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In people with multiple sclerosis (MS), depression symptoms could be a direct consequence of neuropathological processes or a secondary consequence of coping with debilitating illness. We investigated the interaction of white matter structure and patient coping style in predicting positive and negative emotion symptoms of depression.Participants completed a neuropsychological battery, including the Chicago Multiscale Depression Inventory (CMDI) and a measure of coping strategies that has Active Coping (more adaptive) and Avoidant Coping (less adaptive) scales. Participants also completed a diffusion tensor imaging (DTI) scan, from which fractional anisotropy (FA) was calculated to assess integrity in tracts of interest, and the interaction of FA and coping style was analyzed to predict depression symptoms.Significant FA and Active Coping interaction effects for predicting CMDI Negative Emotion scores were found for the anterior thalamic radiation and uncinate fasciculus white matter tracts. For people with MS who showed relatively reduced integrity of these tracts, use of more Active Coping moderated the relationship of microstructure and negative emotion symptoms of depression. This moderating relationship was not seen with other tracts of interest or with positive emotion.There was a protective effect of adaptive coping style against the experience of negative emotion among people with MS who showed compromised regional white matter integrity of certain tracts that connect temporal and thalamic regions to frontal cortex.

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)

Approximately 50% of persons with multiple sclerosis experience cognitive impairment, which adversely affects daily functioning. Although patients report that fatigue contributes to cognitive difficulties, previous empirical studies do not show a clear association. This study assessed coping style as a moderator of the relationship between fatigue and cognition in a 3-year longitudinal sample. Scores on the Fatigue Impact Scale and the Coping Orientation to Problems Experienced (COPE) at baseline were modeled to predict later performance on a composite of cognitive tests to investigate the hypothesis that coping would have a significant moderating effect on fatigue in predicting cognitive performance. Findings partially supported hypotheses by showing that avoidant coping moderated the relationship between fatigue and cognitive performance. Patients who experienced relatively high fatigue performed better on cognitive tests if they used less avoidant coping. Those who reported lower fatigue had relatively good cognitive performance regardless of their coping style. This study provides evidence that coping style is associated with the ability to deal with stress, like fatigue, and their interaction can impact functional outcomes of disease. These results could benefit understanding of prognosis and improve treatment for patients with MS. (JINS, 2014, 20, 1–5.)

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.

Objective The use of normative data is a hallmark of the neuropsychological assessment process. Within the context of sports-related concussion, utilizing normative data is especially essential when individualized baseline data are unavailable for comparison. The primary purpose of this study was to establish normative data for a comprehensive neuropsychological test battery used in the assessment of sports-related concussion. A secondary aim was to provide normative data for pertinent demographic variables relevant to the assessment of college athletes, including sex, previous head injuries (PHI), and history of attention deficit hyperactivity disorder (ADHD)/learning disability (LD). Method Participants included male and female college athletes (N = 794) who were involved in a concussion management program at an NCAA Division I university between 2002 and 2015. Athletes were administered a comprehensive neuropsychological test battery at baseline designed to assess the following cognitive domains: learning and memory, attention and concentration, processing speed, and executive functioning. The test battery primarily comprises paper-and-pencil measures. Results Normative data are presented for the overall athlete sample. Additional sub-norms are then provided for specified demographic populations (i.e., sex, PHIs, and history of ADHD/LD). Findings indicate that there are mild cognitive differences between men and women, as well as between those athletes with and without a history of ADHD/LD. Given these findings, additional norms are provided for men and women with and without a history of ADHD/LD. Conclusions In the absence of baseline testing, the normative data presented here can be used clinically to assess athletes' cognitive functioning post-concussion.

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.

Depression in multiple sclerosis (MS) is very common, with a lifetime prevalence of around 50 %, which is much higher than the 8 % reported for the general population. In this chapter, we explore some of the psychological and behavioral depression treatments that have been studied in MS. Our review shows clearly that depression in MS is treatable, via both psychotherapeutic and behavioral interventions. Randomized clinical trials (RCTs) on psychotherapy have generally revealed very large effect sizes, with the one benchmarking study (one that examines treatment as it actually occurs in clinical settings) in the literature showing a still large but somewhat smaller effect size than RCTs. Exercise appears to be a promising potential treatment of depression in MS and has been shown to be correlated with lower depression. Additionally, RCTs of exercise have revealed small to moderate effect sizes on reducing depression. One problem with psychological and behavioral treatments of depression in MS is the salience of disability and travel issues that make involvement in such intensive treatment more challenging. Thus, even though treatments are often effective, patients may avoid them in favor of other interventions. Telephone-based interventions have been shown to be very effective in treating depression in MS and could represent a promising approach that circumvents such obstacles. Even though current treatments are effective, future research should explore why nearly half of patients do not respond to available treatments. A focus on the possibility that co-morbid conditions (e.g., anxiety or personality disorders) could interfere with standard depression treatments, as well as possible mediators of treatment (e.g., fatigue, disability levels, sleep disturbance), may be promising avenues for future research.

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.