognitive tests. The results suggest that the CMPT has a good sensitivity. Moreover, structural equation modelling confirmed the three underlying constructs of multitasking (Memory, Planning and Intent) which are underpinned by several cognitive functions and multitasking aspects. Taken together, this new cognitive model and the CMPT could be a good basis for cognitive intervention on multitasking