The impact of stress and anxiety on the neurocognitive performance of Australian nurses : an electroencephalographic and psychometric assessment

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Stress and anxiety both have demonstrable impact, causing neuronal damage and death (Sapolsky, 1996, Conrad, 2006), functional connectivity changes (Bishop, 2009, Andreescu et al., 2014), and various cognitive impairments (de Quervain et al., 2000, Savage et al., 2000, Wetzel et al., 2006, Henderson et al., 2012, Nieuwenhuys et al., 2015). However, despite demonstrated quality of care reductions (Sveinsdóttir et al., 2006, Berland et al., 2008) and calls for further research (LeBlanc, 2009, Lees and Lal, 2017), a limited amount of research investigating the impact of stress and anxiety on the cognitive performance of health professionals has been conducted (LeBlanc, 2009). Therefore, the aim of the present study was to examine the relationships between stress, anxiety and cognitive performance in health professionals via comprehensive psychometric and electroencephalography (EEG) assessment; as well as assess the predictive capability of EEG in measuring cognitive performance. Presently, this doctoral research reports on results obtained by analysing data from 118 nurses and 144 non-health professionals. The experimental protocol commenced by capturing participant demographic data, such as, blood pressure, heart rate, as well as hip and waist measurements, followed by the completion of pre-study questionnaires including the Lifestyle Appraisal questionnaire (Craig et al., 1996), the Depression, Anxiety, Stress scale (Lovibond and Lovibond, 1995b), and the Fatigue State Question (Lal and Craig, 2002). Following this, a two lead bipolar or 32 lead monopolar EEG was captured during a resting baseline and a Stroop test based active phase. After the electroencephalogram recording, psychometric cognitive performance was assessed by the Mini-Mental State Examination (Folstein et al., 1975) and the Cognistat (Mueller et al., 2007). Participants then completed the revised Ways of Coping Checklist (Vitaliano et al., 1985), and the Fatigue State Question, again for the latter. Nurse participants also completed parts of the Standard Shiftwork Index (Barton et al., 1995). Lastly, participant’s blood pressure was again recorded and the experiment concluded. The results indicate that both non-health professionals and nurses experience stress and anxiety. In both groups, a stress level within the normal range was significantly associated (p < 0.05) with increased memory performance and delta activity, while theta and beta activity increases were similarly implicated for the nurse group only. However, with an increase in stress levels, stress was associated with increased judgement performance and fronto-temporal and parietal gamma activity, as well as reduced fronto-temporal delta activity in non-health professionals. Additionally, impaired memory performance as well as fronto-central delta, fronto-temporal and parietal gamma, and fronto-central and temporal beta activity increases were associated with this increased stress in nurses. With respect to anxiety, it was associated with increased lifestyle risk factors, impaired global, attention, and memory domain performance, as well as delta, alpha and gamma activity changes in non-health professionals. Comparatively, in nurses anxiety was associated with improved Stroop test performance, global cognitive performance and delta and gamma activity, as well as impaired memory performance. Lastly, it was found that global cognitive performance could be predicted by a combination of fast wave EEG activity variables (R² ≥ 0.440; p ≤ 0.013). Similarly, unique combinations of EEG variables from the 5 investigated frequency bands predicted, in varying degrees, attention (R² ≥ 0.204; p ≤ 0.014), memory (R² ≥ 0.443, p ≤ 0.010) and judgement (R² ≥ 0.407; p ≤ 0.001) domain performance. Collectively, these findings provide an insight into the cognitive impact of stress and anxiety, and determine a unique impact profile of stress and anxiety for both non-health professionals and nurses. Additionally, they demonstrate the multifaceted nature of the relationship between stress, anxiety and cognitive performance, where both improvements and impairments are observed. Further understanding the impact of stress and anxiety on cognitive performance may enable the development and implementation of management and intervention strategies to preserve the cognitive health of health professionals, and in turn, ensure quality of patient care and reduce adverse medical event incidence. Further, it may be possible to use EEG activity to predict early cognitive impairment, which has strong implications for developing diagnostic measures for cognitive impaired states such as dementia and Alzheimer’s disease.
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