Age-related differences in the severity of sexual dysfunction symptoms and psychological distress in individuals with multiple sclerosis.

BACKGROUND: Sexual dysfunction (SD) is a common symptom for many with multiple sclerosis (MS). However, SD research in general appears to often overlook young adults within their samples, which can be a major issue for better understanding and treatment for the MS population. Few studies have compared age-related differences in distress in response to physical disability. Research has also found that many people diagnosed with MS do not discuss any SD struggles with their providers. The present study hopes to see whether age-related differences exist in the reporting of the levels of primary, secondary, and tertiary SD, as defined by subscale scores of the Multiple Sclerosis Intimacy and Sexuality Questionnaire-19 (MSISQ-19), and amount of distress, as defined by the 12-Item Short Form Health Survey (SF-12)'s Mental Component Summary (MCS-12). Additionally, we hope to determine if there are any age-related or sex-related differences in help-seeking behaviors for SD. METHODS: Study participants were recruited from the North American Research Committee on Multiple Sclerosis (NARCOMS) Registry. Participants completed the MSISQ-19, SF-12, and Patient Determined Disease Steps (PDDS), provided demographic information, and responded if they received medical or psychological treatment for SD. Study participants were 5815 respondents (Mage = 51 years, SD = 9.63, 75 % female, 30 % having attained a high school diploma, 35 % scoring "advanced disability" on the PDDS). Young adult (19-39 years), middle adult (40-64 years), and mature adult (65-older) were compared on SD. RESULTS: Linear mixed effects modeling revealed that the MSISQ-19 subscale scores were significantly predicted by secondary SD (t = 2.48, p < .13). Young adult participants had the lowest primary SD (M = 13.87, 95 % CI [13.13, 14.61]) when compared to mature adult (M = 14.12, 95 % CI [13.27, 14.97]) and middle adult participants (M = 14.44, 95 % CI [14.21, 14.66]), though none were statistically significant. Mature adults had the lowest secondary SD (M = 16.50, 95 % CI [15.65, 17.35]), a statistically significant difference from the middle adults (M = 18.20, 95 % CI [17.97, 18.42]) and young adults (M = 18.91, 95 % CI [18.17, 19.65]). Mature adults had the lowest tertiary symptoms (M = 10.12, 95 % CI [9.27, 10.96]), followed by young adults (M = 12.23, 95 % CI [11.48, 12.97]), and middle adults (M = 11.65, 95 % CI [11.43, 11.88]), though none were statistically significant. Hierarchical multiple regressions found that age had the most significant impact on SD. When SF-12 MCS-12 was added, linear mixed effects did not reveal any statistically significant results between the age groups and SD levels. In contrast, hierarchical multiple regressions found that SF-12 MCS-12 scores had the most significant impact on SD. There were significant age-related and sex-related differences in help-seeking behaviors in those who sought psychological counseling as opposed to medical treatment for SD. CONCLUSION: Our study has highlighted the importance of clinicians assessing for SD and psychological distress within their patients and to consider potential differences in symptom presentations of age groups to better address their unique needs.

The spatial contrast sensitivity function and its neurophysiological bases.

Contrast processing is a fundamental function of the visual system, and contrast sensitivity as a function of spatial frequency (CSF) provides critical information about the integrity of the system. Here, we used a novel iPad-based instrument to collect CSFs and fitted the data with a difference of Gaussians model to investigate the neurophysiological bases of the spatial CSF. The reliability of repeat testing within and across sessions was evaluated in a sample of 22 adults for five spatial frequencies (0.41-13 cycles/degree) and two temporal durations (33 and 500 ms). Results demonstrate that the shape of the CSF, lowpass versus bandpass, depends on the temporal stimulus condition. Comparisons with previous psychophysical studies and with single-cell data from macaques and humans indicate that the major portion of the CSF, spatial frequencies >1.5 cycles/degree regardless of temporal condition, is determined by a 'sustained' mechanism (presumably parvocellular input to primary visual cortex [V1]). Contrast sensitivity to the lowest spatial frequency tested appears to be generated by a 'transient' mechanism (presumably magnocellular input to V1). The model fits support the hypothesis that the high spatial frequency limb of the CSF reflects the receptive field profile of the center mechanism of the smallest cells in the parvocellular pathway. These findings enhance the value of contrast sensitivity testing in general and increase the accessibility of this technique for use by clinicians through implementation on a commercially-available device.

Frequency-domain analysis of transient visual evoked potentials in schizophrenia.

PURPOSE: Frequency-domain measures were applied to characterize neural deficits in individuals with schizophrenia using transient visual evoked potentials (tVEP). These measures were compared with conventional time-domain measures to elucidate underlying neurophysiological mechanisms and examine the value of frequency analysis. METHODS: Four frequency bands of activity identified in previous work were explored with respect to magnitude (spectral power), timing (phase), a combined measure, magnitude-squared coherence (MSC), and compared to amplitudes and times of prominent deflections in the response. RESULTS: Band 2 power/MSC (14-28 Hz) captured the major deflections in the waveform and its power predicted N75-P100 amplitude for patients and controls. Band 3 power/MSC (30-40 Hz) correlated highly with the earliest deflection (P60-N75), reflecting input to primary visual cortex (V1) and produced the largest magnitude effect. Phase of the 24th harmonic component predicted P100 peak time for patients and controls and yielded the largest group difference. Cluster analyses including time- and frequency-domain measures identified subgroups of patients with differential neurophysiological effects. A small but significant difference in visual acuity was found between groups that appears to be neurally based: Acuity (range 0.63-1.6) was not correlated with any tVEP measures in controls nor with input timing to V1 (P60 peak time) in patients, but was correlated with later tVEP measures in patients. All but two of the patients were on antipsychotic medication: Medication level (chlorpromazine equivalents) was correlated negatively with tVEP time measures and positively with certain magnitude measures yielding responses similar to controls at high levels. CONCLUSIONS: Overall, frequency-domain measures were shown to be objective and recommended as an alternative to conventional, subjective time-domain measures for analyzing tVEPs and in distinguishing between groups (patients vs. controls and patient subgroups). The findings implicated a loss of excitatory input to V1 in schizophrenia. Acuity as measured in the current study reflected disease status, and medication level was associated with improved tVEP responses. These novel tVEP techniques may be useful in revealing neurophysiological processes affected in schizophrenia and as a clinical tool.

Handedness and Cognition in Multiple Sclerosis: Potential Indications for Hemispheric Vulnerability.

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

Visual Evoked Potential Abnormalities in Phelan-McDermid Syndrome.

OBJECTIVE: The current study used visual evoked potentials (VEPs) to examine excitatory and inhibitory postsynaptic activity in children with Phelan-McDermid syndrome (PMS) and the association with genetic factors. PMS is caused by haploinsufficiency of SHANK3 on chromosome 22 and represents a common single-gene cause of autism spectrum disorder (ASD) and intellectual disability. METHOD: Transient VEPs were obtained from 175 children, including 31 with PMS, 79 with idiopathic ASD, 45 typically developing controls, and 20 unaffected siblings of children with PMS. Stimuli included standard and short-duration contrast-reversing checkerboard conditions, and the reliability between these 2 conditions was assessed. Test-retest reliability and correlations with deletion size were explored in the group with PMS. RESULTS: Children with PMS and, to a lesser extent, those with idiopathic ASD displayed significantly smaller amplitudes and decreased beta and gamma band activity relative to TD controls and PMS siblings. Across groups, high intraclass correlation coefficients were obtained between standard and short-duration conditions. In children with PMS, test-retest reliability was strong. Deletion size was significantly correlated with P60-N75 amplitude for both conditions. CONCLUSION: Children with PMS displayed distinct transient VEP waveform abnormalities in both time and frequency domains that might reflect underlying glutamatergic deficits that were associated with deletion size. A similar response pattern was observed in a subset of children with idiopathic ASD. VEPs offer a noninvasive measure of excitatory and inhibitory neurotransmission that holds promise for stratification and surrogate endpoints in ongoing clinical trials in PMS and ASD.

Objective frequency analysis of transient visual evoked potentials in autistic children.

Visual evoked potentials (VEPs) provide a means to examine neural mechanisms in autism with high temporal resolution. Conventional VEP analysis relies on subjective inspection of a few points (peaks and troughs) in the time-domain waveform. The current study applied power spectral analysis and magnitude-squared coherence (MSC) statistics (frequency-domain measures) to VEPs recorded during 1-minute runs and with a recently developed short-duration technique that allow for objective examination of the responses (Zemon & Gordon, European Journal of Neuroscience, 2018, 48, 1765-1788) from nonautistic and autistic children. Results indicate that, for both groups, early time-domain measures (P60 , N75 , P100 ) are highly correlated with middle- and high-frequency (14-28 and 30-48 Hz, respectively) mechanisms, and late measures are highly correlated with a low-frequency (6-12 Hz) mechanism. One frequency-domain measure (power in the middle-frequency band) is capable of predicting the key amplitude measure (N75 -P100 ) with high accuracy. MSC and power measures were combined to yield separate measures of signal and noise strength to evaluate alternate hypotheses in autism. Linear mixed-effects modeling demonstrated selective differences in early time-domain and middle-to-high frequency-domain measures in autistic children as compared to nonautistic children given both recording techniques, implicating weaker excitatory input to the cortex. Receiver-operating-characteristic curve analysis showed predictive diagnostic accuracy for middle- and high-frequency bands based on MSC. These findings support the value of frequency analysis measures (power spectral analysis and MSC) in the objective examination of neural differences in autism. LAY SUMMARY: Visual evoked potentials (VEPs) are used to assess neural mechanisms. Typically, VEPs are analyzed by subjective examination of time-series waveforms; but here objective techniques were applied to quantify VEP frequency components to investigate neural differences between autistic and nonautistic children. The objective measures demonstrate group differences in brain function that point to weaker excitatory input to the cortex in autism.

Mental health issues among international touring professionals in the music industry.

Music industry touring professionals are generally assumed to be at elevated risk for mental health issues, highlighted by numerous high-profile suicides in recent years. Few studies have explored the prevalence of depression, suicidality and associated factors within this population. This study aims to gain an empirical understanding of the mental health issues among international touring professionals, with a particular focus on risk for depression and suicidality, and to identify potential protective factors. Data were collected between February-March 2020 as part of the Tour Health Research Initiative's Touring Health and Wellness Survey 2020. Using a multidimensional questionnaire with a sample of 1154 international touring professionals (artists and crew members), participants who completed all psychosocial measures (n = 508) demonstrated elevated levels of suicidality, risk for clinical depression, stress, anxiety and burnout. The median depression score for completers matched the recommended cutoff score of 20, which qualified 254 participants as high risk for clinical depression, while 200 (39.4%) demonstrated high scores for suicidality. In ROC curve analyses, all psychosocial measures were significant predictors of high suicidality, with a combined emotional and social measure yielding the highest classification accuracy (80%). Moderate strength linear relations were observed for all pairs of measures. Positive correlations were found among all risk factors (depression, anxiety, stress, and burnout) and these measures yielded negative correlations with the protective factors (mindfulness and the emotional/social measure). Findings suggest that interventions enhancing mindfulness and emotional/social well-being may serve as valuable treatment components for this population.

Cognitive function mediates the relationship between visual contrast sensitivity and functional outcome in schizophrenia.

BACKGROUND: Individuals with schizophrenia exhibit deficits in visual contrast processing, though less is known about how these deficits impact neurocognition and functional outcomes. This study investigated effects of contrast sensitivity (CS) on cognition and capacity for independent living in schizophrenia. METHODS: Participants were 58 patients with schizophrenia (n = 49) and schizoaffective disorder (n = 9). Patients completed a psychophysical paradigm to obtain CS with stimuli consisting of grating patterns of low (0.5 and 1 cycles/degree) and high spatial frequencies (4, 7, 21 cycles/degree). Patients completed the MATRICS Consensus Cognitive Battery and Wechsler Adult Intelligence Scales, Third Edition to assess cognition, and the problem-solving factor of the Independent Living Scales to assess functional capacity. We computed bivariate correlation coefficients for all pairs of variables and tested mediation models with CS to low (CS-LSF) and high spatial frequencies (CS-HSF) as predictors, cognitive measures as mediators, and capacity for independent living as an outcome. RESULTS: Cognition mediated the relationship between CS and independent living with CS-LSF a stronger predictor than CS-HSF. Mediation effects were strongest for perceptual organization and memory-related domains. In an expanded moderated mediation model, CS-HSF was found to be a significant predictor of independent living through perceptual organization as a mediator and CS-LSF as a moderator of this relationship. CONCLUSION: CS relates to functional capacity in schizophrenia through neurocognition. These relationships may inform novel visual remediation interventions.

Children and Telehealth in Mental Healthcare: What We Have Learned From COVID-19 and 40,000+ Sessions.

Objective: Of the many impacts of COVID-19 on contemporary healthcare is the rapid and overwhelming shift to remote telehealth (TH) service. The precise effect of TH on treatment is yet unknown, and the possible child/adult differences are an essential point of clarification for the utility of TH services and efforts to improve upon them. Methods: The current study considers data reflecting pre-, during-, and post-COVID-19 lockdown over the first six months of 2020. Data comprise records of N = 43,294 services delivered to N = 2520 unique clients across multiple outpatient mental health sites at a Certified Community Based Mental Health Clinic (CCBHC) in Rockland County, NY, an area hard hit by COVID-19. Results: Results demonstrate significant differences between child and adult sessions with a relative decrease in the number of child mental health services with the switch to TH in March 2020 (onset of lockdown) and a relatively rapid shift back to face-to-face among child services when in-person services resumed in May and June 2020. Results further highlight significant differences between child age and service type, with psychiatry less affected by TH than psychotherapy. Conclusions: Implicit in the data is the ability to offer remotely, a high volume of ongoing behavioral intervention. Findings support TH as less preferred for children than adults while indicating that child TH is favored for psychiatry and support services, less so for psychotherapy. Implications for enhancing child TH delivery and directions for continued research include relational factors, platform (phone/video) and screen salience.

Childhood adversity and physical health among Asian Indian emerging adults in the United States: Exploring disease-specific vulnerabilities and the role of anger.

Objective: The link between adverse childhood experiences (ACEs) and negative health outcomes is well established among middle-aged adults and within the general population; however, ACEs' impact on physical health among emerging adults and specific ethnic minority groups, such as distinct Asian American subgroups, remains understudied and poorly understood. The aim of this study was to examine the relationships between ACEs, anger expression, stress, and physical health in a sample of Asian Indian (AI) emerging adults (18-29 years) living in the United States. Method: Participants (N = 132; Mage = 23.52; 13.6% first generation; 86.4% born in United States) completed an electronic questionnaire measuring variables of ACEs, anger expression, recent stress, health history, self-rated health, and recent physical illness symptoms. Chi-square, regression, and mediation analyses were conducted to examine associations among variables. Results: ACEs significantly predicted greater anger expression, perceived stress, number of chronic health conditions, and recent physical illness symptoms. Ninety-four percent of participants with ≥ 3 ACEs endorsed at least 1 previously diagnosed medical condition, and these participants exhibited remarkably high odds of diabetes and high blood pressure. Mediation analyses indicated anger expression significantly mediated ACEs' impact on recent stress and physical illness symptoms. Conclusions: Findings evidence that ACE-related physical health consequences are, in fact, already detectable by emerging adulthood among AI Americans. The distinct ACEs patterns and pronounced ACE-related health consequences found in this population warrant further study. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Contrast sensitivity deficits in schizophrenia: A psychophysical investigation.

Individuals with schizophrenia have problems with visual contrast processing. The current study investigated contrast sensitivity (CS) in schizophrenia/schizoaffective disorder to elucidate the underlying neural mechanisms affected by this disorder and to identify critical testing conditions that distinguish individuals with the disorder from healthy individuals. Principal component analysis was applied to the data (N = 143) to separate responses from distinct visual pathways. Participants were 68 patients and 75 age-similar controls. CS was obtained using a forced-choice psychophysical paradigm with grating patterns of low to high spatial frequency presented at short and long durations. Linear mixed-effects models were used to examine differences in log CS with respect to group, duration, and stimulus condition. Lower CSs were found in patients compared to controls over all stimulus conditions with the magnitude of deficits dependent on both spatial frequency and stimulus duration. Log CSs to low and high spatial frequencies loaded onto separate principal components, supporting the existence of two psychophysical mechanisms, transient and sustained. Critical conditions were identified to tap each mechanism. Visual acuity was correlated moderately with log CS to high, but not low, spatial frequencies, and deficits found for acuity and CS to moderate/high spatial frequencies (4-21 cycles/degree) appear to reflect dysfunction in the sustained mechanism. CS deficits found at the lowest spatial frequency tested (0.5 cycles/degree) appear to reflect dysfunction in the transient mechanism. Both types of CS deficits may have diagnostic value and implications for social and neurocognitive deficits in this disorder.

Development and Evaluation of a Visual Remediation Intervention for People with Schizophrenia.

It is now well documented that schizophrenia is associated with impairments in visual processing at all levels of vision, and that these disturbances are related to deficits in multiple higher-level cognitive and social cognitive functions. Visual remediation methods have been slow to appear in the literature as a potential treatment strategy to target these impairments, however, in contrast to interventions that aim to improve auditory and higher cognitive functions in schizophrenia. In this report, we describe a National Institute of Mental Health (NIMH)-funded R61/R33 grant that uses a phased approach to optimize and evaluate a novel visual remediation intervention for people with schizophrenia. The goals of this project are: (1) in the R61 phase, to establish the optimal components and dose (number of sessions) of a visual remediation intervention from among two specific visual training strategies (and their combination) for improving low and mid-level visual functions in schizophrenia; and (2) in the R33 phase, to determine the extent to which the optimal intervention improves not only visual processing but also higher-level cognitive and role functions. Here we present the scientific background for and innovation of the study, along with our methods, hypotheses, and preliminary data. The results of this study will help determine the utility of this novel intervention approach for targeting visual perceptual, cognitive, and functional impairments in schizophrenia.

The influence of trait mindfulness on depression in multiple sclerosis: potential implications for treatment.

PURPOSE: This study seeks to add to existing literature on depression and illness intrusiveness in chronic disorders by examining, (1) how the perceived intrusiveness of multiple sclerosis (MS) leads to depression, (2) and the mediating role trait mindfulness plays in this relationship METHODS: Participants (N = 755) were persons with MS (PwMS) recruited through the North American Research Committee on MS (NARCOMS) registry (a larger study). Participants completed the Illness Intrusiveness Ratings Scale, the Hospital Anxiety and Depression Scale and the Mindful Attention Awareness Scale. A mediation model assessed if trait mindfulness mediates the relationship between illness intrusiveness and depression RESULTS: Illness intrusiveness predicted trait mindfulness (a = - 4.54; p < .001), trait mindfulness predicted depression (b = - .04; p < .001); there was a direct effect of illness intrusiveness on depression (c' = 2.53; p < .001) and an indirect effect on depression (ab = .17, 95% BCa CI [.10, .25]) when trait mindfulness was in the model, which represented a medium size effect, R2med = .10 [95% CI .07, .14] CONCLUSION: Trait mindfulness mediates the relationship between illness intrusiveness and depression in PwMS. Providers could provide psychoeducation on the benefits of mindfulness and mindfulness-based interventions.

Central visual function and inner retinal structure in primary open-angle glaucoma.

To investigate associations between central visual function and inner retinal structure in primary open-angle glaucoma (POAG). This study enrolled 78 POAG patients and 58 healthy controls. POAG was classified into early glaucoma and moderate to advanced glaucoma. The following tests were performed on all participants: isolated-check visual evoked potential (icVEP) testing, 24-2 standard automated perimetry (SAP), and Cirrus optical coherence tomography (OCT) examinations. Signal-to-noise ratio (SNR) measures obtained from icVEP responses to isolated checks presented at four depths of modulation (DOMs; 8%, 14%, 22%, and 32%) were explored. Mean macular sensitivity (mMS) was assessed by calculating the mean sensitivities of central 12 SAP points. Ganglion cell layer+ inner plexiform layer thickness (GCL+IPLT) and peripapillary retinal nerve fiber layer thickness (pRNFLT) were measured by OCT scanning. For each group of subjects, linear relationships among the following measures were analyzed: SNR, mMS, GCL+IPLT, and pRNFLT. SNR, mMS, GCL+IPLT, and pRNFLT were all more significantly decreased in glaucoma than in controls (P<0.001). A significant positive association was found between SNR at 14% DOM and GCL+IPLT at the inferior sector in early glaucoma (r=0.465, P=0.004). In moderate to advanced glaucoma, significant correlations were found between SNR at 32% DOM and mean GCL+IPLT (r=0.364, P=0.023), superior GCL+IPLT (r=0.358, P=0.025), and mean pRNFLT (r=0.396, P=0.025). In addition, in moderate to advanced glaucoma, there were significant correlations between mMS and all relevant measures of retinal thickness (r=0.330-0.663, P< 0.010). In early glaucoma, significant correlations were found between mean mMS and minimum GCL+IPLT (r=0.373, P=0.023), and between inferior mMS and superior GCL+IPLT (r=0.470, P=0.003). Linear models provided a good explanation for the relationship between SNR and inner retinal thickness (IRT), whereas nonlinear models better explained the relationship between mMS and IRT. In early glaucoma, both SNR and mMS were related moderately and significantly to IRT, whereas in moderate to advanced glaucoma, mMS was more strongly correlated with IRT than SNR.

Optical coherence tomography of the retina in schizophrenia: Inter-device agreement and relations with perceptual function.

BACKGROUND: Optical coherence tomography (OCT) studies have demonstrated differences between people with schizophrenia and controls. Many questions remain including the agreement between scanners. The current study seeks to determine inter-device agreement of OCT data in schizophrenia compared to controls and to explore the relations between OCT and visual function measures. METHODS: Participants in this pilot study were 12 individuals with schizophrenia spectrum disorders and 12 age- and sex-matched controls. Spectralis and Cirrus OCT machines were used to obtain retinal nerve fiber layer (RNFL) thickness and macular volume. Cirrus was used to obtain ganglion cell layer + inner plexiform layer (GCL + IPL) thickness. Visual function was assessed with low-contrast visual acuity and the King-Devick test of rapid number naming. RESULTS: There was excellent relative agreement in OCT measurements between the two machines, but poor absolute agreement, for both patients and controls. On both machines, people with schizophrenia showed decreased macular volume but no difference in RNFL thickness compared to controls. No between-group difference in GCL + IPL thickness was found on Cirrus. Controls showed significant associations between King-Devick performance and RNFL thickness and macular volume, and between low-contrast visual acuity and GCL + IPL thickness. Patients did not show significant associations between OCT measurements and visual function. CONCLUSIONS: Good relative agreement suggests that the offset between machines remains constant and should not affect comparisons between groups. Decreased macular volume in individuals with schizophrenia on both machines supports findings of prior studies and provides further evidence that similar results may be found irrespective of OCT device.

Utility of the Modified Isolated-check Visual Evoked Potential Technique in Functional Glaucoma Assessment.

PRE[COMBINING ACUTE ACCENT]CIS:: Cortical response to low-contrast stimuli, as measured by isolated-check visual evoked potential (icVEP) technology, has the potential to provide functional assessment that may complement standard achromatic perimetry in assessing glaucomatous change. PURPOSE: To evaluate the utility of modified icVEP testing in detecting functional glaucomatous damage. MATERIALS AND METHODS: Subjects who met predetermined criteria of controls, glaucoma suspects, preperimetric glaucoma, or glaucoma were enrolled in this prospective cross-sectional study from a single tertiary care center. Glaucoma patients were further categorized as early, moderate, advanced, or severe on the basis of Hodapp-Anderson-Parrish criteria. icVEP testing was performed with ten 2-second runs per qualified eye using the EvokeDx testing software. Multivariate statistics were used to calculate signal-to-noise ratios (SNR) and perform outlier analysis. RESULTS: In total, 140 eyes met criteria (mean±SD; age of 63±14 y; 49% male; logMAR visual acuity, 0.11±0.089). There was no significant difference in age, sex, or logMAR visual acuity among the groups. Controls had a significantly higher SNR than all other groups (P<0.003), including patients with preperimetric glaucoma. Among those with glaucoma, the early glaucoma patients had significantly higher SNR than the moderate, advanced, or severe glaucoma cohorts (P<0.04). The optimal SNR cutoff for differentiating between glaucomatous and nonglaucomatous eyes was 0.95, both with (sensitivity 82%, specificity 76%) and without (sensitivity 82%, specificity 100%) glaucoma suspects included in analysis. CONCLUSIONS: icVEP technology has the potential to complement standard achromatic perimetry in functional assessment of glaucomatous defects.

Measuring personal growth in partners of persons with multiple sclerosis: A new scale.

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

Motivation in multiple sclerosis cognitive fatigue: An experimental approach.

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

Potential differences in cognition by race/ethnicity among persons with multiple sclerosis in a clinical setting: A preliminary study.

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