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Objective: The aim of this study was to assess whether self-report scales and neuropsychological tests used for adult patients with ADHD can help to distinguish between ADHD-specific and depressive symptoms. Method: In a cross-sectional design, differences in self-report questionnaires and neuropsychological tests among clinical subgroups and healthy controls (HC) were evaluated. Patients in clinical groups were diagnosed with major depressive disorder (MDD) or ADHD with or without depressive symptoms according to Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV ) guidelines. Results: The Hyperactivity subscales of the Conners' Adult ADHD Rating Scale (CAARS) differed between MDD and ADHD, whereas self-concept and inattention scales even distinguished comorbidity subgroups within the ADHD population. A reduced alertness and higher variations in reaction times measured by performance tests indicated problems in sustained attention in ADHD patients compared with HC. Conclusion: The diagnostic process of ADHD, and thereby the distinction from other symptom-overlapping, comorbid mental disorders, might be improved by utilizing ADHD-specific self-report questionnaires and neuropsychological tests, which are short, cost-effective, and standardized screening methods.

Objective: Models of ADHD consider the influence of situational factors on cognitive performance and symptoms. Method: The influence of acute physical exercise, stimulation through continuous fine motor movement, and performance-related reward on performance and ADHD symptoms was assessed. Thirty-six adults with ADHD and 36 healthy controls performed executive function tasks (EF-tasks) of inhibition, selective attention, and working memory with material close to daily life. Experimental manipulations aimed at increasing cognitive performance. Results: No significant effects were found, but there were indicators for ADHD-specific impacts: Reward resulted in higher reported hyperactivity. Acute physical exercise slightly tended to improve attention performance and subjective inattention. Conclusion: The manipulations may affect performance and especially symptoms in different ways. Potential symptom interactions and identification of factors that determine whether symptoms may be functional or detrimental for task performance could be future research interests.

EEG studies have shown that adult ADHD patients have less stable brain arousal regulation than age and gender matched controls. Psychostimulants have brain arousal stabilising properties evident in EEG patterns. The aim of this study was to investigate whether the stability of brain arousal regulation has prognostic value in predicting response to methylphenidate therapy in adult ADHD patients. In an open-label, single-arm, multi-centre, confirmatory trial, 121 adult ADHD patients were recruited and 112 qualified for the full analysis set. All participants received an initial dose of 20 mg extended release methylphenidate at baseline. After a titration phase of up to 4 weeks, patients remained on a weight-based target dose of extended release methylphenidate for 4 weeks. Using the Vigilance Algorithm Leipzig (VIGALL 2.1), we assessed brain arousal regulation before the treatment with methylphenidate, based on a 15-min EEG at quiet rest recorded at baseline. Using automatic stage-classification of 1 s segments, we computed the mean EEG-vigilance (indexing arousal level) and an arousal stability score (indexing arousal regulation). The primary endpoint was the association between successful therapy, defined by a 30% reduction in CAARS, and stable/unstable brain arousal. 52 patients (46%) showed an unstable brain arousal regulation of which 23% had therapy success. In the stable group, 35% had therapy success, implying an absolute difference of 12 percentage points (95% CI -5 to 29, p = 0.17) in the direction opposite to the hypothesized one. There were no new findings regarding the tolerability and safety of extended release methylphenidate therapy., Competing Interests: Declaration of Competing Interest MS has received speaker fees from Lilly, Medice Arzneimitte Pütter GmbH & Co. KG and Servier and was an advisory board member for Shire/Takeda. AR has received speaker's honoraria and/or served on advisory boards for Medice, Shire/Takeda, Janssen, neuraxpharm, Sevier and SAGE. SKS received author's, speaker's and consultant's honoraria from Medice MEDICE Arzneimittel Pütter GmbH & Co. KG and Shire/Takeda. EA was an advisory board member for Shire/Takeda. JG has received research funding from the German Federal Ministry of Education and Research, German Science Foundation, and speaker fees from Sanofi, Lundbeck, Janssen-Cilag, Lilly and Otsuka. UH has received funding from Medice Arzneimittel Pütter GmbH & Co. KG and was a consultant for Medice Arzneimittel Pütter GmbH & Co. KG and an advisory board member for Janssen-Cilag. The other authors do not report any possible conflicts of interest., (Copyright © 2020 Elsevier B.V. and ECNP. All rights reserved.)

We investigated whether baseline brain arousal instability during resting state EEG, using the Vigilance Algorithm Leipzig (VIGALL 2.1), can predict response to methylphenidate therapy in adult ADHD patients. An arousal stability score of the EEGs of 28 adult ADHD patients was calculated quantifying the extent of arousal decline. In logistic regression analysis, arousal stability score predicted response to MPH [odds ratio 1.28 (95% CI 1.0-1.65); p = 0.027]. In this pilot study, we demonstrated that arousal stability at baseline predicted methylphenidate treatment response, indicating that less stable arousal regulation during a 15-min EEG at rest increases the chance of treatment response.

Introduction: The aim of this study was to assess cognitive differences between male and female adults with Attention Deficit Hyperactivity Disorder (ADHD)., Methods: Patients with an ADHD diagnosis according to the DSM-IV guidelines were included in a cross-sectional study evaluating cognitive measures. 28 women and 41 men from ages 19 to 56 completed self-report questionnaires and performed a computer-based test of attentional performance (TAP). The TAP assesses cognitive functions highly affected in ADHD patients, including working memory, alertness and attention as well as behavioral control and response inhibition., Results: There were no measurable differences in self-report scales assessing current symptomology between the sexes, however men scored higher on the scale for childhood symptoms. Performance measures for general wakefulness were comparable between men and women, while working memory and behavioral control test results differed. Females reacted significantly slower and more unstable for both the TAP Go/NoGo paradigm and working memory subtest, while also making more errors in the latter., Conclusions: We found gender-specific effects regarding working memory and behavioral control in this sample of adult patients with ADHD. Further studies are warranted, examining whether these differences relate to differences in clinical presentation and comorbidity patterns between men and women., Competing Interests: The authors have declared that no competing interests exist.

Introduction: Self-reported cognitive deficits in adult Attention-Deficit/Hyperactivity-Disorder (ADHD) are often not corroborated by standardized tests. Tests and reports also differ in their correspondence to aspects of psychosocial functioning. Executive function tasks (EF-tasks) using material close to daily life, may provide a more ecologically-valid assessment of cognitive deficits., Method: 36 adults with ADHD and 36 healthy controls performed standardized EF-tasks and corresponding EF-tasks using material close to daily life and gave self-reports on cognitive functioning. The study investigated performance differences and the predictive utility of cognitive measures for psychosocial functioning., Results: While all the self-reports showed substantial cognitive impairments for the ADHD group, this was only shown in some of task measures. For two domains, the deficits in EF-tasks with material close to daily life were similar or smaller than assessed with traditional measures. However, three tasks, which used material of daily life, revealed more deficits than the corresponding more standardized tasks. Beyond cognitive self-reports the new tasks did not contribute substantial to psychosocial functioning, similar to the standardized tasks., Conclusions: Tasks using material close to daily life have the potential to objectify reported everyday life deficits better than more standardized tests, at least in single EF-domains. When relevant methodical aspects of these tasks will be more targeted and considered systematically in future research, the tasks might contribute to assessments of psychosocial functioning. Then they could also be used as outcome measures in intervention studies.

A growing body of evidence indicates the role of melatonin (MT) in the pathogenesis of multiple sclerosis (MS): It modulates immune function, alleviates oxidative stress and it is linked to seasonality of MS relapse. This report addresses the potential clinical relevance of circadian MT rhythms in relapsing-remitting MS (RRMS) patients. The study sample comprised of fifty-five RRMS patients and fifty age- and sex-matched healthy control (HC) subjects. Circadian salivary MT was measured non-invasively at 12 time points over day in participants' home environment. 6-Hydroxy-melatoninsulfate (MT sulfate) concentration in night-time urine was assessed as an estimate for nocturnal MT. Ratings for neurological disability, health-related quality of life (HrQoL), fatigue, depressive symptoms and sleep patterns were additionally obtained. There was no evidence for an overall disturbed MT rhythm in RRMS patients. However, lower MT levels within the first hour after awakening were associated with longer disease duration. MT levels only correlated moderately with neurological disability. Sleep disruptions were more common in patients than in controls and were associated with lower nocturnal MT sulfate levels. MT also correlated moderately with fatigue and HrQoL. We did not find evidence for a generally disturbed circadian MT rhythm in RRMS patients but longer disease duration was associated with significantly lower MT levels. Moreover, MT correlated with a series of clinical features. The exact nature of this relationship remains unclear and future studies are needed in order to determine whether MT could serve as a potential therapeutic target in MS. KEY MESSAGES: Melatonin acts as a free radical scavenger and modulates immune function. In multiple sclerosis, low melatonin levels were associated with acute exacerbations. Melatonin levels are not generally disturbed in multiple sclerosis patients. But lower levels are associated with disease duration and clinical aspects. Salivary melatonin after awakening might serve as a good measure of melatonin.

The main aim of the current study was to test the hypothesis that adult patients with attention-deficit/hyperactivity disorder (ADHD) have less stable brain arousal regulation than healthy controls. We objectively assessed brain arousal regulation using the Vigilance Algorithm Leipzig (VIGALL 2.1) to analyze 15-min resting EEG data of thirty-three ADHD patients and thirty-five matched controls. Based on automatically classified 1-s segments we computed mean EEG-vigilance (indexing arousal level) and arousal stability score (indexing arousal regulation). Adult ADHD patients showed significantly lower arousal levels and significantly less stable brain arousal regulation than controls. Multiple regression analysis indicated that arousal regulation (i.e., arousal stability score) predicted the retrospectively-assessed severity of childhood ADHD symptoms, supporting the trait aspect of brain arousal regulation. Our findings support the arousal regulation model of ADHD, which interprets hyperactivity and sensation seeking as an autoregulatory reaction to an unstable regulation of brain arousal. EEG-based arousal parameters may be candidate biomarkers for adult ADHD., (Copyright © 2017 Elsevier B.V. All rights reserved.)

The monitoring of cognitive functions is central to the assessment and consecutive management of multiple sclerosis (MS). Though, especially cognitive processes that are central to everyday behavior like dual-tasking are often neglected. We examined dual-task performance using a psychological-refractory period (PRP) task in N = 21 patients and healthy controls and conducted standard neuropsychological tests. In dual-tasking, MS patients committed more erroneous responses when dual-tasking was difficult. In easier conditions, performance of MS patients did not differ to controls. Interestingly, the response times were generally not affected by the difficulty of the dual task, showing that the deficits observed do not reflect simple motor deficits or deficits in information processing speed but point out deficits in executive control functions and response selection in particular. Effect sizes were considerably large with d ∼0.80 in mild affected patients and the achieved power was above 99%. There are cognitive control and dual tasking deficits in MS that are not attributable to simple motor speed deficits. Scaling of the difficulty of dual-tasking makes the test applied suitable for a wide variety of MS-patients and may complement neuropsychological assessments in clinical care and research setting.

Background: Multiple sclerosis (MS) patients suffer very often from MS fatigue and sleep problems. Despite the detrimental impact on the activities of daily living, a short and objective quantification of fatigue and sleep problems is currently lacking., Objective: The objective of the study was to systematically investigate tonic, intrinsic, and phasic alertness and the relationship of these performance-based measures with self-report measures of fatigue and quality of sleep., Methods: Thirty-three MS patients without (MS-) and 26 with selected comorbid disorders (MS+) and 43 healthy controls (HCs) performed the pupillographic sleepiness test (measuring tonic alertness) and the alertness subtest of the Test of Attentional Performance (measuring intrinsic and phasic alertness)., Results: Self-reported and performance-based measures revealed poorer performance for both MS groups compared to HC. MS+ patients presented higher rates of MS fatigue, sleep problems and depressive symptoms but similar alertness scores compared to MS- patients. However, tonic alertness was only higher in MS- patients compared to HC. Intrinsic and phasic alertness correlated moderately with fatigue ratings., Conclusion: In the diagnostic process of MS fatigue and quality of sleep comorbid disorders (depression, anemia, thyroid dysfunction) and performance-based measures such as alertness should be considered in daily clinical practice.

Previous dual-task picture-naming studies suggest that lexical processes require capacity-limited processes and prevent other tasks to be carried out in parallel. However, studies involving the processing of multiple pictures suggest that parallel lexical processing is possible. The present study investigated the specific costs that may arise when such parallel processing occurs. We used a novel dual-task paradigm by presenting 2 visual objects associated with different tasks and manipulating between-task similarity. With high similarity, a picture-naming task (T1) was combined with a phoneme-decision task (T2), so that lexical processes were shared across tasks. With low similarity, picture-naming was combined with a size-decision T2 (nonshared lexical processes). In Experiment 1, we found that a manipulation of lexical processes (lexical frequency of T1 object name) showed an additive propagation with low between-task similarity and an overadditive propagation with high between-task similarity. Experiment 2 replicated this differential forward propagation of the lexical effect and showed that it disappeared with longer stimulus onset asynchronies. Moreover, both experiments showed backward crosstalk, indexed as worse T1 performance with high between-task similarity compared with low similarity. Together, these findings suggest that conditions of high between-task similarity can lead to parallel lexical processing in both tasks, which, however, does not result in benefits but rather in extra performance costs. These costs can be attributed to crosstalk based on the dual-task binding problem arising from parallel processing. Hence, the present study reveals that capacity-limited lexical processing can run in parallel across dual tasks but only at the expense of extraordinary high costs., ((c) 2015 APA, all rights reserved).)