Cognitive Reserve Moderates the Effects of Fatigue and Depressive Symptoms in Multiple Sclerosis.

To investigate cognitive reserve as a possible moderator in the relationship between fatigue and depressive symptoms in persons with multiple sclerosis (PwMS). Fifty-three PwMS (37 female; mean age, 52.66; mean education, 14.81) completed comprehensive neuropsychological testing and psychosocial questionnaires assessing the perceived effects of fatigue (Fatigue Impact Scale) and depressive symptoms (Beck Depression Inventory-Fast Screen). Cognitive reserve (CR) was operationalized as Fixed CR and Malleable CR. Fixed CR was quantified as the standardized mean of years of education and a vocabulary-based estimate of premorbid intelligence. Malleable CR was quantified as the standardized mean of cognitive exertion, exercise, and socializing items from the Cognitive Health Questionnaire. Regressions on depressive symptoms examining fatigue, both conceptualizations of CR, and their interactions were explored. A Bonferroni correction was used; results were considered significant at an alpha level of p < .01. The interactions between fatigue and both conceptualizations of CR were significant, p = .005 (Fixed CR); p = .004 (Malleable CR). Simple effects tests revealed that fatigue only predicted depressive symptoms in PwMS with low Fixed CR or low Malleable CR (p's < .001), and not in those with high Fixed or high Malleable CR (p > .01). Cognitive reserve moderated the relationship between fatigue and depressive symptoms in PwMS. Specifically, fatigue does not appear to influence depression in PwMS with high cognitive reserve. Having higher cognitive reserve (either Fixed or Malleable) may reduce the likelihood that fatigue will lead to depressive symptoms in MS.

Coping Style Moderates the Effect of Pain on Depression Symptoms in Multiple Sclerosis.

OBJECTIVE: The present study examined coping style as a possible moderator in the relationship between pain and depression in persons with multiple sclerosis (PwMS). METHODS: Fifty-four PwMS completed a comprehensive neuropsychological test battery and psychosocial questionnaires that assessed physical, cognitive, and emotional functioning. Using four pain indices (i.e., average pain, current pain, pain intensity, and pain interference) from the Brief Pain Inventory (BPI), an overall pain index was created to capture a more comprehensive index of individuals' overall pain intensity and interference. The COPE questionnaire was used to derive three coping indices: active coping, avoidant coping, and a composite cope index that accounts for the relative contributions of both active and avoidant coping. The Beck Depression Inventory-Fast Screen (BDI-FS) was used to measure depressive symptomatology. A series of hierarchical linear regressions were conducted with depressive symptoms as the outcome variable. RESULTS: Regression analyses revealed that the interactions between overall pain and each conceptualization of coping were significant (p = .001-.003). Simple effects tests revealed that overall pain only predicted depressive symptoms in PwMS with low active coping (p < .001), high avoidant coping (p < .001), and less adaptive coping via the composite coping index (p < .001). CONCLUSION: We found that pain predicted depressive symptoms in PwMS who utilized more avoidant and less active coping strategies. Interventions aimed to improve coping style may be effective in enhancing the ability to manage pain and, subsequently, improve depression outcomes in MS.

Cognitive Reserve Attenuates the Effect of Disability on Depression in Multiple Sclerosis.

OBJECTIVE: The current study explored the moderating role of cognitive reserve on the relationship between disability and depression in a sample of individuals in which brain pathology is thought to contribute to depression (multiple sclerosis; MS). METHOD: Fifty-four individuals with MS were examined. Depression was measured using the Beck Depression Inventory-Fast Screen (BDI-FS). In addition to collecting demographic (education) and disease burden (Expanded Disability Status Scale; EDSS) related variables, participants completed a neuropsychological test battery and psychosocial questionnaires. Cognitive reserve (CR) was conceptualized in two ways: Fixed CR and Malleable CR. Fixed CR was measured using years of education and crystallized intelligence (Shipley Vocabulary). Malleable CR was operationalized as a composite of measures from the Cognitive Heath Questionnaire (CHQ). Two regressions on depression (BDI-FS) examining either type of cognitive reserve, EDSS, and their interactions were explored. Results: The interaction between EDSS and both conceptualizations of cognitive reserve were significant, t(50) = -2.60, p = .013, PRE = .12 (Fixed CR); t(47) = -2.02, p = .049, PRE = .08 (Malleable CR). Simple effects testing revealed the same pattern regardless of the type of cognitive reserve examined; EDSS predicted depression only in those with low cognitive reserve. CONCLUSIONS: Cognitive reserve moderates the relationship between disability and depression in MS; disability does not appear to influence depression in those with high cognitive reserve.

Judgment hurts: The psychological consequences of experiencing stigma in multiple sclerosis.

RATIONALE: People living with MS often report feeling stigmatized, but little research has examined the psychological impact of this, which is important considering the high prevalence of depression in this population. OBJECTIVES: The aim of this study was to assess, concurrently and prospectively, the association between stigma and depression in people living with MS. METHODS: Data were available from 5369 participants enrolled in the semi-annual survey conducted by the North American Research Committee on Multiple Sclerosis (NARCOMS). Participants reported their MS stigma and depression in the spring 2013 update survey (T1) and their depression again one year later (T2). Demographic and health-related covariates were also assessed. RESULTS: People experiencing higher levels of stigma reported more depression symptoms and were more likely to meet the threshold for clinical depression at both times, even controlling for covariates. Higher levels of stigma also predicted T2 depression, controlling for T1 depression (and covariates), suggesting a possible causal association. Greater psychosocial reserve, a composite of measures assessing participants' feelings of belonging, social support, and sense of control, attenuated the association between stigma and depression. CONCLUSIONS: Stigma is an important but understudied predictor of depression in people living with MS, but greater psychosocial reserve provides a buffer.

Normative Data for a Comprehensive Neuropsychological Test Battery used in the Assessment of Sports-Related Concussion.

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

Beyond binary: Exploring the merits of three depression groups in multiple sclerosis.

OBJECTIVE: Depression has been traditionally explored in the context of multiple sclerosis (MS) as a binary construct (depressed, not depressed). However, given the 50% lifetime prevalence rate of depression in MS, it may be useful to consider not only currently depressed versus nondepressed patients, but to evaluate groups that better characterize the complexity of MS depression. The objective of the current study was to examine demographic, cognitive, illness, and psychosocial variables thought to associate with depression in MS across 3 groups: currently depressed, remitted depression, and never been depressed. METHOD: Fifty-four individuals with MS were examined. Current depression status was measured using the Beck Depression Inventory-Fast Screen (BDI-FS; Beck, Steer, & Brown, 2000). Past depression was evaluated using the Structured Clinical Interview for DSM-IV Disorders (SCID-IV; First, Spitzer, Gibbon, & Williams, 1998) and a semistructured psychosocial interview. RESULTS: The results of the current study show that evaluating depression in 3 groups is useful for exploring risk, protective, and compensatory factors of depression in MS. A consistent grouping pattern (e.g., the remitted depression group always functioning the same as the never been depressed group) was not found among the variables examined; rather, several different patterns were observed. Several of these patterns revealed differences between the remitted depression and never been depressed groups; these differences would not have been observed had these 2 groups been combined into a "not currently depressed" group. CONCLUSIONS: These different patterns yield important information about the complex relationships of depression in MS that may be obscured when depression is viewed as a binary construct. (PsycINFO Database Record

Vitamin D and long-term memory in multiple sclerosis.

BACKGROUND AND OBJECTIVE: Memory disturbance is a frequent cognitive complaint by patients with multiple sclerosis (MS). Recent dementia research suggests a beneficial role for vitamin D in long-term memory functioning. While data suggest ameliorative effects of vitamin D for the physical impairments of MS, it is unknown whether vitamin D can benefit the cognitive sequelae. We examined the relationship between serum levels of vitamin D and performance on verbal and nonverbal tests of long-term memory in patients with MS. METHODS: A sample of 35 adults with relapsing-remitting MS completed cognitive testing and a vitamin D serum (25[OH]D) assay. Memory assessment used clinically established neuropsychological tests with multiple testing formats to determine whether vitamin D level was associated with memory during conditions of varying retrieval demands. Intellectual functioning and mood were also assessed to control for potential confounds. RESULTS: Vitamin D level was positively associated with performance on immediate and delayed recall trials of the Rey Complex Figure Test, effects that held after controlling for intelligence and disease duration. Vitamin D level was not associated with mood, intelligence, or verbal memory performance on the California Verbal Learning Test, Second Edition. CONCLUSIONS: Higher vitamin D level was associated with better nonverbal long-term memory performance in MS, particularly in conditions when no aid was given to help retrieval. These results supplement the literature on the neuroprotective effects of vitamin D and suggest that vitamin D is a worthwhile adjunct treatment for MS.