Cognitive Challenges in the Workplace

By Joel Becker, PhD, CEAP


It is an undeniable reality that Americans are now compelled to work later into their lives. As a result, our country’s workforce has increased in age. This phenomenon is the result of a number of factors, including increased longevity, tougher economic times, and modifications to retirement options. Unfortunately, the aging process is often accompanied by cognitive decline and the anxiety of adapting to a changing workplace. Even in younger people, illness, injury, effects of medications or surgery, and/or genetic predisposition can adversely affect productivity and job sustainability.

In this article, I will highlight key cognitive functions that have particular relevance for working individuals. I will also address specific contributions that can be made by employee assistance professional as an important resource in identifying and supporting employees that become cognitively challenged.

The EAP offers an invaluable service to both employees and employers in screening, treating, and devising an effective treatment plan with appropriate accommodations to reintegrate the employee into the workplace. For an employee experiencing cognitive and emotional decline due to a medical condition, injury, or compromised cognition, the EAP provides a source of hope both to that individual and to their employer.

With some employees, the transformation is rapid and dramatic as a result of injury or disease; in others it may be gradual and subtle as part of cognitive changes occurring in the normal aging process. As a result, age-related changes have become more common along, with a higher incidence of neurological conditions more frequent in older employed adults.

Signs and Symptoms of Cognitive Decline
* Increased difficulty with learning and retaining new information;
* Periods of confusion and decreased alertness;
* Increased reliance on instruction repetition and reiterated reminders;
* Taking longer to complete a given task;
* Inability to sustain multi-tasking;
* Lower frustration threshold/ more easily angered;
* Decrease in motivation;
* Apparent lack of engagement, loss of work ethic and energy;
* Avoidant, apathetic, less socially interactive;
* Depression and withdrawal;
* Difficulties with coordination and balance;
* An observable tremor;
* Speech/articulation difficulty; and/or
* Worsening of mood or intensification of an affective disorder.

Case Study #1: Cognitive impairment caused by concussion
Jeff is a 58-year-old senior computer engineer at a major information technology company. Three months ago, while cleaning the roof gutters on his house, Jeff falls from a ladder and lands on his head. He is seen at a local ER and diagnosed with a concussion. After seven days of convalescence, Jeff is cleared by his family physician to return to work.

However, what follows is an unexpected series of challenges that neither Jeff, his internist, nor his supervisor could ever have anticipated. Jeff first discovers something is wrong after a few days back on the job. While doing a routine computer task, he can’t remember where he has left off and is forced to retrace his steps in order to proceed. As a result of what is technically referred to as a “working memory difficulty,” it takes Jeff significantly longer than usual to complete the task, much to the disappointment of both himself and his supervisor.

As a member of a highly technical and evolving industry, Jeff must keep up by assimilating new information and learning how to use new data systems and devices. After 10 years with the company, Jeff prides himself in his uncanny ability to digest a new program or algorithm within one reading of a technical manual.

However, since his injury, Jeff finds that he now needs to read and reread the material two to three times before he is able to retain the information and apply it. He can no longer multi-task, which for Jeff requires attending to several projects at the same time. He finds himself losing his place, struggling with sequencing, and forgetting names. Putting in an eight-to-10-hour work day grows more taxing, as Jeff increasingly succumbs to the stress of intense concentration and mental challenge. This is a phenomenon that neuropsychologists refer to as “cognitive fatigue.”

For the first time in his career, Jeff is experiencing an unprecedented degree of self-doubt, frustration, and fear for his job security. Jeff finds himself angry, depressed, and less socially engaged. Emotional troubling feelings and a loss of interest in interpersonal contact are frequently observed complications of cognitive decline.

Individuals who have sustained concussions continue to suffer from the impact of their original injury over an extended period of time. In a competitive work environment with high expectations, job-related pressure can result in vulnerabilities and emotional stress.

Diagnosis and Treatment
Because Jeff’s company has an EAP, his situation is handled with care, sensitivity, and a genuine commitment to helping a valuable employee get back on track. A supportive supervisor and on-site EAP consultant set the process in motion, initiating referral to his internist who ultimately referred Jeff for a neuropsychological evaluation that winds up confirming the persistent presence of Jeff’s post-concussion symptoms.

Upon being informed that his perceived cognitive challenges were indeed real, Jeff was relieved to learn that not only did his company’s health plan offer a number of cognitive rehabilitation options, he learned the EA professional would also assist in obtaining reasonable accommodations during his extended recovery.

Case Study #2: Cognitive impairment caused by disease
Mary is a 42-year-old physician’s assistant at a busy outpatient orthopedic clinic located in a major hospital. Over the past year, she has noticed intermittent periods of confusion and memory loss. More recently, Mary finds herself misplacing charts and forgetting the names of patients she has known for years. She describes herself as “having good days and bad days.” On good days she feels fully functional; on bad days she dreads making an error and possibly harming a patient.

Diagnosis and Treatment
Mary scheduled a visit with her primary care physician, who ordered several diagnostic evaluations. Diagnostic imaging led to a diagnosis of Mild Cerebral Microvascular disease, and a condition known as Transient Ischemic attacks or TIAs. The fluctuations in the efficiency of blood supply to the brain were the likely explanation for Mary’s fluctuations in cognitive performance.

Fortunately for Mary, as in the case of Jeff, it’s possible to objectively identify and treat disease-affected cognition. Much to Mary’s relief, the EAP is able to assist her care providers in implementing a treatment plan that includes appropriate work accommodations and lifestyle changes. The EAP remains an on-going resource for Mary, boosting her functionality and confidence until such assistance is no longer needed.

Support
An employee experiencing cognitive challenges tends to minimize the impact of increased difficulties on functioning. When problems become more self-evident, the employee may experience embarrassment, fear, frustration, and a decrease in self-worth. Supervisory support, flexibility, and knowledge of accommodation options are key to maximizing employee productivity following an injury or illness accommodations. According to the Job Accommodation Network (JAN), there is great variability in employers’ willingness to implement accommodations for qualified employees.

I had the pleasure of interviewing Alan King, COO of Workplace Options, a Fortune 500 company that works with domestic and international employers. King believes that the level of comfort an employee has in communicating difficulties, and a corresponding supportive work environment, are the two most important factors in addressing cognitive challenges. King believes that openly working with an employee and their family can be invaluable in maintaining the health of the individual and their ability to remain on the job. 

Many of the patients I have treated over the years who experience subtle changes in their cognition and memory wait until their jobs are in peril before seeking help. Fear of jeopardizing their position and losing peer respect are common reasons given for not reaching out sooner. In addition, the fear of developing a neurodegenerative condition such as Alzheimer’s disease is ubiquitous.

However, after evaluating these patients, I often find that they are not struggling with a neurodegenerative disease; rather, there are specific cognitive changes due to different causes. Working in partnership with the struggling worker, their employer, and their family is integral to maximizing work-related adjustments and supporting the individual and their needs. 

Evaluation and Treatment Resources
* Neuropsychological evaluation: A good neuropsychological evaluation will develop a profile of the employee’s cognitive strengths and weaknesses along with recommendations to maximize adjustment at work.
* Primary care physician: The PCP should always be kept in the loop regarding any individual who is suspected of having cognitive challenges. If the employee has not had a recent physical examination, referring to the PCP should be the first step.
* Community support groups for individuals who suffer from neurological diseases such as Parkinson’s disease, Multiple Sclerosis, Alzheimer’s, and Traumatic Brain Injury.
* Mental health support: Individuals who are coping with cognitive decline or a neurological disorder often benefit from consultation with mental health clinicians who can provide therapy and support for the individual, couple, and/or family.
* Occupational therapist: This health care professional can be very helpful in implementing strategies to manage psychomotor and/or sensory challenges.

Cognitive Health Awareness in the Work Environment
Cognitive health in the workplace will continue to grow in its importance over the next decade and beyond. The following are some suggestions in promoting awareness and programs that will support cognitive health:

* Key professionals in an organization, including employee assistance, Human Resources, and occupational health professionals, can help managers and supervisors understand the importance of cognitive health and work with employees who are experiencing cognitive challenges. 
* Create an environment that promotes awareness and support of neurocognitive health while encouraging working with employees who manifest cognitive challenges.
* Make cognitive health awareness part of an overall workplace wellness initiative. Promote educational services, exercise, and nutrition programs, as well as professional development and socialization opportunities to maintain employee physical, mental, and emotional health.

Summary
Unlike a physical injury or developmental disability, the symptoms of cognitive decline are not always apparent and are often misconstrued as the effects of emotional or family-related problems. There is a great deal of relief that is experienced by affected individuals when they realize that someone understands and accepts their condition.

The good news is that as first-line health care professionals, EAP practitioners can offer much-needed relief, support, resources, and targeted referrals, which in turn can make an invaluable difference to a cognitively challenged employee.

Dr. Joel Becker specializes in the maintenance of cognitive health in the workplace. A clinical neuropsychologist and CEAP, Dr. Becker created the Cognitive Functional Assessment Screening Tool (CFAST*) to initially screen and help refer employees experiencing cognitive decline due to age or injury. * Research version. 

Sidebar

The Value of Aging Employees

An undeniable trend in Western societies is that more people are not only living longer, they are also working longer. This trend, combined with the inevitable fact that aging can result in cognitive challenges, makes addressing these growing challenges crucial for retaining and maximizing the contributions of aging employees.

A recent study (Center for Retirement Research Boston College, 2015) focused on the relationship between age-related cognitive decline and work ability. For 10% of respondents, there was a steep decline in cognitive ability over 10 years. Shifting to a less demanding job or retiring early was much more likely for this subgroup.

However, the vast majority of individuals who participated in the study (90%) were able to remain in their current occupational role through variables such as utilizing cognitive reserve (recognizing their cognitive capacity), maintaining a healthy lifestyle, and understanding the specific cognitive requirements of their jobs.

Normal Aging
From an EAP perspective, it’s important to understand what normal aging involves. Typically, there is a decrease in “fluid” cognitive ability (the ability to learn and apply new information) while “crystallized” cognitive abilities (learned skills and acquired knowledge) will remain intact.
The implications of these differences are substantial. When a position is heavily based on acquired knowledge, such as an educator, that individual can likely continue to work well into their later years. In contrast, for a career such as a surgeon, proficiency and speed often declines, which can directly affect the outcome (i.e. successful surgery).

Don’t Underestimate Value
The value of an aging employee should not be underestimated. Older workers offer assets based on experience and knowledge of their particular occupation. These individuals are highly reliable, consistent in their attendance, and often will go the extra mile. Older employees can serve as peer mentors, teach aspects of job functions, and add to the knowledge base of their teams.

Recent studies have found that key variables in retaining and maintaining work satisfaction of older employees are based on two factors: supervisory support and job flexibility. Examples of job flexibility include allowing brief rest breaks during the workday and flexibility in the hours that the employee is required to work accounting for personal needs such as medical appointments. 

The ability of the EAP to recognize the possibility of age-related cognitive changes as a factor affecting employee performance can substantially help in understanding what is needed for job retention and employee satisfaction for older employees.

- Joel Becker, PhD

Joel Becker's website is http://cognitiveconsultationhealthservices.com. He can be reached at cognitivehealthservices@gmail.com or 888-290-7460.