A scoping review assessing the usability of digital health technologies targeting people with multiple sclerosis.

Digital health technologies (DHTs) have become progressively more integrated into the healthcare of people with multiple sclerosis (MS). To ensure that DHTs meet end-users' needs, it is essential to assess their usability. The objective of this study was to determine how DHTs targeting people with MS incorporate usability characteristics into their design and/or evaluation. We conducted a scoping review of DHT studies in MS published from 2010 to the present using PubMed, Web of Science, OVID Medline, CINAHL, Embase, and medRxiv. Covidence was used to facilitate the review. We included articles that focused on people with MS and/or their caregivers, studied DHTs (including mhealth, telehealth, and wearables), and employed quantitative, qualitative, or mixed methods designs. Thirty-two studies that assessed usability were included, which represents a minority of studies (26%) that assessed DHTs in MS. The most common DHT was mobile applications (n = 23, 70%). Overall, studies were highly heterogeneous with respect to what usability principles were considered and how usability was assessed. These findings suggest that there is a major gap in the application of standardized usability assessments to DHTs in MS. Improvements in the standardization of usability assessments will have implications for the future of digital health care for people with MS.

Impact of APOE-ε alleles on brain structure and cognitive function in healthy older adults: A VBM and DTI replication study.

BACKGROUND: The Apolipoprotein E (APOE) gene has been established in the Alzheimer's disease (AD) literature to impact brain structure and function and may also show congruent effects in healthy older adults, although findings in this population are much less consistent. The current study aimed to replicate and expand the multimodal approach employed by Honea et al. Structural magnetic resonance imaging (MRI), diffusion tensor imaging (DTI), and neuropsychological measures were used to investigate the impact of APOE-ε status on grey matter structure, white matter integrity, and cognitive functioning. METHODS: Data were obtained from the Alzheimer's Disease Initiative Phase 3 (ADNI3) database. Baseline MRI, DTI and cognitive composite scores for memory (ADNI-Mem) and executive function (ADNI-EF) were acquired from 116 healthy controls. Participants were grouped according to APOE allele presence (APOE-ε2+ N = 17, APOE-ε3ε3 N = 64, APOE-ε4+ N = 35). Voxel-based morphometry (VBM) and tract-based spatial statistics (TBSS) were used to compare grey matter volume (GMV) and white matter integrity, respectively, between APOE-ε2+ and APOE-ε3ε3 controls, and again between APOE-ε4+ and APOE-ε3ε3 controls. Multivariate analysis of covariance (MANCOVA) was used to examine the effects of APOE polymorphism on memory and EF across all APOE groups with age, sex and education as regressors of no interest. Cognitive scores were correlated (Pearson r) with imaging metrics within groups. RESULTS: No significant differences were seen across groups, within groups in MRI metrics, or cognitive performance (p>0.05, corrected for multiple comparisons). CONCLUSIONS: The current study partially replicated and extended previous findings from an earlier multimodal study (Honea 2009). Future studies should clarify APOE mechanisms in healthy ageing by adding other imaging, cognitive, and lifestyle metrics and longitudinal design in larger sample sizes.

Functional connectivity pre-post exercise intervention in individuals with relapsing-remitting multiple sclerosis.

OBJECTIVE: Exercise interventions have emerged as a promising approach for managing symptoms associated with multiple sclerosis (MS). However, changes in brain function underlying exercise-related improvements in symptoms of MS have not been fully investigated, and in no instances have they been investigated using a graph theory approach. For the first time, the effects of an exercise intervention on functional brain network connectivity were examined using graph theory analyses of resting-state functional MRI (fMRI) data among individuals with relapsing-remitting MS (RRMS). METHODS: Resting-state fMRI data were obtained from 10 participants before and after 12 weeks of a speeded walking intervention. Functional connectivity data were preprocessed in Data Processing Assistant for Resting-State fMRI Advanced (DPARSF A version 4.2) and analyzed in GraphVar2.02 to compute global and local graph theory metrics. To examine differences in graph metrics before and after the intervention, one-sample permutation tests were performed. RESULTS: There were no significant pre to post exercise intervention changes in global metrics. Changes in local metrics (i.e. clustering coefficient, local efficiency, degree centrality and betweenness centrality) were mixed, with both increases and decreases observed. CONCLUSION: Following a 12-week speeded walking exercise intervention, there were no significant increases or decreases in global graph metrics and results at the level of local metrics were equivocal in individuals with RRMS. Further research with experimental designs that include baseline and longitudinal follow-up, as well as larger sample sizes, is needed to understand the underlying mechanisms of symptom improvement following exercise in RRMS.

Differences in symptoms of depression between females and males with relapsing-remitting multiple sclerosis.

INTRODUCTION: Depressive symptoms are experienced by up to 50% of individuals diagnosed with Multiple Sclerosis (MS). Furthermore, depressive symptoms are sometimes experienced differently for females and males in the general population, but it is unclear if this is true for people with Relapsing-Remitting MS (RRMS). The current study aimed to investigate whether there are differences between females and males with RRMS in overall depression scores as well as the types of depressive symptoms reported (somatic or cognitive). METHOD: Demographic and Beck Depression Inventory, 2nd edition (BDI-II) raw scores for females and males with RRMS were downloaded with permission from the Multiple Sclerosis Outcome Assessments Consortium (MSOAC) Placebo database. A total of 494 individuals (n=354 females) with RRMS were included in analyses. Non-parametric Wilcoxon rank-sum tests were used to compare BDI-II Total Scores, Somatic Scores, and Cognitive Scores between females and males with RRMS. RESULTS: Females reported significantly greater overall symptoms of depression compared to males. Furthermore, females endorsed significantly greater somatic symptoms than males. There were no significant differences in females' reports of cognitive symptoms compared to males. CONCLUSIONS: Depressive symptoms in RRMS are experienced differently for females and males. Females with RRMS report higher levels of overall depression and somatic depressive symptoms compared to males with RRMS; this knowledge may help inform best strategies for treatment planning. Future studies should investigate depressive symptoms in females and males with progressive forms of MS, and track symptom changes longitudinally.

Microstructural White Matter Characteristics in Parkinson's Disease With Depression: A Diffusion Tensor Imaging Replication Study.

Background: Clarifying the neuropathology of depression as a symptom of Parkinson's disease (PD) has been the goal of recent neuroimaging studies; however, results have been conflicting and lack replication. The purpose of the current study was to replicate recent methods that have used diffusion tensor imaging (DTI) to compare individuals with PD with and without depression and to extend previous findings to allow for a better understanding of the results. Methods: Thirty-seven participants with de novo PD were retrieved from the Parkinson's Progression Marker's Initiative (PPMI) and were separated into a depressed PD group (dPD) or a non-depressed PD group (ndPD). Groups were determined based on scores on the Geriatric Depression Scale Short Form (GDS-15). Initially, a replicated cut off score of ≥ 5 for dPD and <5 for ndPD was applied. To better understand the results, we secondarily applied a more extreme group analysis with ≥ 9 for dPD and 0 for ndPD. White matter integrity between groups was compared between groups using tract-based spatial statistics. Results and Conclusion: The current study did not reveal significant differences in white matter microstructure between dPD and ndPD groups at the whole brain level or in specific regions of interest. The extreme group results were consistent. These findings did not replicate previous work that found reduced white matter integrity in limbic prefrontal regions in dPD relative to ndPD. The current study highlights the need for more replications of neuroimaging research.

The impact of positioning on fear during immunizations: supine versus sitting up.

This study explored the impact of a child's position on the level of fear and perception of pain during an immunization injection. One hundred seven children, ages 4-6, participated in a random-assignment, two-group design study to evaluate the effect of positioning on fear and perceived pain. Group 1 was placed in the supine position and Group 2 in the sitting position prior to immunizations. The results substantiated the belief that children are significantly less fearful about receiving an injection when they are sitting up as compared to when they are lying down. There was no difference in perception of pain.