A promising cognitive screener in multiple sclerosis: The NIH toolbox cognition battery concords with gold standard neuropsychological measures.

BACKGROUND: Routine cognitive screening is a priority in MS clinical care. The National Institutes of Health Toolbox (NIHTB) Cognition Battery is a 30-min instrument validated in neurological populations excluding MS. OBJECTIVES: To assess construct validity of NIHTB tests and compare classification of cognitive impairment with gold-standard tests. To evaluate relationships between fluid cognition and clinical measures. METHODS: Eighty-seven individuals, aged 30-59 years, completed the NIHTB, Minimal Assessment of Cognitive Function in MS (MACFIMS), Wechsler Adult Intelligence Scale-IV subtests, and measures of disease severity, depression, and fatigue. RESULTS: The NIHTB showed adequate convergent validity for processing speed, working memory, and episodic memory. Although fluid cognition scores from the NIHTB and MACFIMS classified a similar proportion of participants as cognitively impaired, the two batteries differed in which individuals were classified as impaired versus preserved. NIHTB fluid cognition was inversely correlated with disease severity but not related to depression or fatigue. CONCLUSIONS: The NIHTB concords with gold-standard measures, and classifies cognitive impairment at similar rates to the MACFIMS. Adjusted NIHTB fluid cognition was negatively associated with disease severity suggesting clinical utility. Psychometric validation of the NIHTB in clinical practice will elucidate its promise as a cognitive screener in MS.

TRACking health behavior in people with multiple sclerosis: Effects of a randomized trial on physical activity and working memory.

OBJECTIVE: Multiple sclerosis is associated with impairments in working memory functioning. Lifestyle physical activity interventions show promise in improving cognitive functioning; however, the evidence is limited. We examined the efficacy of a lifestyle physical activity intervention, involving step tracking and psychoeducational materials, on improving step counts, working memory functioning, and network strength in a whole-brain network of working memory. METHOD: Participants (n = 75) were randomly assigned to a group tracking steps with a pedometer (step-track), or a group tracking water intake with a smart water bottle (water-track), for 6 months. At baseline, mid, and postintervention, we assessed weekly physical activity (GT3X+ accelerometer), weekly water intake (H20 Pal Smart Bottle), and working memory functioning. Additionally, the combined network strength of a validated working memory connectome was calculated. RESULTS: We ran random intercept linear mixed models to examine differences between the groups, over time. A significant Group × Time interaction effect with steps and water intake indicated that the step-track group increased their steps, and the water-track group increased their water intake, in comparison to each other, from baseline to postintervention (p < .05). Both groups improved in behavioral working memory over time (p < .05). No significant differences were found on the network strength. CONCLUSION: Our 6-month randomized controlled trial involving physical activity tracking showed increased step count in the intervention group. Behavioral working memory improved in both groups, potentially due to practice effects. Future studies should include both active and passive control groups to discern practice effects from intervention impact. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Accelerometry measures of physical activity and sedentary behavior: Associations with cognitive functioning in MS.

BACKGROUND: Cognitive dysfunction is a pervasive symptom of multiple sclerosis (MS). Correlational evidence on the relationships between physical activity, sedentary behavior, and cognition has been mixed and limited to a few activity measures. The collinearity of accelerometry-based metrics has precluded an assessment of the full activity spectrum. Here, we aimed to examine the rich set of activity measures using analytic approaches suitable for collinear metrics. We investigated the combination of physical activity, sedentary, and clinicodemographic measures that explain the most variance in composite scores of working memory/processing speed, visual memory, and verbal memory. METHODS: We analyzed baseline accelerometry and neuropsychological data (n = 80) from a randomized controlled trial of pedometer tracking. Using partial least squares regression (PLSR), we built three models to predict latent scores on the three domains of cognition using 12 activity metrics, sex, education, and Expanded Disability Status Scale (EDSS) scores. Significance was assessed using linear regression models with model component scores as predictors and cognitive composites as outcomes. RESULTS: The latent component was significant for working memory/processing speed but was not significant for visual memory and verbal memory after Bonferroni correction. Working memory/processing speed was positively associated with average kilocalories, moderate-to-vigorous physical activity (MVPA), steps, and sex (i.e., higher scores in males) and negatively related to duration of long sedentary bouts and EDSS. CONCLUSIONS: These findings suggest that increasing overall energy expenditure through walking and MVPA, while decreasing prolonged sedentary time may positively benefit working memory/processing speed in people with MS. TRIAL REGISTRATION: This RCT #NCT03244696 was registered on Clinicaltrials.gov (https://www. CLINICALTRIALS: gov/ct2/show/NCT03244696).

Trait mindfulness, emotion dysregulation, and depression in individuals with multiple sclerosis.

OBJECTIVES: Emotion dysregulation plays a role in the development and maintenance of psychopathology. Given the higher rates of mood disturbances in people with multiple sclerosis (PwMS), there is a need to explore the relationships between metrics of emotion dysregulation and potential protective traits. Mindfulness, a multi-faceted trait characteristic reflecting present moment awareness, is one such trait showing promise for positive associations with affective health. The current project assessed the relationship between trait mindfulness, the use of emotion regulation strategies during an emotionally evocative task, and depression in PwMS. METHODS: Sixty-one PwMS completed a worry/rumination induction task that examined emotion regulation strategy use in response to emotionally evocative stimuli. RESULTS: Higher trait mindfulness was associated with both lower symptoms of depression and greater employment of acceptance-based strategies following worry and rumination inductions. Acceptance use mediated the relationship between trait mindfulness and symptoms of depression. CONCLUSIONS: Our results suggest that the association between trait mindfulness and emotion dysregulation extends to the use of emotion regulation strategies during an emotionally evocative task. Additionally, emotion regulation strategy use, and acceptance in particular, may play a role in the relationship between trait mindfulness and depression. These findings suggest that increasing levels of mindfulness through clinical interventions may present a path toward improving emotion regulation, and by extension, reducing the symptoms of depression in PwMS.

Impact of mindfulness training on emotion regulation in multiple sclerosis: Secondary analysis of a pilot randomized controlled trial.

Purpose/Objective Research: This secondary analysis of a pilot randomized controlled trial in people with multiple sclerosis (PwMS) aimed to compare mindfulness-based training (MBT), adaptive cognitive training (aCT), and a waitlist control (WL) on the use of emotion regulation strategies during daily worries and ruminations. Further, we examined cognitive functioning as a moderator of training effects. RESEARCH METHOD/DESIGN: Sixty-one PwMS were randomized into an MBT, aCT, or a WL control group for four weeks. Participants completed daily diaries assessing their use of emotion regulation strategies and measures of cognitive functioning at pre- and posttraining. The frequency of acceptance use, maladaptive strategies, and cognitive reappraisal, as well as the success of acceptance use, were the primary outcomes of interest. We also examined whether a cognitive composite score moderated treatment gains. RESULTS: Relative to pretraining, at posttraining, participants in the MBT group used acceptance more frequently, and this change was significantly greater compared to the change in aCT and WL groups. Training did not have differential effects on the frequency of maladaptive strategy and cognitive reappraisal use or on the success of acceptance use. Cognitive functioning did not moderate observed treatment gains. CONCLUSION/IMPLICATIONS: Our findings, based on this pilot study, suggest that after brief training in mindfulness meditation, PwMS used more acceptance strategies to regulate their emotions. Future studies with larger sample sizes, longer duration of treatment, and longitudinal follow-up are needed to better understand the efficacy of mindfulness mediation for promoting affective and cognitive health in PwMS. (PsycInfo Database Record (c) 2022 APA, all rights reserved).