Symptom management: loss of concentration

The Effects of a Restorative Intervention on Undergraduate Nursing Students’ Capacity to Direct Attention

Purpose: The purpose of this study was to examine the effects of a restorative intervention on undergraduate nursing students’ capacity to direct attention. Method: Kaplan and Kaplan’s attention restoration theory, which describes and links concepts of directed attention, attention fatigue, and restorative environments, formed the theoretical basis for this research. A convenience sample consisted of 33 students randomly assigned to nonintervention and intervention groups. The intervention was a 1-hr walk in natural surroundings. Both groups completed study instruments prior to and following the intervention. Findings: Intervention group students scored higher on a measure of quality of life at posttest (p < .05). Differences in a measure of perceived attention were not observed between groups over time. Both groups improved on other measures of attention; however, the results did not provide support for the hypotheses. Conclusion: Students were a highly functioning group participating in many activities they considered restorative, prior to the study.

Memory and cancer: a review of the literature

The mental health of cancer survivors has not always been the primary emphasis of treatment protocols since physical health outcomes have taken precedence. Older cancer survivors experience a double jeopardy since they are at risk for memory impairments and mild cognitive impairment and because they are greater than 55 years of age. Of the 9.6 million cancer survivors in the US who have completed active treatment, many report cognitive difficulties, with labels such as "chemo brain," "not as sharp," "woolly-headedness," or the "mind does not work as quickly". To date, most of our knowledge of cognitive impairment in cancer survivors comes from female breast cancer survivors. Studies indicate that these survivors have diminished executive function, verbal memory, and motor function. Cancer survivors want to live independently in the community for as long as possible however, these cognitive deficits may prevent this desired lifestyle. To broaden our understanding this paper reviews the literature on the cognitive impairment and memory deficits experienced by three groups of cancer survivors breast, colorectal, and prostate cancer, that make up 60% of all survivors nationally. Even though mental health declined after a cancer diagnosis, the long-term outcomes of cancer survivors did not differ from persons without cancer in depression or cognitive function.

Natural activity: an explorative study of the interplay between cage-birds and older people in a Swedish hospital setting

Aim.  The aim of this study was to describe the interaction between cage-birds and older people as it arises in spontaneous situations in a Swedish hospital ward setting. Background.  Older people are at risk of being affected by mental fatigue because of various age-related reductions and disease. Mental fatigue manifests itself through a reduced ability to concentrate. The method of alleviating mental fatigue with the use of stimulating natural settings or animal-assisted activities is so far unexplored in Sweden and subsequently it is important to study the method in a Swedish context to implement it as a recognized nursing intervention in the care of older people. Design.  The study had an explorative observational design, and was conducted at a geriatric ward with a consecutive selection of participants. Method.  The observations were analysed using a constant comparative method influenced by Grounded Theory. 'Attention restorative theory' was used as the theoretical framework to guide the study. Result.  Our findings indicate that animal-assisted therapy has a positive effect on involuntary attention and mental restoration, as well as on enhanced social behaviour among older people. Relevance to clinical practice.  The result strengthens the assumption that animal companionship should be considered a beneficial nursing intervention for older people to prevent mental fatigue.

Predictors of the trajectories of self-reported attentional fatigue in women with breast cancer undergoing radiation therapy

PURPOSE/OBJECTIVES

To examine how attentional fatigue changed from the time of simulation to four months after the completion of radiation therapy and to investigate whether specific variables predicted initial levels and trajectories of attentional fatigue.

DESIGN

Descriptive, longitudinal study.

SETTING

Two radiation therapy departments.

SAMPLE

73 women with breast cancer who received primary or adjuvant radiation therapy.

METHODS

Participants completed questionnaires prior to, during, and after radiation therapy. Descriptive statistics and hierarchical linear modeling were used for data analysis.

MAIN RESEARCH VARIABLES

Attentional fatigue; demographic, clinical, and symptom characteristics.

FINDINGS

Large amounts of interindividual variability were found in the trajectories of attentional fatigue. At baseline, higher levels of attentional fatigue were associated with younger age, not working, a higher number of comorbidities, and higher levels of trait anxiety. The trajectory of attentional fatigue improved over time for women with higher body mass index at baseline.

CONCLUSIONS

This study is the first to identify predictors of interindividual variability in attentional fatigue in women with breast cancer undergoing radiation therapy. The predictors should be considered in the design of future correlational and interventional studies.

IMPLICATIONS FOR NURSING

Nurses could use knowledge of the predictors to identify patients at risk for higher levels of attentional fatigue. In addition, nurses could use the information to educate patients about how attentional fatigue may change during and following radiation therapy for breast cancer.

Psychosocial implications for the patient with a high-grade glioma

The purpose of this article was to explore the psychosocial implications of being diagnosed with a high-grade glioma, World Health Organization III/IV and IV/IV, to better inform healthcare providers and researchers of the patient experience. The information is the cumulative data collected from hundreds of patient interviews in a large metropolitan brain tumor clinic over a 7-year period. Three themes of loss emerged--loss of independence, loss of self, and loss of relationships. This information is presented on behalf of the patients for acknowledgement of their experience and for identification of the need for increased psychological and concrete services to better serve this population.

Acetyl l-carnitine (ALC) treatment in elderly patients with fatigue

Fatigue is one of the conditions most frequently complained by the elderly. There are few effective treatment options for patients with chronic fatigue syndrome. To determine the efficacy, tolerability and impact on the fatigue, as well as on cognitive and functional status of elderly subjects with acetyl L-carnitine (ALC), 96 aged subjects (>70 years, range 71-88) were investigated (50 females and 46 males; mean age 76.2+/-7.6 and 78.4+/-6.4 years, respectively). They met four or more of the Holmes major criteria or at least six of Fukuda minor criteria. Fatigue was measured with the Wessely and Powell [Wessely, S., Powell, R., 1989. Fatigue syndromes: a comparison of chronic postviral fatigue with neuromuscular and affective disorders. J. Neurol. Neurosurg. Psychiatry 52, 940-948] scores, with the fatigue severity scale. At the end of the treatment, we observed a decrease of physical fatigue: 6.2 (p<0.001), of mental fatigue: 2.8 (p<0.001), of severity fatigue: 21.0 (p<0.001) and improvements in functional status: 16.1 (p<0.001) and cognitive functions: 2.7 (p<0.001). By the end of the treatment, significant differences between the two groups were found for the following parameters: muscle pain -27% versus -3% (p<0.05); prolonged fatigue after exercise: 51% versus -4% (p<0.0001); sleep disorders: 28% versus 4% (p<0.05); physical fatigue: 7 versus -0.5 (p<0.0001); mental fatigue: -3.3 versus 0.6 (p<0.0001); fatigue severity scale: -22.5 versus 1.2 (p<0.0001); functional status 17.1 versus 0.6 (p<0.0001); mini mental state examination (MMSE) improvements: 3.4 versus 0.5 (p<0.0001). Our data show that administering ALC may reduce both physical and mental fatigue in elderly and improves both the cognitive status and physical functions.

Cognitive function after chemotherapy in adults with solid tumours

BACKGROUND

Evidence is emerging that some cancer survivors suffer cognitive impairment after chemotherapy; the cause is unknown.

METHODS

Here we review studies evaluating cognitive impairment in adult cancer survivors and discuss methodological challenges associated with this research. We evaluate evidence for cognitive impairment in cancer patients, the incidence of self-reported impairment, and identify potential mechanisms and confounders.

RESULTS

Most studies of cognitive function are cross-sectional and report impairment in 15-45% of subjects. Longitudinal studies suggest that some impairment is present prior to receiving chemotherapy, and that this worsens in some patients. The aetiology is unknown. A larger number of subjects self-report changes in cognitive function after chemotherapy; this does not correlate with objective testing.

CONCLUSIONS

Cognitive impairment occurs in a subset of cancer survivors and is generally subtle. Most evidence suggests an association with chemotherapy although other factors associated with the diagnosis and treatment of cancer may contribute.

Music imagery for adults with acute leukemia in protective environments: a feasibility study

BACKGROUND

Patients receiving intensive chemotherapy can experience increased distressed related to both the cancer diagnosis and treatment isolation. If not addressed, distress can lead to anxiety, depression, and post-traumatic stress disorder. The purpose of this study was to determine the feasibility and possible benefits of a music imagery intervention for patients hospitalized in a protective environment for the treatment of acute leukemia or high-grade non-Hodgkin's lymphoma.

MATERIALS AND METHODS

Adults receiving intensive myelosuppressive chemotherapy in a protective environment were randomized to standard care or standard care plus music imagery. The music imagery sessions occurred twice weekly for up to eight sessions. Patients were encouraged to use the music imagery daily.

RESULTS

The principal criteria of feasibility were rate of consent, rate of completion of scheduled sessions, and rate of questionnaire completion. Forty-nine out of 78 patients consented, a 63% consent rate. Seventy-two percent of all scheduled music imagery sessions were completed. The rate of questionnaire completion was 60% with missing data because of illness severity and early discharge. The principal outcomes of benefit (e.g., efficacy) were positive and negative affects, fatigue, and anxiety. Both groups improved over time on all outcomes (all p < 0.001). However, a subgroup of individuals with low baseline negative affect who received the intervention reported significantly less anxiety at discharge than individuals with low baseline negative affect who did not receive the intervention.

CONCLUSIONS

Music imagery is feasible for adults with acute leukemia in protected environments. Patients with lower initial distress may benefit from a music imagery program in terms of reduced anxiety at discharge.

An Integrated Approach to an Analysis of Symptom Management in Patients With Cancer

PURPOSE/OBJECTIVES

To provide a definition, describe uses, and identify essential attributes of symptom management by emphasizing the philosophical base for the concept.

DATA SOURCES

51 references (i.e., books and articles) published from 1980-2003 and located through the Ovid database.

DATA SYNTHESIS

Symptoms are subjective and personal phenomena, incorporating the dimensions of symptom occurrence, symptom distress, and symptom experience. Symptom management has been conceptualized and described as self-activity. Symptom status is the direct outcome of symptom management, with symptom distress, quality of life, and performance as major indicators.

CONCLUSIONS

The essential attributes of symptom management in patients with cancer are subjectivity, experientiality, intentionality, multidimensionality, dynamic process, and positive and negative outcomes.

IMPLICATIONS FOR NURSING

Findings can help oncology nurses and other healthcare professionals to better understand the process of managing a symptom and the influential factors that affect positive outcomes. The information from this analysis can be used to design educational and interventional programs for symptom management. Future research is needed to establish interventions that relieve and decrease the distress from or prevent the occurrence of symptoms.

Capacity for Direct Attention in Patients Undergoing Percutaneous Coronary Intervention: The Effects of Psychological Distress

Emphasis is placed on educating coronary heart disease patients about lifestyle choices to reduce the risk of further cardiovascular events, but little attention has been paid to the impact of attentional capacity on patients' learning. The purpose of this study is to identify and compare the capacity for direct attention and the effect of psychological distress during hospitalization and 6 weeks after percutaneous coronary intervention. Forty subjects, mean age of 63 years, 27 men and 13 women, completed components of the Wechsler Memory Test to measure direct attention, and the Profile of Mood States. There were significant differences in the Digit Span Test-backward, a measure of working memory (t=-2.79; p<0.009), and the Profile of Mood States total score, a measure of psychological distress (t=3.183; p<0.003), from hospitalization to 6 weeks post-percutaneous coronary intervention. Data demonstrate psychological distress and reduced capacity for direct attention during hospitalization indicating that hospital environments are suboptimal for learning.

Directed Attention in Normal and High‐Risk Pregnancy

OBJECTIVE

To compare the ability to direct attention in women having a high-risk pregnancy with those having an uncomplicated pregnancy.

DESIGN

Descriptive comparative.

SETTING

A tertiary-care hospital.

PARTICIPANTS

Women in the 3rd trimester of pregnancy receiving care from perinatologists were recruited for this study and comprised the high-risk group (n = 67). Women in their 3rd trimester of pregnancy with uncomplicated pregnancies and enrolled in prenatal classes were the comparison group (n = 57).

MAIN OUTCOME MEASURES

Objective measures of directed attention included digit span forward, digit span backward, Trailmaking A, and Trailmaking B. Subjective measures included the Attentional Function Index and Mental Effort in Tasks.

RESULTS

Women having a complicated pregnancy had significantly more difficulty directing attention on all measures than women having normal pregnancies. When all covariates were considered, women having a high-risk pregnancy had significantly more difficulty directing attention as measured by Trailmaking A, Trailmaking B, and Mental Effort in Tasks.

CONCLUSIONS

Women having high-risk pregnancies may have more difficulty with activities that require directed attention than women having normal pregnancies. Learning new information and skills, problem solving, and planning may require additional effort for women having complicated pregnancies.

Attentional Demands and Daily Functioning Among Community-Dwelling Elders

Everyday life is full of numerous demands for attention that can affect the ability to function. For elders, examples of these attentional demands include negotiating public transportation and driving, sensory losses, and physical discomforts and worries that make it harder to concentrate and complete tasks. The purpose of this study was to examine the relation between attentional demands and the ability to manage daily activities requiring concentration for 54 community-dwelling elders (34 women, 20 men). As theorized, attentional demands correlated (r = -.58) significantly with daily functioning: Elders with more attentional demands perceived themselves as having greater difficulty managing tasks requiring concentration. Attentional demands accounted for a significant proportion of variance in functioning (12%), even after partialling out the effects of depressive symptoms and health. Findings support the theorized relation between attentional demands and daily functioning, as well as nursing interventions aimed at decreasing attentional demands to promote effective functioning for elders.

Attention and Restoration in Post-RN Students

BACKGROUND

The impact of a restorative intervention using the natural environment on capacity to direct attention and issues that contribute to attention fatigue for diploma-prepared nursing students (Post-RN students) enrolled in a baccalaureate nursing program was examined.

METHODS

This study used a quasi-experimental comparison group design. Subjective (Attentional Functional Index) and objective (Finding A's Test and Symbol Digits Modalities Test) measures were employed.

RESULTS

Thirty-two students at two universities participated. Results of the split-plot analysis revealed a within-subject effect on the Attentional Functional Index (p < .05), a significant within-subject effect on the Finding A's Test (p < .05), and a significant within- and between-subject effect on the Symbol Digits Modalities Test (p < .05).

CONCLUSION

Recognizing and managing attention fatigue throughout the school year may enhance Post-RN students' abilities to direct attention and contribute to an enhanced academic experience.

Nursing tools and strategies to assess cognition and confusion

Terms used to describe a patient's mental state, such as "confused", are often considered to be ambiguous and the meaning personal to individuals describing what they observe. Cognitive deficits are often subtle in their presentation and can easily be overlooked in the arena of acute nursing, with its focus on physical status. Clinicians are reported as not adequately assessing cognitive status and yet such deficits may impact on a patient's activities of living at all levels. Identification of alternations in a patient's mental status is important in maintaining patient safety and dignity. This article aims to review bedside assessment of a patient's mental status and the implications for nursing practice.

Chemotherapy-related cognitive dysfunction in breast cancer

OBJECTIVES

To provide an overview of chemotherapy-related cognitive dysfunction in breast cancer survivors, focusing on its pathophysiology, risk factors, assessment, and management.

DATA SOURCES

Published biomedical literature.

CONCLUSION

Chemotherapy-related cognitive dysfunction in patients with breast cancer is multifactorial and possibly related to anemia or a direct effect of chemotherapy on brain function. Clinical observation and subjective reports are useful assessments. Therapies directed at alleviating or preventing cognitive deficits are being investigated.

IMPLICATIONS FOR NURSING PRACTICE

Oncology nurses are important in monitoring cognitive function in patients with breast cancer receiving chemotherapy. Nurses who are aware of the risks, assessment, and management of cognitive impairment are better able to discuss these issues with patients and caregivers.

Restoring attention in pregnancy: the natural environment

The purpose of this quasi-experimental pretest-posttest study was to test whether regularly spending time in the natural environment would improve concentration for women in the third trimester of pregnancy, a time when women rely on their ability to concentrate in order to prepare for birth and parenting. Several measures requiring concentration were administered before an intervention that included spending 120 minutes each week in restorative activities involving nature. When posttest measures were collected women in the intervention group had signficantly fewer errors compared to the control group. Other measures did not reveal significant differences. These results suggest that encouraging women to spend time in activities that involve nature and designing health care environments to incorporate nature may help pregnant women improve their ability to concentrate and reduce errors at a time when they have many demands on their time and attention.

An environmental intervention to restore attention in women with newly diagnosed breast cancer

Earlier research indicated that attentional fatigue with reduced capacity to direct attention in women treated for breast cancer may be ameliorated by a theoretically based intervention involving regular exposure to the natural environment. This study tested the efficacy of a natural environment intervention aimed at restoring attention in 157 women with newly diagnosed breast cancer. Capacity to direct attention was assessed with a brief battery of objective measures at two time points: approximately 17 days before surgery (time 1) and 19 days after surgery (time 2). A randomly assigned intervention protocol was initiated after the first assessment and before any treatment. The intervention comprised a home-based program involving 120 minutes of exposure to the natural environment per week. The intervention group (n = 83) showed greater recovery of capacity to direct attention from the pretreatment (time 1) to the preadjuvant therapy period (time 2), as compared with the nonintervention group (n = 74). A significant effect of the natural environment intervention was observed even after control was used for the effects of age, education, attention scores at time 1, other health problems, symptom distress, and extent of surgery. The findings suggest therapeutic benefits for capacity to direct attention from early intervention aimed at restoring attention in women with newly diagnosed breast cancer.

Cognitive function in community-dwelling elderly women. Attentional demands and capacity to direct attention

As individuals get older, their capacity to direct attention (CDA) appears to decline. The decline in CDA may be caused by age-related changes in the brain and demands on attentional mechanisms. These demands require older adults to expend significant attentional effort to maintain focus and achieve mental clarity while negotiating activities of daily life. The purpose of this study was to examine the relationship between attentional demands and CDA among a convenience sample of 72 community-dwelling older women with normal mental status. Findings indicate attentional demands correlated significantly with CDA and accounted for a significant proportion of the variance. No relationship was found between depressive symptoms and CDA. Implications for practice are nursing interventions aimed at decreasing attentional demands, thereby supporting attentional processes and functioning by community-dwelling older adults.

Relations between fatigue, neuropsychological functioning, and physical activity after treatment for breast carcinoma: daily self-report and objective behavior

BACKGROUND

Previous research indicates that disease free breast carcinoma survivors who experienced severe fatigue also had many problems with regard to neuropsychological functioning and physical activity, measured with general self-report questionnaires. Both neuropsychological functioning and physical activity can be measured with daily self-report measures in addition to measures of objective behavior. The main objective of this study was to examine the relations between 1) fatigue and 2) daily self-reported and objective measures of neuropsychological functioning and physical activity.

METHODS

Disease free breast carcinoma survivors and age-matched women with no history of breast carcinoma filled out a daily self-observation list and wore an actometer during a period of 12 days. Furthermore, they performed two standardized tests to assess neuropsychological functioning.

RESULTS

No differences were found between severely fatigued disease free breast carcinoma survivors, nonseverely fatigued disease free breast carcinoma survivors, and women in a control group with regard to daily self-reported and objective physical activity. The severely fatigued disease free patients reported more impairment in neuropsychological functioning on daily questionnaires compared with nonseverely fatigued disease free patients and women in the control group. However, no differences were found between these three groups on a standardized concentration task. On a standardized reaction time task, no significant differences were found between the two groups of disease free breast carcinoma survivors: However, women in the severely fatigued group had a significantly longer reaction time compared with women in the control group.

CONCLUSIONS

Fatigue is correlated strongly with daily self-reported neuropsychological functioning, but not with objective neuropsychological functioning, in a laboratory setting. In the current study, fatigue was not correlated with daily self-reported and objective physical activity.

Breast cancer: education, counseling, and adjustment--a pilot study

The feasibility of a randomized clinical trial to implement and compare the effectiveness of three components of an intervention for women with breast cancer and their partners was tested. The intervention components, standardized education by videotape (SE), telephone counseling (TC), and education with telephone counseling (SE+TC), were designed with a complementary approach to disease management of breast cancer at each of four phases of the breast cancer experience: diagnostic, postsurgery, adjuvant therapy, and ongoing recovery. A standardized Telephone Counseling Training Manual was developed. A nonprobability sample of 12 patient-partner pairs was accrued. Four pairs were randomly assigned to each of the three intervention components. A set of questionnaires was completed by each patient and partner at baseline and following each intervention for assessment of emotional, physical, and social adjustment, and perceived support. Attrition was minimal and return rate for the completed questionnaires at all five data-collection points was high. Validation of the SE and the TC, one of the objectives, was by data from the preliminary descriptive study (Hoskins, 1990-1994), pretests and posttests for standardized education, audiotapes for each phase-specific telephone counseling session, and evaluation forms for each intervention session. The positive findings included significant changes from pre- to postmeasurement in patients' and partners' scores for the standardized education in each of the four phases. Even with the limited statistical power, the effects were marked, lending support for a full-scale randomized clinical trial, to understand better the relative treatment efficacy and differential benefit of one or some interventions over others.

Nature as a complementary therapy for women

Evaluating the safety and effectiveness of complementary therapies is a challenge for nurses. Many people enjoy spending time in nature. The purpose of this article is to examine the theoretical and empirical evidence for using nature as a complementary therapy to rest and restore one's ability to concentrate. As women become active participants in their health care, a complementary therapy to restore and maintain concentration may help promote self-care.

Long-term persistence of symptoms

OBJECTIVES

To provide a brief review of cognitive changes, fatigue, lymphedema, and peripheral neuropathy as persistent symptoms, and provide assessment and management information.

DATA SOURCES

Published articles and research studies.

CONCLUSIONS

As the number of people surviving cancer for extended periods of time continues to increase, the phenomenon of symptoms that persist following the completion of treatment is being recognized.

IMPLICATIONS FOR NURSING PRACTICE

Research is needed to provide adequate knowledge about symptoms that persist following cancer treatment.

Memory improvement program for elderly cancer survivors

Elderly cancer survivors report difficulty with attention, concentration, and memory. This study tested the effectiveness of the Cognitive Behavioral Model of Everyday Memory, an efficacy-based intervention designed to improve memory performance, memory self-efficacy, and metamemory in older adult cancer survivors and those with other chronic conditions. The study provides interesting new evidence that the responses of a group of elders to training varies depending on their health status.

Relationship of psychosocial tasks of pregnancy and attentional functioning in the third trimester

Because childbearing women function in multiple roles, the capacity to focus or concentrate is an important resource while preparing for birth and parenting. In addition to daily tasks that require mental effort, gravidas have psychosocial demands related to pregnancy. The purpose of this study was to examine the relationship between the psychosocial tasks of pregnancy and the capacity to focus or direct attention. A convenience sample of 57 pregnant women in their third trimester was recruited from prenatal education classes to participate in this descriptive correlational study. After other variables thought to influence attentional functioning were considered, women experiencing the greatest conflict in psychosocial tasks had the most difficulty using directed attention and more negatively evaluated their attentional functioning. In order to empower gravidas to participate in their health care, it is important for researchers and practitioners to understand and support directed attentional functioning, an important area for nursing care and research.

Cognitive function and reproductive hormones in adjuvant therapy for breast cancer: a critical review

Deterioration in cognitive function-particularly learning, memory, and attention-has been reported by women with breast cancer who receive adjuvant chemotherapy. Deficits in cognitive function reported by women with breast cancer are similar to those experienced by women as a consequence of natural or surgical menopause. The basis of these deteriorations may include reductions in reproductive hormone levels, particularly estrogens and progesterones, that occur as a result of adjuvant chemotherapy. This paper critically examines the literature related to the impact of adjuvant chemotherapy and reproductive hormone changes on cognitive function in women with breast cancer and suggests direction for future research in this area. The paper proposes a framework for investigation of the problem and discusses the challenges associated with the conduct of this research.

Attention and symptom distress in women with and without breast cancer

BACKGROUND

The cognitive capacity to direct attention (CDA) is essential for self-care and independent functioning. Older women may be more vulnerable to fatigue-related losses in CDA following surgery for breast cancer. Normal functional variations in CDA associated with aging might affect attentional responses in older women newly diagnosed with breast cancer, and factors such as extent of surgery or symptom distress might influence CDA over time.

OBJECTIVES

To examine (a) differences in CDA and symptom distress in older women newly diagnosed with breast cancer as compared to a control group of older women without breast cancer; (b) the pattern of change in CDA and symptom distress from the pretreatment period to 3 months after surgery; and (c) to examine the relationship of CDA with symptom distress and extent of surgery over time.

METHODS

Women, 55 to 79 years of age, newly diagnosed with breast cancer (N = 47), were assessed with measures of CDA and symptom distress: (a) before surgery, (b) at 2 weeks postsurgery, and (c) 3 months postsurgery. To account for normal variations associated with aging, 48 women of similar age without breast cancer were assessed following a routine screening mammogram and 3 months later.

RESULTS

Before treatment, the breast cancer group scored significantly lower than the control group (p < .05) on measures of CDA and higher on symptom distress. Repeated measures ANOVA showed significant main effects of group, but not time, for the measures of CDA and symptom distress with the breast cancer group having worse status than the control group. For CDA only, there was a significant group by time interaction effect (p = .005) so that the breast cancer group showed a gradual gain in CDA over time.

CONCLUSIONS

Reduced performance in a cognitive function was observed before treatment and found to persist over an extended interval in older women newly diagnosed with breast cancer.

Fatigue and basal ganglia

Fatigue is a common symptom in neurology and occurs in the diseases of the central and peripheral nervous system. In order to understand the mechanism of fatigue, it is important to distinguish symptoms of peripheral neuromuscular fatigue from the symptoms of physical and mental fatigue characteristic of disorders like Parkinson's disease or multiple sclerosis. We have introduced and defined the concept of central fatigue for the latter disorders. We have further proposed, with supportive neuropathological data, that central fatigue may occur due to a failure in the integration of the limbic input and the motor functions within the basal ganglia affecting the striatal-thalamic-frontal cortical system.

Is it difficult to concentrate during the 3rd trimester and postpartum?

OBJECTIVE

The purpose of this study was to examine changes in women's directed attention, the ability to focus or concentrate, during the last trimester of pregnancy and during 1st week postpartum.

DESIGN

Pregnant women were tested at enrollment (during the 3rd trimester), at 37 weeks gestation, and during the 1st postpartum week for this descriptive, repeated measures study.

SETTING

Women were recruited from childbirth education classes in southwestern Michigan.

PARTICIPANTS

Fifty-seven women in their 3rd trimester of pregnancy.

MAIN OUTCOME MEASURES

Directed attention was measured objectively by the Digits Span Forward and Backward, Trailmaking A and B, and Category Matching tests. Subjective measures were the Attentional Function Index and Mental Effort in Tasks tests.

RESULTS

Participant means on the objective measures were within the normal range at all three time points. Some individuals, however, showed limitations in the capacity to direct their attention. Ability to use directed attention was lowest at enrollment and improved during the study, with statistically significant changes from Times 1 to 2 on several measures. Subjectively, the participants felt that they had moderately low competence on tasks that required directed attention throughout the study.

CONCLUSIONS

Women had the greatest difficulty focusing during the 3rd trimester. Some individuals had problems with tasks requiring directed attention at all three time points. Many participants perceived that their ability to pay attention was lower than normal. Some women may benefit from nursing interventions to reduce attentional demands during the 3rd trimester and early postpartum period.

Changes in directed attention and short-term memory in depression

This study examined changes in directed attention and short-term memory in depression using a newly constructed battery of computerized measures. A repeated measures design was used with two sample groups; 25 individuals meeting DSM-IV criteria for Major Depression and a group-matched comparison sample of 27. Both groups were tested at three points in time over a 10-week period. Test-retest reliability of the measures was examined. Profile analysis demonstrated that there were differences between the depressed and comparison groups in both directed attention and short-term memory. Recommendations for specific improvements in the testing battery are discussed. The ability to detect changes in directed attention and short-term memory may have clinical utility in early detection of impending onset of depression or subtle residual symptoms of an acute episode that may impair functioning or signal a relapse.

The occupation of gardening in life-threatening illness: a qualitative pilot project

This qualitative pilot study was completed as an exploratory study of the meaning of gardening using attention restoration theory. Three women with breast cancer who garden for leisure were recruited from a cancer support group. Each participant was interviewed at her home on two occasions. To complement the qualitative data, participants also completed the Perceived Restorativeness Scale (PRS) (Hartig, Korpela, Evans, & Garling, 1996). The interviews revealed six major themes some of which were concerned with the interactions between the gardener and the garden, and others which focused on gardening within the context of having cancer. The qualitative and quantitative outcomes supported the perspective of attention restoration theory. Spirituality was interwoven throughout the comments of two participants but was less important for one participant. The implications of this study for practice and future research are discussed.

Identifying the attentional demands perceived by elderly people

The capacity to direct attention is an essential part of life. However, excessive demand for attention produces difficulty in managing everyday activities and stressful life events. This study identified attentional demands of elderly people. Thirty elderly adults were interviewed to ascertain their perceptions of demands on them in four theoretically derived domains. Physical environmental demands included the weather and living space. Informational demands included facing new situations because of a move or the loss of a spouse as well as vision and hearing difficulties. Behavioral demands mentioned were tasks such as exercising, cooking, being able to drive, dealing with finances, and a loss of stamina. Affective demands mentioned were loneliness and worries and sadness about health and the future. A content analysis of the interview data produced items for an instrument to be used during future interventions with elderly people aimed at decreasing the level of demands and restoring the attentional capacity necessary for functioning at an optimal level. This article also discusses the implications of assessing elderly patients.