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The Chicago Multiscale Depression Inventory (CMDI) was developed to improve accuracy in measuring depression symptoms in individuals with non-psychiatric medical illness. Earlier psychometric evaluation of the CMDI has emphasized properties of items that measure negative affect and experience. In this study, we provide an initial evaluation of an outcome scale of positive items that are also included within the CMDI but have previously been excluded from calculation of the total score. Psychometric data for the CMDI negative and positive item subscales were determined in healthy adults and patients with multiple sclerosis. Analysis included measurements of factor structure, reliability, and validity in comparison with other established measures of depression and affect. Study findings indicate that in healthy and patient samples, the CMDI Positive scale has very good reliability and validity. The Positive scale score also appears to predict depression symptoms beyond the negative item scale scores. The CMDI Positive scale could be a valuable clinical and research tool. Inclusion of the Positive scale in the CMDI total score appears to improve the measure by further capturing symptoms of affect and experience that are important to diagnosis of depression and are not covered by the negative scales alone. (JINS, 2016, 22, 76–82)

Dr Arnett received his PhD in Psychology (Clinical) from the University of Wisconsin – Madison (WI, USA), and completed a postdoctoral fellowship in Clinical Neuropsychology at the Medical College of Wisconsin. He is currently a psychology professor and Director of Clinical Training at Penn State University (PA, USA). Dr Arnett’s research focuses on clinical neuropsychology, with an emphasis on secondary influences on cognitive functioning in persons with multiple sclerosis and mild traumatic brain injury. He is the director of the Neuropsychology of Sports-Related Concussion and Multiple Sclerosis programs at Penn State University, a fellow of the National Academy of Neuropsychology (NAN), past winner of NAN’s Nelson Butters Award for Research Contributions to Clinical Neuropsychology, and was Program Co-Chair for the 2010 Mid-Year Meeting of the International Neuropsychological Society (INS). He has authored over 90 research articles and book chapters, as well as over 160 conference presentations. He is an editorial board member of several journals, including Neuropsychology, Journal of the International Neuropsychological Society and Archives of Clinical Neuropsychology. Dede Ukueberuwa received her bachelor’s degree from Princeton University (NJ, USA) and earned a master’s degree in Psychology at Penn State University (PA, USA), where she is currently a PhD student in Clinical Psychology. She is also the coordinator of the Penn State University Multiple Sclerosis Project. Her work uses neuropsychological testing and neuroimaging to understand cognitive and biological factors relating to emotional difficulties in multiple sclerosis. She is the author of several publications pertaining to multiple sclerosis and has also presented her work at numerous conferences.

Headache is one of the most commonly reported and longest lasting symptoms that concussed athletes report, yet the etiology of headache symptoms following concussion is not entirely clear. The purpose of this study was to determine whether the e4 allele of the apolipoprotein E (APOE) gene influences the presence and severity of postconcussion headache.Participants were composed of 45 concussed athletes and 43 healthy/nonconcussed athletes who were involved in a clinically based sports concussion management program. All athletes completed the Post-Concussion Symptom Scale (PCSS). The "headache" symptom from the PCSS was the primary outcome variable. Buccal samples were collected and analyzed to determine APOE genotype.A significantly greater proportion of concussed e4+ athletes than e4- athletes endorsed headache. Furthermore, concussed e4+ athletes endorsed more severe headaches than e4- athletes. When examining the healthy/nonconcussed sample (i.e., athletes at baseline), results showed no differences between e4 allele groups with respect to the presence and severity of headache.These findings show that when compared to concussed e4- athletes, e4+ athletes are more likely to (a) endorse postconcussion headache and (b) report more severe headache symptoms following concussion. Conversely, it appears that the e4 allele does not influence baseline reports of headache. Thus, results suggest that those with the e4 genotype may be at a higher risk for experiencing headache-related difficulties only after a concussion is sustained.

Since Barth and colleagues’ seminal study used baseline neuropsychological testing as a model for sports concussion management, many collegiate sports medicine programs have adopted variations of their approach. However, no evidence-based strategy has yet been clearly articulated for the use of neuropsychological tests in concussion management that involves consideration of cases in which no baseline testing has been conducted. In this chapter, we articulate an evidence-based model for neuropsychological sports concussion management in collegiate athletes for cases in which baseline data are not available. The model involves an algorithm that is based upon base rates of impairment in a typical neurocognitive sports concussion battery, with decision rules that differ slightly for males and females. Although we use our population of collegiate athletes and the tests we administer as a framework to provide concrete values to the proposed algorithm, our evidence-based model could easily be applied to other sports concussion populations and neurocognitive test batteries. Our proposed neuropsychological concussion management guidelines provide an evidence-based model, while at the same time remain consistent with trends in the literature, suggesting that increasingly individualistic clinical concussion management approaches are most prudent.