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Background: Sexual dysfunction (SD) is a common symptom for many with multiple sclerosis (MS). However, SD research in general appears to often overlook young adults within their samples, which can be a major issue for better understanding and treatment for the MS population. Few studies have compared age-related differences in distress in response to physical disability. Research has also found that many people diagnosed with MS do not discuss any SD struggles with their providers. The present study hopes to see whether age-related differences exist in the reporting of the levels of primary, secondary, and tertiary SD, as defined by subscale scores of the Multiple Sclerosis Intimacy and Sexuality Questionnaire-19 (MSISQ-19), and amount of distress, as defined by the 12-Item Short Form Health Survey (SF-12)'s Mental Component Summary (MCS-12). Additionally, we hope to determine if there are any age-related or sex-related differences in help-seeking behaviors for SD., Methods: Study participants were recruited from the North American Research Committee on Multiple Sclerosis (NARCOMS) Registry. Participants completed the MSISQ-19, SF-12, and Patient Determined Disease Steps (PDDS), provided demographic information, and responded if they received medical or psychological treatment for SD. Study participants were 5815 respondents (M age  = 51 years, SD = 9.63, 75 % female, 30 % having attained a high school diploma, 35 % scoring "advanced disability" on the PDDS). Young adult (19-39 years), middle adult (40-64 years), and mature adult (65-older) were compared on SD., Results: Linear mixed effects modeling revealed that the MSISQ-19 subscale scores were significantly predicted by secondary SD (t = 2.48, p < .13). Young adult participants had the lowest primary SD (M = 13.87, 95 % CI [13.13, 14.61]) when compared to mature adult (M = 14.12, 95 % CI [13.27, 14.97]) and middle adult participants (M = 14.44, 95 % CI [14.21, 14.66]), though none were statistically significant. Mature adults had the lowest secondary SD (M = 16.50, 95 % CI [15.65, 17.35]), a statistically significant difference from the middle adults (M = 18.20, 95 % CI [17.97, 18.42]) and young adults (M = 18.91, 95 % CI [18.17, 19.65]). Mature adults had the lowest tertiary symptoms (M = 10.12, 95 % CI [9.27, 10.96]), followed by young adults (M = 12.23, 95 % CI [11.48, 12.97]), and middle adults (M = 11.65, 95 % CI [11.43, 11.88]), though none were statistically significant. Hierarchical multiple regressions found that age had the most significant impact on SD. When SF-12 MCS-12 was added, linear mixed effects did not reveal any statistically significant results between the age groups and SD levels. In contrast, hierarchical multiple regressions found that SF-12 MCS-12 scores had the most significant impact on SD. There were significant age-related and sex-related differences in help-seeking behaviors in those who sought psychological counseling as opposed to medical treatment for SD., Conclusion: Our study has highlighted the importance of clinicians assessing for SD and psychological distress within their patients and to consider potential differences in symptom presentations of age groups to better address their unique needs., Competing Interests: Declaration of Competing Interest The authors have no relevant financial or non-financial interests to disclose., (Copyright © 2023. Published by Elsevier B.V.)

Background: Multiple sclerosis (MS) affects over 2.5 million individuals worldwide, yet much of the disease course is unknown. Hemispheric vulnerability in MS may elucidate part of this process but has not yet been studied. The current study assessed neuropsychological functioning as it relates to hemispheric vulnerability in MS., Methods: Verbal IQ, as measured by verbal comprehension index (VCI), nonverbal IQ, as measured by perceptual reasoning index (PRI) and memory acquisition were compared in right-handed (dextral) and non-right-handed (non-dextral) persons with MS (PwMS)., Results: Linear mixed-effects modeling indicated a significant main effect of handedness, F(1, 195.35) = 3.95, p = .048, for a composite measure of VCI, PRI, and memory acquisition, with better performance for dextral PwMS. In examining differences for specific neuropsychological measures, the largest effect size between dextral and non-dextral participants was seen in PRI (d = 0.643), F(1,341) = 12.163, p = .001. No significant interaction effect between handedness and IQ was found, F(3, 525.60) = 0.75, p = .523., Conclusions: Dextral PwMS perform better than non-dextral PwMS when assessing neuropsychological performance for memory and IQ combined. Results are suggestive of increased vulnerability in the left brain to the pathological process of MS., (© The Author(s) 2022. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permission@oup.com.)

Purpose: This study seeks to add to existing literature on depression and illness intrusiveness in chronic disorders by examining, (1) how the perceived intrusiveness of multiple sclerosis (MS) leads to depression, (2) and the mediating role trait mindfulness plays in this relationship METHODS: Participants (N = 755) were persons with MS (PwMS) recruited through the North American Research Committee on MS (NARCOMS) registry (a larger study). Participants completed the Illness Intrusiveness Ratings Scale, the Hospital Anxiety and Depression Scale and the Mindful Attention Awareness Scale. A mediation model assessed if trait mindfulness mediates the relationship between illness intrusiveness and depression RESULTS: Illness intrusiveness predicted trait mindfulness (a =  - 4.54; p < .001), trait mindfulness predicted depression (b =  - .04; p < .001); there was a direct effect of illness intrusiveness on depression (c' = 2.53; p < .001) and an indirect effect on depression (ab = .17, 95% BCa CI [.10, .25]) when trait mindfulness was in the model, which represented a medium size effect, R 2 med  = .10 [95% CI .07, .14] CONCLUSION: Trait mindfulness mediates the relationship between illness intrusiveness and depression in PwMS. Providers could provide psychoeducation on the benefits of mindfulness and mindfulness-based interventions.

Objective: The purpose of this study was to describe the development and validation of a personal growth scale in caregiving partners of persons with multiple sclerosis (MS)., Method: Two studies were conducted: one to identify possible constructs and items, and another to and examine the instrument's psychometric properties. Study 1 consisted of focus groups of 39 partners of patients with MS, expert reviews, and qualitative methodology for identifying themes. In Study 2, the items generated were administered to a new sample ( N = 315), and the instrument's psychometric properties were assessed., Results: Study 2 sample was suitable for principal component analysis (PCA), and PCA was performed with oblique rotation. A 6-component solution was deemed most parsimonious and interpretable. Subscales were formed and labeled as follows: Positivity, Appreciation, Acceptance, Insight, Independence, and Spirituality. Reliability analysis of the subscales showed acceptable to high internal consistency. A secondary PCA was performed on mean subscale scores. Five of the six subscales clustered together along one dimension, and the sixth, Spirituality, was found to be distinct as represented in a loading plot. This subscale was retained as an independent measure; the remaining subscale scores were summed to create a total score. Measures of convergent and discriminant validity evaluated against existing instruments yielded findings in the expected directions., Conclusions: The dimensionality and structure of personal growth in caregiving partners of persons with MS were delineated in a novel instrument. Future studies should confirm its structure, establish classification criteria, and standardize it as an assessment tool. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Introduction : Cognitive fatigue is a common symptom in multiple sclerosis (MS). Recent research has implicated dopaminergic pathways originating in the basal ganglia as neurological correlates of cognitive fatigue in MS. This same system has long been associated with goal-directed behavior and reward-based motivation. While researchers have demonstrated that reward has a reliable impact on performance in tasks of sustained attention in healthy individuals, the effect of reward on fatigue is less clear, as prior research has not adequately controlled for desensitization to reward in a sustained attention task. The primary aims of this study were to examine the effect of reward on attention in MS patients, and to examine the effect of reward on objective cognitive fatigue. Method : The study employed a 3 × 3 repeated measures design to evaluate performance of N  = 64 patients with definite MS on a measure of cognitive fatigue across several reward conditions. The study utilized a novel delayed-reward paradigm to better control the measured effect of reward on fatigue. Results : Reward (main effect) displayed a significant effect on overall performance ( F =  3.050, p <  .05). Reward was also shown to affect fatigue trajectory (Reward × Interval, F =  2.433, p <  .05). However, this effect was dependent on the method of reward administration. Conclusions : Study findings support the role of motivation in MS cognitive performance, particularly in objective cognitive fatigue, a behavioral finding that is consistent with current neuropsychological theory. Study findings support the delayed-reward paradigm as an effective method for measuring reward effect on tasks of sustained attention.

Background: While there is evidence of differences in the disease characteristics of multiple sclerosis (MS) across ethnic and racial groups, there has been limited research on cognitive functioning., Objective: To explore potential differences among Caucasian (CA), African-American (AA), and Hispanic (HA) adults from a clinical sample on the Minimal Assessment of Cognitive Function in MS (MACFIMS)., Methods: A total of 245 age- and disease duration-matched individuals (194 CA, 23 AA, and 28 HA) were included in the analyses. Their rates of impairment, using the criterion of two standard deviations (SD) below the normative mean, on the MACFIMS were compared using chi-square analyses with post-hoc pairwise comparisons (Bonferroni adjusted)., Results: Compared to CA, AA had higher rates of impairment on measures of complex attention (p < 0.001) and executive functions (p < 0.001)., Conclusions: These findings raise questions of whether the observed differences reflect the more aggressive disease course noted among AA or are due to discrepancies in performance on neuropsychological assessment that is associated with race/ethnicity in the general population. Future directions and implications are discussed.

Objectives: While resilience has been an area of increasing research, there are no measures that are specific to the psychological, social, and physical factors associated with resilience in persons with multiple sclerosis (PwMS). This study aimed to develop the MS Resiliency Scale (MSRS), a multidimensional measure. Items were created based on a review of the literature, with five hypothesized subscales, and then evaluated in a large sample of PwMS., Method: Participants ( N = 932) were primarily recruited through the North American Research Committee on MS (NARCOMS) and completed the study electronically. Principal components analysis was utilized to determine the number of factors and whether they aligned with the theorized model., Results: Using an unforced solution with oblique (promax) rotation and Kaiser normalization, and suppressing items with coefficients below 0.4, 25 items were retained in five subscales that accounted for 42.75% of the variance: Emotional and Cognitive Strategies (13 items; α = .92), Physical Activity and Diet (3 items; α = .77), MS Peer Support (2 items; α = .82), Support from Family and Friends (5 items; α = .79), and Spirituality (2 items; α = .91). The total score was negatively correlated with depression, r = -.72, p < .001 and anxiety, r = -.56, p < .001., Implications: The 25-item MSRS assesses several psychological, social, and physical factors associated with resilience in PwMS, and may be a helpful tool in identifying individuals in need of additional assistance or support. (PsycINFO Database Record, ((c) 2018 APA, all rights reserved).)

Objective: Cognitive dysfunction is prevalent in multiple sclerosis. As self-reported cognitive functioning is unreliable, brief objective screening measures are needed. Utilizing widely used full-length neuropsychological tests, this study aimed to establish the criterion validity of highly abbreviated versions of the Brief Visuospatial Memory Test - Revised (BVMT-R), Symbol Digit Modalities Test (SDMT), Delis-Kaplan Executive Function System (D-KEFS) Sorting Test, and Controlled Oral Word Association Test (COWAT) in order to begin developing an MS-specific screening battery., Method: Participants from Holy Name Medical Center and the Kessler Foundation were administered one or more of these four measures. Using test-specific criterion to identify impairment at both -1.5 and -2.0 SD, receiver-operating-characteristic (ROC) analyses of BVMT-R Trial 1, Trial 2, and Trial 1 + 2 raw data (N = 286) were run to calculate the classification accuracy of the abbreviated version, as well as the sensitivity and specificity. The same methods were used for SDMT 30-s and 60-s (N = 321), D-KEFS Sorting Free Card Sort 1 (N = 120), and COWAT letters F and A (N = 298)., Results: Using these definitions of impairment, each analysis yielded high classification accuracy (89.3 to 94.3%)., Conclusions: BVMT-R Trial 1, SDMT 30-s, D-KEFS Free Card Sort 1, and COWAT F possess good criterion validity in detecting impairment on their respective overall measure, capturing much of the same information as the full version. Along with the first two trials of the California Verbal Learning Test - Second Edition (CVLT-II), these five highly abbreviated measures may be used to develop a brief screening battery.

Background: Sexual dysfunction is a prevalent symptom in multiple sclerosis (MS) that may affect patients' health-related quality of life (HrQoL)., Objective: The objective of this paper is to examine the impact of sexual dysfunction on HrQoL in a large national sample using The Multiple Sclerosis Intimacy and Sexuality Questionnaire-19 (MSISQ-19)., Methods: Participants were recruited from a large MS registry, the North American Research Committee on Multiple Sclerosis (NARCOMS) Registry. Participants self-reported demographic information and completed the Patient Determined Disease Steps (PDDS), MSISQ-19, and the Short Form-12 (SF-12)., Results: The study population included 6183 persons (mean age: 50.6, SD = 9.6; 74.7% female, 42.3% currently employed). Using multivariate hierarchical regression analyses, all variables excluding gender predicted both the physical component summary (PCS-12) and the mental component summary (MCS-12) of the SF-12. Scores on the MSISQ-19 uniquely accounted for 3% of the variance in PCS-12 scores while disability level, as measured by PDDS, accounted for 31% of the variance. Conversely, MSISQ-19 scores uniquely accounted for 13% of the variance in MCS-12 scores, whereas disability level accounted for less than 1% of the variance., Conclusion: In patients with MS, sexual dysfunction has a much larger detrimental impact on the mental health aspects of HrQoL than severity of physical disability.

Purpose: Studies show that suicidality is greater in persons with multiple sclerosis (MS) than in the general population. In this study, we evaluated the consistency of suicidality over time in patients with MS., Method: Participants were patients (n = 344) at an outpatient clinic at a large medical center in New Jersey. Longitudinal data was collected as part of an ongoing research project. Binary logistic regression examined the effect of gender, age, depression and disability on level of suicidality at Time 1 versus Time 2., Results: Baseline depression and change in level of depression significantly predicted level of suicidality at Time 2, while demographic variables, baseline disability, change in level of disability, and the interaction between change in depression and change in disability over time did not., Conclusions: Interventions aimed at evaluating and monitoring depression over time should be considered in order to reduce the risk of suicidality. Implications for Rehabilitation Due to the inconsistency and unpredictability of MS, depression should be assessed routinely. Given the high prevalence of depression and suicidality in MS, mental health services should be available and encouraged by healthcare providers treating individuals with MS.

Physical disability as well as psychological factors may contribute to illness intrusiveness. The aim of this study was to determine if level of disability, anxiety, and depression predicted illness intrusiveness in patients with multiple sclerosis (MS). A second aim of this study was to determine if anxiety and depression moderated the impact of disability on illness intrusiveness. MS (N=185) patients were recruited from a MS outpatient clinic that was part of a major medical center in New Jersey. Hierarchical linear regressions demonstrated that disability, anxiety, and depression each independently predicted illness intrusiveness. Anxiety and depression were not shown to moderate the impact of disability on illness intrusiveness. Implications of results from the first aim suggest that reducing psychological distress such as anxiety and depression may also reduce illness intrusiveness in patients with MS., (© 2013 Elsevier B.V. All rights reserved.)

Background: Sexual dysfunction is common in multiple sclerosis (MS) but reliable and valid measurement in this population is needed., Objective: The objective of this research is to re-validate the Multiple Sclerosis Intimacy and Sexuality Questionnaire-19 in a large US sample., Methods: A total of 6300 MS patients from the NARCOMS registry completed the MSISQ-19. Unforced principal component analysis utilizing oblique rotation with Kaiser Normalization validated its construct validity., Results: The scree plot supported a three-component solution, with 63% of total variance explained. The components mirrored the original validation study measuring primary, secondary, and tertiary sexual dysfunction. PCA suggested the scale could be shortened to 15 items, which were found to apply equally well to males and females (with one primary item specific for each sex). The components were moderately intercorrelated (Pearson rs ranged from 0.5 to 0.67). The secondary subscale correlated most highly with self-reported disability (r (6081) = 0.44, p < 0.001), whereas the tertiary subscale correlated most highly with psychological distress (r (5992) = -.37, p < 0.001). Cronbach's alpha for the total scale (0.92) and the subscales (primary, 0.87; secondary, 0.82; tertiary, 0.91) demonstrated good reliability., Conclusion: The revised 15-item MSISQ is a reliable and valid measure of sexual dysfunction in men and women with MS.

Multiple sclerosis (MS) is frequently accompanied by changes in verbal memory. We hypothesized that administering an abbreviated California Verbal Learning Test-II (CVLT-II) would detect verbal memory problems in MS accurately, thus serving as a potential screening tool. We performed receiver-operating-characteristic (ROC) analyses of three trials (trial 1, trial 2, and trial 1+2 combined) for raw data against standardized total scores. The results showed that at 1.5 standard deviations (SD) from the mean, the first two trials were 96.3% accurate, while at 2 SD from the mean, the first two trials combined were 97.5% accurate. We conclude that this study demonstrates than an abbreviated CVLT-II is a valid screening tool for verbal memory impairments.

Sexual dysfunction is a highly prevalent symptom of multiple sclerosis (MS), with little published research on effective treatments. This pilot study tested the efficacy of a counseling intervention in nine couples utilizing a quasi-experimental research design. The intervention consisted of 12 counseling sessions, communication with the MS medical treatment team, education, and tailoring symptomatic treatments so they interfere less with sexual function. Repeated measures analysis of variance indicated significant improvements in affective and problem-solving communication, marital satisfaction, and sexual satisfaction during the treatment vs. the waiting list phase of the study (F=1.7, P<.001). MS patients and their spouses reported similar levels of improvement.

Objective: The Paced Auditory Serial Addition Test (PASAT) is a commonly used test for patients with multiple sclerosis (MS). This study evaluated the usefulness of novel scoring methods of the test, including the total number of three, four, and five consecutive correct responses as well as the longest string of consecutive correct responses for predicting overall cognitive function and detecting impairment. Strings were compared to traditional total correct and the more recently developed dyad scores. Method: 201 MS patients seen for neuropsychological evaluation at an outpatient MS clinic in New Jersey were administered the Minimal Assessment of Cognitive Function in MS (MACFIMS) battery. Overall cognitive functioning was represented by a composite z-score of all test performances excluding the PASAT. Cognitive impairment was defined in three ways for the analyses: composite z-score < −1 and < −1.5, and at least two cognitive domains with composite z-scores < −1.5. Results: Each scoring variable was found to be effective at predicting overall cognitive functioning and classifying those with cognitive impairment in separate regression analyses (p < .05) and ROC curve analyses. Total correct and dyad scores were the most effective scoring variables, although there were not statistically significant differences between these and the longer strings of responses. Conclusion(s): The findings provide support for the continued use of total correct scores and dyad scores on the PASAT as predictors of overall cognitive functioning for patients with multiple sclerosis. Longer strings of consecutive responses may be too difficult for many MS patients to achieve, which likely contributed to their limited usefulness for this clinical sample.ROC Curves for Detection of Impairment Defined as Composite z-scores ≤−1, ≤−1.5, and ≤−1.5 in ≤2 Domains, respectively [ABSTRACT FROM AUTHOR]