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BACKGROUND: The study of job interview training is an emerging area among transition-age autistic youth who face significant challenges when navigating job interviews. The autism field has limited measures that have undergone rigorous psychometric evaluation. OBJECTIVE: We sought to evaluate the psychometric properties of adapted self-report measures assessing job interview skills and job interview anxiety. METHODS: As part of two parent randomized controlled trials, eighty-five transition-age autistic youth completed measures related to the strength of their job interview skills and their level of job interview anxiety. We conducted classical test theory analyses, exploratory and confirmatory factor analyses, and Rasch model analytic and calibration analyses. Pearson correlations were used to establish concurrent, divergent, and criterion validity by correlating these scales with measures of social challenges, depressive symptoms, behaviors, neuropsychological functioning, and work history. RESULTS: Our analyses yielded two brief and reliable scales: Measure of Job Interview Skills (MOJO-iSkills) and Measure of Job Interview Anxiety (MOJO-iAnxiety), which demonstrated initial concurrent, divergent, and criterion validities when correlated with measures of depressive symptoms, social challenges, internalizing and externalizing behavior, and work history. CONCLUSION: This study presents initial evidence that MOJO-iSkills and MOJO-iAnxiety have acceptable psychometric properties supporting they can be used to reliably and validly assess job interview skills and interview anxiety.

Because cognitive fatigue (CF) is common and debilitating following brain injury or disease we investigated the relationships among CF, behavioral performance, and cerebral activation within and across populations by combining the data from two cross-sectional studies. Individuals with multiple sclerosis (MS) were included to model CF resulting from neurological disease; individuals who had sustained a traumatic brain injury (TBI) were included to model CF resulting from neurological insult; both groups were compared with a control group (Controls). CF was induced while neuroimaging data was acquired using two different tasks. CF significantly differed between the groups, with the clinical groups reporting more CF than Controls. The accrual of CF did not differ across the three groups; and CF ratings were consistent across tasks. Increasing CF was associated with longer response time for all groups. The brain activation in the caudate nucleus and the thalamus was consistently correlated with CF in all three groups, while more dorsally in the caudate, activation differed across the groups. These results suggest the caudate and thalamus to be central to CF while more dorsal aspects of the caudate may be sensitive to damage associated with particular types of insult.

OBJECTIVE Cognitive fatigue is a common and disabling symptom following a traumatic brain injury (TBI). Literature on cognitive fatigue has distinguished between two types of fatigue: "state" fatigue refers to the acute experience of fatigue, whereas "trait" fatigue refers to the susceptibility to fatigue over an extended period. However, it is not clear whether state and trait fatigue are distinguishable constructs. Here, we examine the relationship between state and trait fatigue in individuals with TBI, hypothesizing that trait and state measures assess different constructs. PARTICIPANTS Twenty-one participants with moderate-severe TBI were recruited. DESIGN Participants underwent a cognitively fatiguing task while in an MRI scanner and completed self-report measures examining trait and state fatigue. RESULTS No correlation was found between state and trait fatigue. However, the two measures of trait fatigue, Fatigue Severity Scale (FSS) and the Modified Fatigue Impact Scale (MFIS), correlated with one another; additionally only trait fatigue correlated with depression scores, consistent with the literature. CONCLUSION These findings suggest that trait and state fatigue may not be interdependent and that it is important to carefully define the type of fatigue under consideration when assessing fatigue in individuals with TBI.

Objective Examine the associations between smartphone keystroke dynamics and cognitive functioning among persons with multiple sclerosis (MS). Methods Sixteen persons with MS with no self-reported upper extremity or typing difficulties and 10 healthy controls (HCs) completed six weeks of remote monitoring of their keystroke dynamics (i.e., how they typed on their smartphone keyboards). They also completed a comprehensive neuropsychological assessment and symptom ratings about fatigue, depression, and anxiety at baseline. Results A total of 1,335,787 keystrokes were collected, which were part of 30,968 typing sessions. The MS group typed slower ( P Conclusion Typing speed may be sensitive to cognitive functions subserved by the frontal–subcortical brain circuits. Individuals with better cognitive functioning and less severe symptoms may be better at monitoring their typing errors. Keystroke dynamics have the potential to be used as an unobtrusive remote monitoring method for real-life cognitive functioning among persons with MS, which may improve the detection of relapses, evaluate treatment efficacy, and track disability progression.

Cognitive fatigue, or fatigue related to mental work, is a common experience. A growing body of work using functional neuroimaging has identified several regions that appear to be related to cognitive fatigue and that potentially comprise a “fatigue network”. These include the striatum of the basal ganglia, the dorsolateral prefrontal cortex (DLPFC), the dorsal anterior cingulate cortex (dACC), the ventro-medial prefrontal cortex (vmPFC) and the anterior insula. However, no work has been conducted to assess whether the connectivity between these regions changes as a function of cognitive fatigue. We used a task-based functional neuroimaging paradigm to induce fatigue in 39 healthy individuals, regressed the signal associated with the task out of the data, and investigated how the functional connectivity between these regions changed as cognitive fatigue increased. We observed functional connectivity between these regions and other frontal regions largely decreased as cognitive fatigue increased while connectivity between these seeds and more posterior regions increased. Furthermore the striatum, the DLPFC, the insula and the vmPFC appeared to be central ‘nodes’ or hubs of the fatigue network. These findings represent the first demonstration that the functional connectivity between these areas changes as a function of cognitive fatigue.

Introduction Cognitive impairment is prevalent and debilitating among persons with multiple sclerosis (MS). While many pharmacologic treatments have shown good efficacy in reducing clinical relapses, brain lesions, and improving certain physical symptoms, their efficacy for improving cognitive function is not well understood. Objectives The current systematic review aimed to evaluate the efficacy of pharmacologic treatments for improving cognitive function among persons with MS. Methods A literature search was conducted through the PubMed and PsycINFO databases. Two independent reviewers assessed each paper, and a third reviewer weighed in if the two reviewers could not reach a consensus. Classification of evidence was determined using the 2017 American Academy of Neurology (AAN) criteria for therapeutic trials. Standardized effect sizes (Cohen’s d) were calculated to compare across studies. Results Eighty-seven journal articles published between 1990 and January 2020 were included in the current review. Overall, there is insufficient evidence to support the use of pharmacologic treatments to improve cognitive function in persons with MS. There were many contradictory findings observed in this review, which may be due to possible unidentified moderating treatment response variables and/or lack of standardization in assessment procedures. There was also an overreliance on statistical significance (most papers did not provide sizes of treatment effects), which may not be clinically meaningful. Conclusions Higher-quality randomized controlled trials are needed to establish the cognitive efficacy of pharmacologic treatments for MS-related cognitive dysfunction, with cognition as the primary endpoint. Researchers are urged to use standardized criteria (such as the AAN criteria) to guide their research designs. Clinicians should consider effect sizes of studies before deciding whether to prescribe certain medications to ameliorate cognitive symptoms. Electronic supplementary material The online version of this article (10.1007/s40263-020-00734-4) contains supplementary material, which is available to authorized users.

While cognitive fatigue is experienced by up to 80% of individuals with traumatic brain injury (TBI), little is known about its neural underpinnings. We previously hypothesized that presentation of rewarding outcomes leads to cognitive fatigue reduction and activation of the striatum, a brain region shown to be associated with cognitive fatigue in clinical populations and processing of rewarding outcomes. We have demonstrated this in individuals with multiple sclerosis. Here, we tested this hypothesis in individuals with TBI. Twenty-one individuals with TBI and 24 healthy participants underwent functional magnetic resonance imaging. Participants performed a task during which they were presented with 1) the Outcome condition where they were exposed to monetary rewards, and 2) the No Outcome condition that served as the control condition and was not associated with monetary rewards. In accordance with our hypothesis, results showed that attainment of rewarding outcomes leads to cognitive fatigue reduction in individuals with TBI, as well as activation of the striatum. Specifically, we observed a significant group by condition interaction on fatigue scores driven by the TBI group reporting lower levels of fatigue after the Outcome condition. fMRI data revealed a significant main-effect of condition in regions previously implicated in outcome processing, while a significant group by condition interaction was observed in the left ventral striatum as revealed by a priori region of interest analysis. Results suggest that a salient motivator can significantly reduce fatigue and that outcome presentation leads to increased activation of the ventral striatum in TBI. These findings can inform the development of future non-pharmacological cognitive fatigue treatment methods and contribute to the growing body of evidence showing the association between cognitive fatigue and the striatum.

Neuroimaging underpinnings of state (in the moment, transient) mental fatigue in multiple sclerosis (MS) are not well understood. The current pilot study examined the effect of state mental fatigue on brain activation (measured using functional magnetic resonance imaging [fMRI]) during conditions of varying cognitive loads of rapid information processing in persons with MS relative to healthy controls. Nineteen persons with MS and 17 healthy controls underwent fMRI scanning while performing a modified version of the Symbol Digit Modalities Test, which consisted of high and low cognitive load conditions with comparable visual stimulation. State mental fatigue was assessed using the Visual Analog Scale of Fatigue before and after each run of the behavioral task. Results indicated that the healthy control group recruited significantly more anterior brain regions (superior and middle frontal gyri, insula, and superior temporal gyrus) to meet increased task demands during the high cognitive load condition as fatigue level increased (p

Impairments in cognitive processing related to social understanding and communication (i.e., "social cognition") are well documented after moderate or severe traumatic brain injury (TBI) and can contribute to negative functional outcome. Depression is also a common feature of TBI with detrimental functional consequences. We evaluated relationships between social cognition, depression symptom severity, and functional status in individuals with chronic TBI (1 year post injury

OBJECTIVE To document the process by which metacognitive judgments ("online" monitoring of one's own cognitive performance during task completion) are made after traumatic brain injury (TBI). PARTICIPANTS Sixteen community-dwelling adults with moderate to severe TBI and 16 matched healthy controls. DESIGN Prospective, cross-sectional design. MEASURES Metacognitive retrospective confidence judgments and reaction times were collected as participants performed a metamemory task. RESULTS Adults with TBI did not differ from healthy peers in metacognitive accuracy; however, they took significantly longer to make retrospective confidence judgments. Retrospective confidence judgment reaction times were not consistently correlated to measures of processing speed in either sample. CONCLUSIONS Adults with TBI engage in different postdecisional processes to make metacognitive judgments compared with healthy controls. Findings suggest that reaction times may be an important dimension of metacognition to assess clinically after TBI.

This study examined (a) the impact of coronavirus disease-2019 (COVID-19) pandemic on engagement in activity participation in persons with acquired brain injury (ABI); and (b) whether changes in activity participation during the pandemic were associated participants' health-related quality of life (HRQoL).Exploratory online survey study.Eighty-seven respondents with ABI and 98 healthy adults (HA) participated in this study. Engagement in activity participation during COVID-19 was calculated as a percentage of the activities participants performed before the pandemic.Participants with ABI modified their activities less than HA in order to maintain level of engagement in activity participation. They stopped performing more activities during the pandemic compared to HA and compared to their pre-pandemic engagement. Both groups continued to do similar percentage of activities without modifications compared to before the pandemic. Better HRQoL in both groups was predicted by a larger percentage of activities continued and fewer activities stopped.Results emphasize the importance of addressing activity participation changes during situations where there are disruptions of the individual's habits and routines in order to minimize negative consequences of such changes.

Background: Physical activity is known to be an effective way of managing multiple sclerosis (MS)–related symptoms. Furthermore, it has been reported that even a single bout of physical activity can yield improvements in mood in persons with MS. Aquatic exercise can be an effective and enjoyable physical activity in persons with MS. However, there is little research on the immediate effects of aquatic exercise on mood in people with MS. Thus, we assessed the acute effects of a single bout of aquatic exercise on mood. Methods: Eight adults with MS participated in a 45-minute aquatic exercise class as well as 45 minutes of a seated rest control condition. The Profile of Mood States questionnaire was given before and after each condition (rest and aquatic exercise). Repeated-measures analysis of variance and paired-samples t tests were used to examine whether aquatic exercise resulted in improvement in mood. Due to the small sample size, effect sizes were considered. Results: Moderate-to-large effect sizes indicated a condition × time interaction such that mood increased and fatigue decreased after a single bout of aquatic exercise compared with after rest. Conclusions: This proof-of-concept study suggests that mood symptoms are improved immediately after a short bout of aquatic exercise. Future research is needed to explore whether these effects are reliable and whether they can be sustained with more frequent bouts of aquatic exercise.

Objective To delineate healthcare disruption for individuals with (ABI) during the peak of the pandemic, and to understand the impact of healthcare disruption on health-related quality of life (HRQoL). Design Cross-sectional survey Setting General community Participants N=207. Volunteer sample of adults with traumatic brain injury (TBI, n=33), stroke (n=66), and healthy adults (n=108) with access to the internet and personal technology. Interventions NA Main Outcome Measures NA Results Participants with TBI and stroke reported high rates of disruption in care specific to their diagnosis (53-54.5%), while participants across all groups reported disruption for major medical care (ranging from 68.2-80%), general healthcare (ranging from 60.3-72.4%), and mental healthcare (ranging from 31.8-83.3%). During the pandemic, participants with TBI and stroke used telehealth for care specific to their diagnosis (40.9-42.4%), while all participants used telehealth for major medical care (ranging from 50-86.7%), general healthcare (ranging from 31.2-53.3%), and mental healthcare (ranging from 53.8-72.7%). Disruption in TBI/stroke care and type of ABI explained 27.1% of the variance in HRQoL scores (F (2, 95) = 16.82, p

Many persons with multiple sclerosis (MS) have difficulties engaging in traditional land-based physical activity due to heat sensitivity and physical disability. Aquatic exercise may be a suitable alternative for these individuals, preventing overheating and enabling a range of movements that were otherwise difficult on land. The objective of the current study was to understand why some persons with MS prefer aquatic exercise while others prefer non-aquatic exercise, which will inform recommendations.A total of 179 persons with MS completed a brief online survey (∼10 min) about their exercise routines between October 2020 and April 2021.Fifty-sex percent of respondents reported that they only engaged in non-aquatic exercise (i.e., land-based activities such as jogging), followed by 36% of respondents who reported that they engaged in both aquatic and non-aquatic exercise, and 7% of respondents who participated in aquatic exercise only. The most frequently reported barriers for aquatic exercise were lack of access to pools and its associated expense. Among individuals who had tried aquatic exercise, aquatic exercise was preferred over non-aquatic exercise, and 100% reported that they would recommend aquatic exercise to other persons with MS. Finally, the majority of respondents reported exercising less during the coronavirus disease 2019 (COVID-19) pandemic.Aquatic exercise is well liked among persons with MS who have tried it; however, it may not be feasible for economically disadvantaged persons with MS. Local charities and health organizations may consider financially sponsoring aquatic exercise programs to encourage participation in physical activity for the MS population. Due to the negative impact of the pandemic on exercise routines, MS clinicians should encourage their patients to resume their exercise routines once the pandemic subsides.

Facial affect recognition deficits have been noted in persons with MS, however there is no treatment for these impairments. We investigated the efficacy of the Emotional Processing Intervention (EMOPRINT), a 12-session behavioral intervention teaching facial affect recognition skills and mimicry to improve facial affect recognition abilities in persons with MS.This double blind, placebo-controlled, randomized clinical trial with two time points (pre-treatment; post-treatment) included 36 participants with clinically definite MS, 21 in the treatment group and 15 in the placebo control group. Participants completed a pre-test and post-test neuropsychological assessment, which consisted of tasks of facial affect recognition (primary outcome measure) and questionnaires to assess quality of life and emotional functioning (secondary outcome measures). We hypothesized that improvements in facial affect recognition skills would be observed following treatment. We also examined changes to quality of life and social functioning. Changes in outcome measures were analyzed using a mixed-method analysis of variance.The treatment group showed significantly improved facial affect recognition skills relative to the placebo group post-treatment, F(1,34)=5.91, p=.022, partial ꞃEMOPRINT is effective for improving facial affect recognition skills in MS.

ObjectiveFatigue is commonly thought to worsen with age, but the literature is mixed: some studies show that older individuals experience more fatigue, others report the reverse. Some inconsistencies in the literature may be related to gender differences in fatigue while others may be due to differences in the instruments used to study fatigue, since the correlation between state (in the moment) and trait (over an extended period of time) measures of fatigue has been shown to be weak. The purpose of the current study was to examine both state and trait fatigue across age and gender using neuroimaging and self-report data.MethodsWe investigated the effects of age and gender in 43 healthy individuals on self-reported fatigue using the Modified Fatigue Impact Scale (MFIS), a measure of trait fatigue. We also conducted fMRI scans on these individuals and collected self-reported measures of state fatigue using the visual analog scale of fatigue (VAS-F) during a fatiguing task.ResultsThere was no correlation between age and total MFIS score (trait fatigue) (r = –0.029, p = 0.873), nor was there an effect of gender [F(1,31) < 1]. However, for state fatigue, increasing age was associated with less fatigue [F(1,35) = 9.19, p < 0.01, coefficient = –0.4]. In the neuroimaging data, age interacted with VAS-F in the middle frontal gyrus. In younger individuals (20–32), more activation was associated with less fatigue, for individuals aged 33–48 there was no relationship, and for older individuals (55+) more activation was associated with more fatigue. Gender also interacted with VAS-F in several areas including the orbital, middle, and inferior frontal gyri. For women, more activation was associated with less fatigue while for men, more activation was associated with more fatigue.ConclusionOlder individuals reported less fatigue during task performance (state measures). The neuroimaging data indicate that the role of middle frontal areas change across age: younger individuals may use these areas to combat fatigue, but this is not the case with older individuals. Moreover, these results may suggest greater resilience in females than males when faced with a fatiguing task.

Background: The COVID-19 pandemic provided a unique opportunity to explore the impact of the mandated lockdown and social distancing policies on engagement in daily occupations for individuals with multiple sclerosis (MS) and able bodied (i.e. healthy) adults. The study also examined whether the changes in daily occupations were associated with health-related quality of life (HrQOL). Methods: Between the spring and early fall of 2020, 69 persons with MS and 95 healthy adults completed an online survey that included measurements of 26 activities of daily life. For each activity, participants reported whether they continued to perform the activity (with or without adjustments), whether they stopped, or started to perform the activity during the pandemic. Social support, HrQOL, and demographics, including financial distress were also obtained. Results: Participants with MS and healthy adults both reduced the number of activities performed during the pandemic. Healthy adults continued to do more activities with and without adjustments compared with participants with MS. In both groups, better HrQOL was associated with the number of activities participants continued to do with and without adjustments, and worse HrQOL with the number of activities they stopped doing. Conclusions: Fewer persons with MS engaged in everyday occupations than healthy adults following the COVID-19 pandemic. The ability to maintain occupational engagement and to participate in social and daily activities is important for maintaining high HrQOL in both groups. Thus, these results call for attention in treatment and self-management of MS symptomatology.

Over a third of people with Multiple Sclerosis (PwMS) struggle with poor mental health, which exacerbates physical symptoms and complicates clinical treatment. To address this, we tested the efficacy of an interpersonal emotion regulation intervention: this intervention seeks to improve mental health by teaching participants to use emotion regulation strategies which leverage social support (e.g., reaching out to others for comfort when experiencing a stressful event).Nineteen PwMS completed this prospective, blinded randomized controlled trial (intervention n = 10; control n = 9). Intervention participants met with an interventionist over six weeks to discuss their emotional challenges and develop goals to use interpersonal emotion regulation strategies. Participants in the control condition met with the interventionist on the same schedule but their emotion regulation strategies were only measured and not manipulated. Pre-registered primary outcomes were self-reported depression, stress, and quality of life (QoL). The pre-registered secondary outcome was self-reported social support.Intervention participants' depression scores improved from time 1 to time 2 (mean difference=3.60, 95% CI [0.44-6.76]), yet remained unchanged for the control group (mean difference=-1.67, 95% CI [-5.00-1.67], overall interaction, F(1,17)=5.84, p=.027, ηInterpersonal emotion regulation is beneficial in improving depression in PwMS. Consequently, these strategies can be implemented in conjunction with existing mental health treatments in a holistic approach to improving well-being.

Objective The current study examined healthcare disruptions and use of telehealth services among persons with multiple sclerosis (pwMS) during the coronavirus disease 2019 (COVID-19) pandemic. Design Cross-sectional survey. Setting General community. Participants Seventy pwMS and 93 healthy controls (HCs). The majority of respondents were from the United States (U.S.; 88%). Interventions Not applicable. Main Outcome Measure(s) Rates of healthcare disruptions (e.g., missing/canceling appointments, experiencing delays) and telehealth use for MS and non-MS medical care and mental healthcare. Results In this U.S.-majority, predominantly white and high socioeconomic status sample, 38-50% of pwMS reported experiencing disruptions in their MS and non-MS medical care and 20-33% reported disruptions in their mental healthcare, which were significantly lower than those observed among HCs. Compared to HCs, pwMS were more likely to utilize telehealth than in-person services, especially for mental healthcare. The majority of pwMS and HCs reported being satisfied with telehealth services. Individuals with higher degrees of functional limitation experienced more healthcare disruptions and were more likely to utilize telehealth services than individuals with lower degrees of functional limitation. Conclusions Despite high healthcare disruption rates, pwMS frequently utilized and were highly satisfied with telehealth services during the COVID-19 pandemic. Due to physical limitations commonly observed in the MS population which may preclude travel, telehealth services should be continued even after resolution of the pandemic, in order to expand access and reduce healthcare disparities.

Objective:Social cognitive deficits are an important consequence of multiple sclerosis (MS), yet our understanding of how these deficits manifest in progressive MS is currently limited. To this end, we examined theory of mind (ToM) ability in a sample of individuals with progressive MS using an ecologically valid virtual assessment tool that allows for delineation of cognitive ToM (inferring thoughts and intentions of others) from affective ToM (inferring emotions of others).Methods & Results:We compared 15 individuals with progressive MS and 15 healthy controls on their ToM ability using the Virtual Assessment of Mentalising Ability. We found that, relative to healthy controls, participants with progressive MS were impaired in cognitive ToM, but not in affective ToM. Furthermore, we found that the MS participants’ deficits in cognitive ToM were mediated by their general cognitive ability such that poor cognitive ToM ability in MS was explained by poor performance on tests of memory and processing speed.Conclusions:Our findings demonstrate that ToM deficits in progressive MS may be limited to cognitive ToM, while affective ToM is conserved. This could be attributable to the MS-related deficits in general cognitive ability, which appear to negatively affect only the cognitive component of ToM.

Objective: Individuals with traumatic brain injury (TBI) can experience social isolation, which is damaging to well-being and counterproductive to successful rehabilitation. It has been proposed that social cognitive deficits that commonly result from TBI may contribute to weakened social integration. However, the consequences of specific social cognitive deficits in TBI are still being delineated. The current work sought to better characterize the relationship between community integration and facial affect recognition (FAR) in TBI. Participants and Methods: A total of 27 participants with moderate to severe TBI and 30 healthy controls (HCs) completed two tests of FAR, which employed either static photographic stimuli or dynamic video stimuli (The Awareness of Social Inference Test). The Community Integration Questionnaire was also administered to participants. Results: Participants with TBI were significantly impaired on both the static and dynamic FAR measures, yet the deficits were most pronounced within the dynamic task. Furthermore, participants with TBI reported lower community integration compared with HCs. FAR was positively associated with community integration in both groups, such that participants with proficient affect recognition skills were better integrated into their communities. Conclusions: FAR deficits may contribute to the lack of community integration often observed in TBI; thus, interventions designed to improve FAR may be beneficial to this population’s ability to successfully reintegrate into society.

Emerging research indicates that in addition to physical and cognitive deficits, individuals with multiple sclerosis (MS) may also have impairments in social cognition, such as facial affect recognition and Theory of Mind (ToM). However, there is little research into how social cognition impairments relate to other domains in MS, such as mood and fatigue levels. The current study investigated whether social cognitive ability is associated with fatigue, depressive symptoms and anxiety in MS. Twenty-eight individuals with MS completed questionnaires assessing fatigue (Modified Fatigue Impact Scale), depression (Beck Depression Inventory) and anxiety (State-Trait Anxiety Inventory), as well as tasks of facial affect recognition and ToM (Reading the Mind in the Eyes; Strange Stories). Bivariate correlations were run to examine relationships between variables; partial correlations were subsequently used to ascertain whether these relationships persisted after controlling for cognitive ability (measured with the Symbol Digit Modalities Test). The results indicated that worse performance in both facial affect recognition and ToM were associated with higher rates of psychosocial fatigue, depressive symptoms, and anxiety levels; furthermore, these relationships were not explained by participants' cognitive ability. These preliminary results help us better understand the association between social cognitive abilities and other symptoms in MS, including depressive symptomatology, anxiety and fatigue.

Background and Objective: Changes in cerebral white matter organization have been documented in acute phases of recovery from traumatic brain injury (TBI). However, little is known about reorganiza...

Social cognition (SC) can be impaired in multiple sclerosis (MS) patients; however, most studies have not controlled for generalized cognitive impairment (CI), nor have they examined the role of the amygdala using advanced structural neuroimaging. Whether deficits in SC occur in the disease even before the concomitant manifestation of CI, with a specific interest in the role of bilateral amygdala.In this study, we enrolled 31 RRMS patients and 38 healthy controls (HC). SC was examined with the Reading the Mind in the Eyes (RME), a task of facial affect recognition (FAR), and the empathy quotient (EQ). 3T MRI scans were obtained for all patients with special interest in quantifying amygdala lesions by cortical lesion volume (CLV) estimation.The results showed that the RRMS group did worse as compared to HC in the RME (p .001), the FAR task (p = .001), and the EQ (p = .022). Patients had mainly difficulties in recognition the negative emotions of fear (p .001) and anger (p = .036). Finally, CLV of bilateral amygdala was a significant predictor of RME (p .001) and FAR (p = .005).We conclude that SC can be impaired in several domains in RRMS patients even in the absence of CI and that it is related specifically to bilateral amygdala damage as measured by CLV.

Social cognition (SC) has become a topic of widespread interest in the last decade. SC deficits were described in multiple sclerosis (MS) patients, in association with amygdala lesions, even in those without formal cognitive impairment. In this 3-year follow-up study, we aimed at longitudinally investigating the evolution of SC deficits and amygdala damage in a group of cognitive-normal MS patients, and the association between SC and psychological well-being. After 3 years (T3) from the baseline examination (T0), 26 relapsing-remitting MS patients (RRMS) were retested with a neuropsychological battery and SC tasks (theory of mind, facial emotion recognition, empathy). A SC composite score (SCcomp) was calculated for each patient. Emotional state, fatigue, and quality of life (QoL) were also evaluated. RRMS patients at T3 underwent a 3T-MRI as performed at T0, from which were calculated both volume and cortical lesion volume (CLV) of the amygdalae. Compared to T0, at T3 all RRMS patients were still cognitive-normal and remained stable in their global SC impaired performance. At T0, SCcomp correlated with amygdala CLV (p = 0.002) while, at T3, was more associated with amygdala volume (p = 0.035) rather than amygdala CLV (p = 0.043). SCcomp change T3-T0 correlated with global emotional state (p = 0.043), depression (p = 0.046), anxiety (p = 0.034), fatigue (p = 0.025), and QoL-social functioning (p = 0.033). We showed the longitudinal stability of SC deficits in cognitive-normal RRMS patients, mirroring the amygdala structural damage and the psychological well-being. These results highlight that SC exerts a key role in MS.

This chapter provides a review of the emotional and psychosocial consequences of moderate to severe traumatic brain injury (TBI). Many of the disorders affecting socioemotional function arise from damage to frontotemporal systems, exacerbated by white matter injury. They include disorders of social cognition, such as the ability to recognize emotions in others, the ability to attribute mental states to others, and the ability to experience empathy. Patients with TBI also often have disorders of emotion regulation. Disorders of drive or apathy can manifest across cognitive, emotional, and behavioral domains. Likewise, disorders of control can lead to dysregulated emotions and behavior. Other disorders, such as loss of self-awareness, are also implicated in poor psychosocial recovery. Finally, this chapter overviews psychiatric disorders associated with TBI, especially anxiety and depression. For each kind of disorder, the nature of the disorder and its prevalence, as well as theoretical considerations and impact on every day functions, are reviewed.

Cognitive fatigue is common and debilitating among persons with multiple sclerosis (pwMS). Neural mechanisms underlying fatigue are not well understood, which results in lack of adequate treatment. The current study examined cognitive fatigue-related functional connectivity among 26 pwMS and 14 demographically matched healthy controls (HCs). Participants underwent functional magnetic resonance imaging (fMRI) scanning while performing a working memory task (n-back), with two conditions: one with higher cognitive load (2-back) to induce fatigue and one with lower cognitive load (0-back) as a control condition. Task-independent residual functional connectivity was assessed, with seeds in brain regions previously implicated in cognitive fatigue (dorsolateral prefrontal cortex (DLPFC), ventromedial prefrontal cortex (vmPFC), dorsal anterior cingulate cortex (dACC), insula, and striatum). Cognitive fatigue was measured using the Visual Analogue Scale of Fatigue (VAS-F). Results indicated that as VAS-F scores increased, HCs showed increased residual functional connectivity between the striatum and the vmPFC (crucial in reward processing) during the 2-back condition compared to the 0-back condition. In contrast, pwMS displayed increased residual functional connectivity from interoceptive hubs&mdash, the insula and the dACC&mdash, to the striatum. In conclusion, pwMS showed a hyperconnectivity within the interoceptive network and disconnection within the reward circuitry when experiencing cognitive fatigue.

The global burden of mortality and morbidity caused by traumatic brain injury (TBI) is significant, and the heterogeneity of TBI patients and the relatively small sample sizes of most current neuroimaging studies is a major challenge for scientific advances and clinical translation. The ENIGMA (Enhancing NeuroImaging Genetics through Meta-Analysis) Adult moderate/severe TBI (AMS-TBI) working group aims to be a driving force for new discoveries in AMS-TBI by providing researchers world-wide with an effective framework and platform for large-scale cross-border collaboration and data sharing. Based on the principles of transparency, rigor, reproducibility and collaboration, we will facilitate the development and dissemination of multiscale and big data analysis pipelines for harmonized analyses in AMS-TBI using structural and functional neuroimaging in combination with non-imaging biomarkers, genetics, as well as clinical and behavioral measures. Ultimately, we will offer investigators an unprecedented opportunity to test important hypotheses about recovery and morbidity in AMS-TBI by taking advantage of our robust methods for large-scale neuroimaging data analysis. In this consensus statement we outline the working group’s short-term, intermediate, and long-term goals. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

Background: Multiple sclerosis (MS) results in impairments in cognitive and motor skills, which may reduce the level of activity participation in people with MS. This study compares past and current levels of activity participation in adults with MS and controls. The relationship between retained activity participation (since diagnosis) and cognitive, motor, functional status, and depression symptoms of persons with MS was examined. Methods: Twenty-seven individuals with MS living in the community and 21 controls completed cognitive and motor tests and rated their activity participation (using the Activity Card Sort), depression symptoms, and functional status. Results: The MS group reported significantly lower current activity participation than the control group. Percentage of retained activity participation (from prediagnosis to current) in the MS group correlated with time since diagnosis, executive function and motor skill ability, depression symptoms, and current functional status. Conclusions: Persons with MS report negative changes in activity participation in most aspects of life after diagnosis. These findings call attention to changes in activity participation in people with MS that are directly related to disease symptoms. Therefore, using a quantitative measure of activity participation—the Activity Card Sort—can provide important information to aid the clinician in developing individualized treatment goals for people with MS.

Objective:Individuals with multiple sclerosis (MS) can have difficulty on tasks requiring social cognition, including Theory of Mind (ToM) and facial affect recognition. However, most research on social cognition in MS has focused on Relapsing–Remitting MS; less is known about deficits in individuals with progressive MS. This pilot study examined the social cognitive abilities of individuals with progressive MS on a dynamic social cognition task: The Awareness of Social Inference Test – Short Form (TASIT-S).Methods:Fifteen individuals with progressive MS and 17 healthy controls performed TASIT-S, which includes 3 subtests assessing facial affect recognition and ToM.Results:The MS group was impaired on all subtests of TASIT-S, including Emotion Evaluation, Social Inference – Minimal, and Social Inference – Enriched, which examine facial affect recognition and ToM. Deficits on TASIT-S were significantly correlated with several cognitive abilities including working memory, learning memory, and verbal IQ.Conclusions:Our findings suggest individuals with progressive MS were impaired across multiple social cognition domains as assessed by the TASIT-S. Furthermore, social cognitive abilities were related to cognitive abilities such as visuospatial memory and executive abilities. Results are discussed in terms of social cognition deficits in MS and how they relate to cognitive abilities.

Our objective was to determine differences in brain activation during a processing-speed task in individuals with SCI compared to a group of age-matched healthy controls and to a group of older healthy controls. Ten individuals with cervical SCI (C3–C5), 10 age-matched healthy controls and 10 older healthy controls participated in a cross-sectional study in which performance on neuropsychological tests of processing speed and brain activation were the main outcome measures. The brain areas used by the individuals with SCI during the processing-speed task differed significantly from the age-matched healthy controls, but were similar to the older control cohort, and included activation in frontal, parietal and hippocampal areas. This suggests that individuals with SCI may compensate for processing-speed deficits by relying on brain regions that classically support control cognitive processes such as executive control and memory.

Multiple sclerosis is a neurological disease which has a significant deleterious impact in both cognitive and motor functions. Cognitive rehabilitation studies have increased steadily over the past 20 years, showing significant improvements in cognitive functioning with treatment. However, relatively few of these studies have included neuroimaging techniques to examine the neural mechanisms of treatment effectiveness following cognitive rehabilitation. The few that have been conducted however have generally shown a positive relationship between increased brain activation and/or connectivity on MRI and treatment effectiveness. The preliminary uses of new neuroimaging techniques, such as transcranial magnetic stimulation and transcranial direct stimulation, have also been positive, but still need to be refined and studied further. New approaches such as real-time fMRI may provide additional tools, which may further help to understand the mechanisms associated with treatment effectiveness and neural plasticity. In the end, the discovery of mechanisms associated with effective cognitive rehabilitation may help guide our understanding of which treatments may be best for improving the quality of life of persons with MS.

Objective To explore the added value of dynamic functional connectivity (dFC) of the default mode network (DMN) during resting-state (RS), during an information processing speed (IPS) task, and the within-subject difference between these conditions, on top of conventional brain measures in explaining IPS in people with multiple sclerosis (pwMS). Methods In 29 pwMS and 18 healthy controls, IPS was assessed with the Letter Digit Substitution Test and Stroop Card I and combined into an IPS-composite score. White matter (WM), grey matter (GM) and lesion volume were measured using 3 T MRI. WM integrity was assessed with diffusion tensor imaging. During RS and task-state fMRI (i.e. symbol digit modalities task, IPS), stationary functional connectivity (sFC; average connectivity over the entire time series) and dFC (variation in connectivity using a sliding window approach) of the DMN was calculated, as well as the difference between both conditions (i.e. task-state minus RS; ΔsFC-DMN and ΔdFC-DMN). Regression analysis was performed to determine the most important predictors for IPS. Results Compared to controls, pwMS performed worse on IPS-composite (p = 0.022), had lower GM volume (p, Highlights • Problems with information processing speed occur often in multiple sclerosis (MS) • Dynamics in brain communication can reflect information transfer within the brain • With fMRI, dynamic communication can be measured, which increases upon task demands • This increase in dynamics explains information processing speed in MS

Background Adolescents on the autism spectrum may have difficulty obtaining and maintaining employment. One particular obstacle for adolescents on the autism spectrum is the job interview. The purpose of the current pilot randomized controlled trial is to examine the preliminary effectiveness and feasibility of a virtual reality job interview tool (VR-JIT) in improving job interview performance in adolescents on the autism spectrum. Method The study was implemented in a high school setting. Fourteen adolescents on the autism spectrum were randomly divided into two groups: an experimental group (n = 7) and a services as usual (SAU) control group (n = 7). The intervention group received 10 h of VR-JIT, which includes interviewing with a virtual human and receiving feedback. All participants performed a video-recorded mock job interview at pre-test and post-test, which was rated by blinded assessors to track interview skills. Students filled out questionnaires related to job interviewing anxiety and self-efficacy pre- and post- intervention. Feasibility metrics were recorded as well. Results Repeated Measures ANOVA revealed improved a metric of job interview performance in the experimental group following the intervention compared to the control group, indicated by medium to large effect sizes. However, perceptions of anxiety and self-efficacy did not improve following the intervention. Students reported that the intervention was easy to use and enjoyable. Conclusions The current pilot study indicates preliminary evidence of the VR-JIT’s effectiveness in improving measures of job interview performance in adolescents on the autism spectrum, even though their own perceptions did not improve. Importantly, the VR-JIT intervention was implemented in a school setting, demonstrating feasibility in its adoption as part of curriculum to help improve employment outcomes in transition age youth on the autism spectrum.

Research Objectives To examine psychometric properties of a COVID-19 Impact Scale among individuals with disabilities. Design Cross-sectional analysis. Setting Web-based survey. Participants A sample of 418 individuals with multiple sclerosis (62.68%), traumatic brain injury (n=15.07%), and spinal cord injury (22.25%) completed a survey about experiences during the COVID-19 pandemic. The sample was 71.01% female. Ages ranged from 21-84 (M=52.00, SD=11.56). Interventions Not Applicable. Main Outcome Measures COVID-19: Impact of the Pandemic and Health Related Quality of Life (Penedo, Cohen, Bower, & Antoni, 2020). Analysis was restricted to the Psychosocial and Practical Experiences portion of the questionnaire, which yields a Total Measure Score representing overall impact of the pandemic and has three subscales (Distress, Disruption, and Resiliency). Results Principal components analysis of Rasch residuals demonstrated lack of unidimensionality for the overall Total Measure Score. Therefore, subscales were analyzed separately, each showing satisfactory internal consistency (Cronbach's alpha>0.80). The person separation index was 2.48 for Distress, 2.00 for Disruption, and 1.88 for Resiliency. Infit mean square values and corrected item-total correlations were satisfactory for all items on the Distress subscale. However, two items on Disruption and two on Resiliency had corrected item-total correlations < 0.30 and/or infit mean square values>1.30. Conclusions The three subscales on the COVID-19 impact scale had good internal consistency reliability and could differentiate the sample into at least two levels on their respective constructs. Two items referring to pandemic-related practices of health care providers showed poor fit on the Disruption subscale, and items referring to acceptance and the ability to provide others with instrumental social support showed poor fit on the Resiliency subscale. Overall, the study suggests that the instrument provides a reliable indicator of various levels of COVID impact in clinical samples with neurological disabilities. Author(s) Disclosures All authors have no conflicts of interest to declare.

Background: Difficulties in learning and memory are among the most persistent and frequently reported cognitive symptoms in individuals with multiple sclerosis (MS). Objective: To examine the efficacy of the self-generation learning program ( self-GEN trial) that consist of behavioral intervention sessions, teaching self-generation technique while using metacognitive strategies to improve learning and memory abilities in persons with MS. Additionally, the treatment aimed to address generalization of the treatment to activities of daily living. Methods: This double-blind, placebo-controlled, randomized clinical trial included 35 participants with clinically definite MS, 19 in the treatment group and 16 in the placebo control group. Participants completed a baseline neuropsychological assessment, including questionnaires assessing everyday memory and a repeat assessment immediately post-treatment. Results: The treatment group showed significantly improved learning and memory, self-regulation, and metacognition relative to the placebo post-treatment. Similar results were noted on measures of depression, functional status, and quality of life (QOL). Conclusion: This study provides initial Class I evidence that the self-GEN behavioral intervention improves memory, self-regulation, functional status, affective symptomatology, and QOL in patients with MS.

Gulf War Illness (GWI) is a chronic, multi-symptom illness that affects approximately 25% of Gulf veterans, with cognitive fatigue as one of its primary symptoms. Here, we investigated the neural networks associated with cognitive fatigue in GWI by asking 35 veterans with GWI and 25 healthy control subjects to perform a series of fatiguing tasks while in the MRI scanner. Two types of cognitive fatigue were assessed: state fatigue, which is the fatigue that developed as the tasks were completed, and trait fatigue, or one's propensity to experience fatigue when assessed over several weeks. Our results showed that the neural networks associated with state and trait fatigue differed. Irrespective of group, the network underlying trait fatigue included areas associated with memory whereas the neural network associated with state fatigue included key areas of a fronto-striatal-thalamic circuit that has been implicated in fatigue in other populations. As in other investigations of fatigue, the caudate of the basal ganglia was implicated in fatigue. Furthermore, individuals with GWI showed greater activation than the HC group in frontal and parietal areas for the less difficult task. This suggests that an inability to modulate brain activation as task demands change may underlie fatigue in GWI., Highlights • Fatigue-related brain activation can be induced and measured in veterans with GWI. • A network of brain areas was associated with cognitive fatigue during a working memory task. • The fatigue network included the basal ganglia, prefrontal and parietal areas. • Persistent activation in frontal and parietal areas in the GWI group suggests dysregulation of the cognitive control network.