Chicago Multiscale Depression Inventory Research Articles

46 Depression and Reward Responsiveness in Multiple Sclerosis

Objective:Depression is common in persons with MS (PwMS), substantially contributing to morbidity and mortality. Depression can dually impact PwMS as both a psychosocial reaction to living with the disease and a neurological effect of it. Cardinal features of depression include reduced ability to seek and experience pleasure, often attributed to dysregulation of the brain's reward system. People with depression exhibit atypical reward processing, as do fatigued PwMS. However, it is unclear whether MS itself affects reward processing, and whether it interacts with depression. The current study explored the associations of depression, MS, and their interaction on reward responsiveness. We hypothesized that depression and MS would independently be associated with poorer reward responsiveness and that they would interact synergistically to impair reward responsiveness.Participants and Methods:Forty PwMS and 40 healthy age- and education-matched healthy controls (HC) participated in a computerized switching task with high- and low-reward manipulations. The Chicago Multiscale Depression Inventory (CMDI) Mood subscale measured depressive symptoms. The Behavioral Inhibition/Activation Scales (BIS/BAS) measured self-reported reward responsiveness and behavioral inhibition. Switching task performance was measured as response time (RT) and accuracy. Performance differences between the high- and low-reward conditions represented performance-based reward responsiveness. Linear mixed effects models were used to estimate the associations of MS and depression with reward responsiveness, behavioral inhibition, and task performance.Results:Depression, but not MS, was associated with higher BIS scores (p=.007). Neither depression nor MS was associated with BAS subscales. On the switching task, participants who reported lower depression responded to reward such that they were slightly faster in the high-reward condition compared to the low-reward condition (p=.07). By contrast, in participants who reported higher depression, there was no effect of reward on response time. Additionally, MS (p=.009) and depression (p=.018) were each associated with slower response times. Regarding accuracy, no effects of reward were observed; however, there was an interaction between MS and depression. Among HC participants, depression was not related to accuracy. In comparison, PwMS who reported higher depression were more accurate than PwMS who reported less depression (p=.043).Conclusions:Consistent with hypotheses, higher depressive symptoms were associated with increased behavioral inhibition. Depression was not associated with self-reported reward responsiveness, but it was associated with reduced reward responsiveness on a cognitive task. Contrary to hypotheses, MS was not associated with reduced reward responsiveness. Additionally, higher depression and an MS diagnosis were related to slower response time, consistent with prior findings that psychomotor slowing is a hallmark feature of both disorders. Interestingly, we observed a unique behavioral trend in PwMS, such that PwMS with higher depressive symptoms were more accurate than PwMS with lower depressive symptoms, whereas this relationship was not present among HCs. Altogether, depression in both PwMS and cognitively healthy individuals may be associated with blunted reward responsiveness, but MS does not exacerbate this relationship. In fact, PwMS with depression may be more conscientious in their functioning and therefore perform better on cognitive task accuracy. Continued work should examine how reward processing and its underlying mechanisms may differ in depressed PwMS.

29 Associations Between Social Support and Cognitive Performance Among Persons with MS

Objective:Social support is an emerging protective factor against cognitive decline. However, the relationship between social support and cognitive functioning in the multiple sclerosis (MS) population is not well understood. The present study aimed to investigate the associations between different aspects of social support and cognitive performance among persons with MS.Participants and Methods:A volunteer sample of 63 persons with MS (% female = 88.9, mean age = 48.16) completed measures assessing perceived levels of social support measured by the Medical Outcomes Study Support Social Survey 5-item short form (MSSS-5), and social network (social network diversity and total size of social network) measured by the Social Network Index (SNI). Cognitive functioning was assessed by a brief virtual examiner-administered neuropsychological test battery (using a teleconferencing platform), including the Rey Auditory Verbal Learning Test, Controlled Oral Word Association Test, animal naming, and the Symbol Digit Modalities Test. Participants also completed brief, self-paced, virtual cognitive tests through the testmybrain.org platform, which consisted of digit span and the Trail-Making Test. A principal component analysis (PCA) was carried out to reduce the number of neuropsychological outcomes into fewer dimensions. Multiple linear regressions were conducted to examine the associations between social support measures and cognitive performance. Regression models were adjusted by the levels of depressive symptoms (operationalized by the Chicago Multiscale Depression Inventory or the Hospital Anxiety and Depression Scale) and premorbid functioning (measured by the Test of Premorbid Functioning).Results:A PCA reduced neuropsychological outcomes into 3 components representing cognitive domains of 1) processing speed/executive functioning, 2) verbal memory, and 3) verbal fluency / simple attention. In the unadjusted models, both perceived social support (i.e., to what extent one receives assistance from their social network) as well as total size of social network (i.e., total number of people one regularly talks to) were significant predictors of the processing speed/executive functioning component score of moderate strength, where F(1, 59) = 11.93, p = .001, β = 0.41 and F(1, 59) = 11.57, p = .001, β = 0.41, respectively. These associations were maintained after adjusting for depressive symptoms and level of premorbid functioning (F(4, 55) = 3.31, p = .003 and F(4, 55) = 3.31, p = .006, respectively). On the other hand, social network diversity (i.e., number of different types of close social relationships one has) was not a significant predictor of the processing speed/executive functioning component score (p > 0.05). None of the social support measures were significantly associated with the verbal memory and verbal fluency/simple attention component scores.Conclusions:Greater social support (specifically, perceived levels of assistance and total size of social network) is associated with better performance on processing speed/executive functioning measures among persons with MS, independent of effects from depressive symptoms and premorbid functioning. Maintaining a strong social support network may be an important factor in optimizing cognitive health in MS.

11 The Moderating Effect of Depression on Workload Perception in Traumatic Brain Injury

Objective:Individuals who have experienced traumatic brain injury (TBI) are at an elevated risk for worsened physical and psychological outcomes. Increased rates of anxiety and depression, along with cognitive issues, are common post-TBI. While there is some evidence that anxiety and depression may affect objective cognitive performance, less is known about their effect on other factors that are associated with the individual’s capacity to complete the task, such as perceived workload of the cognitive task. Workload represents an individual’s perception of task difficulty and serves as a proxy for the magnitude of mental demands a given task places on an individual. Preliminary findings in the literature suggest that individuals with TBI commonly report greater workload when completing cognitive tasks compared to neurotypical peers, but the influence of anxiety and depression on survivors’ workload remains unclear. Considering the elevated rates of psychological and cognitive problems in individuals with TBI, the present study examined the moderating role of anxiety and depression on TBI survivor workload perception of a stress-inducing working memory task.Participants and Methods:Ten participants with moderate to severe TBI and eight neurologically healthy controls performed the Paced Auditory Serial Addition Task (PASAT). After completing the PASAT, participants reported their subjective workload using the NASA task load index (NASA-TLX). Participants also completed measures of psychological functioning, including the Chicago Multiscale Depression Inventory (CMDI) and the State-Trait Anxiety Inventory (STAI). Relationships between workload and depression and trait anxiety were examined using linear regression.Results:Linear regression was employed for both the TBI and the healthy control groups to assess the influence of trait anxiety and depression on perceived workload. There was no significant difference between the TBI and HC NASA perceived workload scores. Within the TBI group, there was a significant anxiety by depression interaction (b = -.015, p < .001). Simple slopes analyses revealed that for TBI participants reporting low depression, perceived workload increased with increased anxiety (b = .093, p < .001). For TBI participants reporting high depression, perceived workload decreased as anxiety increased (b = -.38, p = .03). While there was also significant anxiety by depression interaction in the healthy control group (b = .033, p = .04), simple slopes analyses revealed that there were no significant associations for healthy controls.Conclusions:These results demonstrate that in TBI, level of depression moderates the relationship between anxiety and workload perception. The pattern observed in the TBI group was unique from controls. The present findings suggest that post-TBI, higher depression may temper the influence of anxiety on stressful cognitive task performance and workload rating. The tempering effect of high depression in TBI may represent a biased reporting style or impaired assessment of task difficulty, which may ultimately affect the individual’s capacity to accomplish a task well.

The impact of personal protective factors on quality of life after traumatic brain injury

ABSTRACT Primary objective Examine the impact of four personal protective factors (self-awareness (SA), self-efficacy (SE), cognitive and emotional factors) on positive adaptation, or resiliency, in persons with traumatic brain injury (TBI). We hypothesized that people with better SA and cognitive skills, less depression and positive SE will report better quality of life (QOL). Research design Correlational longitudinal design was used to explore relationships between outcome variables at initial evaluation and 6-months following initial evaluation Methods and procedures 38 community-dwelling adults at least 1 year after sustaining a moderate-to-severe TBI were administered the Self-Efficacy Scale, Awareness Questionnaire, Chicago Multiscale Depression Inventory, Symbol Digit Modalities Test, and SF-12. Main outcome and results Higher rated SE and emotional functioning correlated with better QOL indicating SE and emotional functioning may be personal factors facilitating positive adaptation in persons with TBI. Interestingly, poorer cognitive functioning (i.e. processing speed) and lower SA correlated with better QOL. Additionally, cognitive and emotional functioning were significant predictors of QOL. Conclusion Strengthening emotional functioning and SE may improve outcomes after TBI. However, it may be that self-reported QoL is a poor outcome for people with TBI and measurement in future studies and practice should focus on actual engagement of activities.

Multiple Sclerosis and Depression: Translation and Adaptation of the Spanish Version of the Chicago Multiscale Depression Inventory and the Study of Factors Associated with Depressive Symptoms.

Depressive disorder occurs in up to 50% of persons with Multiple Sclerosis (PwMS). Accurate assessment of depression in MS is essential in clinical settings because depressive symptomatology can affect the clinical course of the disease. We translated, adapted, and tested the Spanish version of the Chicago Multiscale Depression Inventory (CMDI), a specific test to assess depression in neurological disorders. We compare our results with those obtained with previous versions of the questionnaire (English and Italian). Finally, we also analyze the relationship between the results obtained on the CMDI and demographic, clinical, and cognitive variables. The results obtained with the Spanish version of the CMDI were similar to those observed in previous published versions. We also observed higher depression scores in PwMS (especially in progressive forms) compared with healthy controls. Moreover, depression symptomatology was related to higher disability and fatigue and worse cognitive performance in PwMS. The results support the validity of the CDMI in the Spanish population, as well as the association between depression and other characteristic symptoms of MS. These findings also emphasize the importance of good assessment and multidisciplinary treatment of depression in PwMS.

Effects of diminished positive mood and depressed mood upon verbal learning and memory among people with multiple sclerosis

ABSTRACT Objective: Cognitive impairment affects as many as 65% of people with multiple sclerosis (PWMS), and memory impairment confers greater severity of disability and functional impairment. Depression is also common among PWMS, and lifetime prevalence rates are as high as 50%. Research has yet to clearly define the relationship between memory dysfunction and depression among PWMS, and may reflect incomplete assessment of depressive symptoms. The present study examined different aspects of depressive symptoms including anhedonia (i.e., diminished positive mood) and their relationships with verbal learning and memory among PWMS. Method: Participants were 48 healthy individuals and 96 PWMS. They were primarily Caucasian (90.3%) and female (75.0%). Participants completed the California Verbal Learning Test-2 (CVLT-2) to assess verbal learning and memory and the Chicago Multiscale Depression inventory to assess depressed mood (CMDI-Mood) and diminished positive mood (CMDI-DPM). Results: Linear regression revealed that the main effect of CMDI-DPM and the interaction of CMDI-DPM and CMDI-Mood significantly explained variance across learning, recall, and recognition CVLT-2 indices. Follow-up analyses indicated that CMDI-DPM was only significant in the absence of high CMDI-Mood scores. CMDI-Mood explained variance in only CVLT-2 Trial B. Conclusions: Depressed mood had little direct effect upon memory performance in PWMS. In the absence of severe depressed mood, higher levels of positive mood corresponded to better memory performance. However, the impact of diminished positive mood was rendered null among those endorsing high levels of depressed mood. These data may imply that anhedonia corresponds with poorer memory function among PWMS, and suggests that investigators and clinicians should assess multiple mood dimensions among PWMS.

Corticostriatal Hyperactivation to Reward Presentation in Individuals With TBI With High Depressive Symptomatology: A Pilot Study.

To examine the impact of depression on neural mechanisms associated with outcome processing (rewarding and punishing outcomes) in persons with traumatic brain injury (TBI). Kessler Foundation's Rocco Ortenzio Neuroimaging Center. A total of 16 adults with moderate to severe TBI. Chicago Multiscale Depression Inventory (CMDI); Behavioral Inhibition/Behavioral Activation Scale (BIS/BAS); functional MRI of the head while performing a gambling task, with a reward (+$1.00) and punishment (-$0.50). Individuals with TBI reporting high depressive symptomatology exhibited increased activation in the ventromedial prefrontal cortex (VMPFC) and striatum during presentation of rewarding outcomes compared with individuals with TBI reporting low depressive symptomatology. Punishing outcome presentation was not associated with any change in brain activation. No differences in volume of the striatum and VMPFC were observed between groups. Current findings provide the first evidence of differences in neural mechanisms underlying outcome processing between individuals with TBI with and without depression. The results suggest that depressive symptomatology might have a different effect on individuals with TBI than what is typically observed in individuals without TBI reporting with depression, with the possibility of rewards becoming more reinforcing as depressive symptomatology increases. Future studies should explore the potential implications of behavioral responses to rewards and punishments in TBI and how they can affect rehabilitation approaches and activities of daily living.

Coping style as a protective factor for emotional consequences of structural neuropathology in multiple sclerosis

ABSTRACTIntroduction: In people with multiple sclerosis (MS), depression symptoms could be a direct consequence of neuropathological processes or a secondary consequence of coping with debilitating illness. We investigated the interaction of white matter structure and patient coping style in predicting positive and negative emotion symptoms of depression.Method: Participants completed a neuropsychological battery, including the Chicago Multiscale Depression Inventory (CMDI) and a measure of coping strategies that has Active Coping (more adaptive) and Avoidant Coping (less adaptive) scales. Participants also completed a diffusion tensor imaging (DTI) scan, from which fractional anisotropy (FA) was calculated to assess integrity in tracts of interest, and the interaction of FA and coping style was analyzed to predict depression symptoms.Results: Significant FA and Active Coping interaction effects for predicting CMDI Negative Emotion scores were found for the anterior thalamic radiation and uncinate fasciculus white matter tracts. For people with MS who showed relatively reduced integrity of these tracts, use of more Active Coping moderated the relationship of microstructure and negative emotion symptoms of depression. This moderating relationship was not seen with other tracts of interest or with positive emotion.Conclusion: There was a protective effect of adaptive coping style against the experience of negative emotion among people with MS who showed compromised regional white matter integrity of certain tracts that connect temporal and thalamic regions to frontal cortex.

Subjective well-being differs with age in multiple sclerosis: A brief report.

Increased age is associated with improved subjective well-being in the general population. However, there are conflicting findings regarding this association in individuals with multiple sclerosis (MS). In the present study, we examined differences in depression and quality of life (QOL) among 3 age groups of individuals with MS. Participants consisted of 57 individuals with MS who were divided into 3 age groups: 35-44, 45-54, and 55-65 years. Outcome measures included the Mood and Evaluative scale t scores on the Chicago Multiscale Depression Inventory (CMDI) and the Physical and Mental scale scores on the Multiple Sclerosis Quality of Life Instrument (MSQOL-54). After controlling for disease duration, individuals in the oldest group reported significantly less severe depressive symptoms and better physical QOL than the youngest group. Results are consistent with theoretical predictions and observations of improved subjective well-being with age in the general population. Younger individuals with MS may be at higher risk for depression and poor QOL. Additional research is needed to model the findings in larger samples and clarify the theoretical mechanisms of the observed associations. (PsycINFO Database Record

Psychometric properties and validity of Beck Depression Inventory II in multiple sclerosis

Depression is the most common psychiatric disorder in multiple sclerosis (MS). Self-report depression scales are frequently used as screening, diagnostic and grading instruments. This study investigated the psychometric properties of the Beck Depression Inventory second edition (BDI-II) for assessing depressive disorders in a sample of Italian MS patients. The sample included 141 consecutive non-demented MS patients who completed the BDI-II and the Chicago Multiscale Depression Inventory (CMDI). MS patients also completed a clinical interview, a neurological/neuropsychological examination and a Fatigue Severity Score (FSS) questionnaire in order to assess divergent validity. The BDI-II showed good internal consistency (Cronbach's alpha 0.89) and good convergent and divergent validity. With respect to CMDI serving as the 'gold standard', the receiver operating characteristic curve revealed that BDI-II is an adequate diagnostic measure and that the optimum total cut-off score was 18.5. Such score identified clinically relevant depressive symptoms in 25.5% of our MS sample. The BDI-II is a simple, reliable and valid tool for detecting and grading depressive symptoms in Italian MS patients.

Examination of the Chicago Multiscale Depression Inventory and Initial Validation of a Positive Scale.

The Chicago Multiscale Depression Inventory (CMDI) was developed to improve accuracy in measuring depression symptoms in individuals with non-psychiatric medical illness. Earlier psychometric evaluation of the CMDI has emphasized properties of items that measure negative affect and experience. In this study, we provide an initial evaluation of an outcome scale of positive items that are also included within the CMDI but have previously been excluded from calculation of the total score. Psychometric data for the CMDI negative and positive item subscales were determined in healthy adults and patients with multiple sclerosis. Analysis included measurements of factor structure, reliability, and validity in comparison with other established measures of depression and affect. Study findings indicate that in healthy and patient samples, the CMDI Positive scale has very good reliability and validity. The Positive scale score also appears to predict depression symptoms beyond the negative item scale scores. The CMDI Positive scale could be a valuable clinical and research tool. Inclusion of the Positive scale in the CMDI total score appears to improve the measure by further capturing symptoms of affect and experience that are important to diagnosis of depression and are not covered by the negative scales alone. (JINS, 2016, 22, 76-82).

Depression in multiple sclerosis: The utility of common self-report instruments and development of a disease-specific measure

The ultimate objective of the present investigation was to improve the detection of depression in multiple sclerosis (MS) by comparing common self-report depression measures to a new, modified measure, which takes into account the contribution that symptoms of MS may have on individuals’ reports. There has been a longstanding concern regarding the accurate assessment of depression in MS, particularly with regard to the overlap of MS symptomatology and neurovegetative depression symptoms on self-report questionnaires, which may lead to an overdiagnosis of depression in MS. To address these difficulties, we previously proposed a “trunk and branch” of depression in MS. This model allows for the delineation of what symptoms are most reflective of depression in MS. By identifying these symptoms, it was possible to develop a modified Beck Depression Inventory (BDI) in which only the items found to be most related to depression in MS are included in the new measure, the MS Specific BDI (MS-BDI). We compared this measure to common self-report instruments (Beck Depression Inventory–Second Edition, BDI–II; Beck Depression Inventory–Fast Screen, BDI–FS; Chicago Multiscale Depression Inventory, CMDI). Results suggest that cutoffs of 4 on the BDI–FS and 23 on the CMDI Mood subscale are most useful when screening for depression in MS, with a sensitivity for both of 100%, while a cutoff of 19 on the BDI–II, a cutoff of 22 on the CMDI Evaluative scale, and a cutoff of 8 on the MS-BDI had high specificities, suggesting they can be used as to assist in diagnosing depression in MS.

Perfectionism and physical disability predict depression in multiple sclerosis

ObjectiveThe relationship between depression and physical disability in multiple sclerosis (MS) is unclear. This investigation examines the interaction between disability and perfectionism in predicting depression in MS. MethodsParticipants (n=51) completed the Frost Multidimensional Perfectionism Scale (FMPS), the Chicago Multiscale Depression Inventory (CMDI), and the Expanded Disability Status Scale (EDSS). ResultsRegression revealed that the FMPS×EDSS interaction predicted depression above the variance predicted by each variable alone. Perfectionism predicted depression at high levels of disability. ConclusionOur results suggest a means of reconciling inconsistent findings regarding physical disability and depression in MS and offer a potential target for psychotherapy.

Health‐related quality of life and depressive symptoms in significant others of people with multiple sclerosis: a community study

Uncertain prognosis and modest treatment efficacy make multiple sclerosis (MS) a particularly difficult disease to adjust to for both patients and their significant others (SOs). Few studies have assessed health-related quality of life (HRQOL) and depressive symptoms in SOs of people with MS in the community. We assessed, and identified predictors of, HRQOL and depression in SOs of adults with MS. POSMOS (postal survey of self-assessed health in MS adults and SOs) is a longitudinal survey on a random sample of 251 people with MS in the Milan area. In 2010, SOs and contemporaneous controls completed the SF-36 and Chicago Multiscale Depression Inventory (CMDI). Overall, 142 SOs (mean age 53.1 years; 50% women, 65% partners) and 120 controls (similar to SOs for sex and education, but older) participated. By multivariable modeling of the SO plus control population, SF-36 vitality was lower in SOs (proportional odds ratio 0.45; 95% confidence interval 0.28-0.70), women (0.41; 0.27-0.64), and older subjects (0.98; 0.97-0.99). SF-36 mental health was also lower in SOs (0.62; 0.40-0.96) and women (0.43; 0.28-0.67). Regarding MS characteristics associated with HRQOL and depression in SOs, severe disability [Expanded Disability Status Scale (EDSS > 6.5)] had no effect, whilst depressive symptoms (pathologic CMDI) negatively influenced most SF-36 and all CMDI scores in SOs. SOs had significantly lower vitality and psychological well-being than controls, identifying a burden in being the companion of a person with MS. This burden was unrelated to physical compromise but associated with depressive symptoms in MS.

Relationship Between Global Cognitive Decline and Depressive Symptoms in Multiple Sclerosis

Cognitive impairment and depressed mood are common symptoms in multiple sclerosis (MS), which significantly impact patients’ role functioning and quality of life. Cross-sectional studies indicate a modest association between cognitive impairment and depressive symptoms in MS. Longitudinal studies show inconsistent results but provide some data indicating a relationship between increasing global cognitive decline and increasing depressive symptoms over time. Establishing whether such a relationship exists represents an important first step in understanding the temporal nature of that relationship along with any treatment implications. The current study investigated this relationship by using the adjusted difference between a demographic estimate of premorbid intellectual functioning (Barona) and a performance measure of current intellectual functioning (Shipley Institute of Living) to capture long-term global cognitive decline in MS patients. Degree of global cognitive decline was then related to a self-report measure of mood, evaluative, and vegetative depression symptoms (Chicago Multiscale Depression Inventory). Global cognitive decline accounted for 5% of the variance in mood-evaluative symptoms but none of the variance in vegetative symptoms. When groups experiencing moderate, mild, and no global cognitive decline were compared on depression symptom subscales, MS patients experiencing moderate cognitive decline reported significantly higher mood and evaluative, but not vegetative, depressive symptoms than MS patients with stable cognitive functioning.

Positive everyday experiences interact with social support to predict depression in multiple sclerosis

Both social support and stress predict depression in multiple sclerosis (MS) patients. Little work has been done on the relationship between positive life experiences and depression in this group. Ninety MS patients completed the Social Support Questionnaire (SSQ), the Hassles and Uplifts Scale (HUS), the Chicago Multiscale Depression Inventory (CMDI), and the Affective Reading Span Task (ARST). The Expanded Disability Status Scale (EDSS) was also used. Separate regression analyses were conducted with the EDSS entered at step 1, ARST memory bias score at step 2, SSQ at step 3, either Hassles or Uplifts at step 4, and the interaction term at step 5 to predict depression. Uplifts interacted significantly with social support to predict depression, but hassles did not. After considering disability level, memory bias, and social support and uplifts main effects, the interaction of uplifts and social support accounted for nearly 5% independent variance in depression (p < .05). These results suggest that the absence of uplifts, combined with low levels of social support, is related to depression in MS patients. More generally, these data indicate that it is important to study the absence of positive experiences along with stress and negative experiences in this population.

An exploration of anger phenomenology in multiple sclerosis

Multiple sclerosis (MS) patients are often emotionally disturbed. We investigated anger in these patients in relation to demographic, clinical, and mood characteristics. About 195 cognitively unimpaired MS patients (150 relapsing-remitting and 45 progressive) were evaluated with the State Trait Anger Expression Inventory, the Chicago Multiscale Depression Inventory, and the State Trait Anxiety Inventory. The patients' anger score distribution was compared with that of the normal Italian population. Correlation coefficients among scale scores were calculated and mean anger scores were compared across different groups of patients by analysis of variance. Of the five different aspects of anger, levels of withheld and controlled Anger were respectively higher and lower than what is expected in the normal population. Although anger was correlated with anxiety and depression, it was largely independent from these mood conditions. Mean anger severity scores were not strongly influenced by individual demographic characteristics and were not higher in more severe patients. The presence of an altered pattern of anger, unrelated to the clinical severity of MS, suggests that anger is not an emotional reaction to disease stress. An alteration of anger mechanisms might be a direct consequence of the demyelination of the connections among the amygdale, the basal ganglia and the medial prefrontal cortex.

Relationships among Anxiety, Depression, and Executive Functioning in Multiple Sclerosis

Anxiety is a common psychiatric symptom among patients with multiple sclerosis (MS), however compared to depression it is relatively under-studied. The relative contribution of anxiety and depression to cognitive functioning was evaluated among 77 persons with MS. Participants completed the Chicago Multiscale Depression Inventory, the State-Trait Anxiety Inventory, and neuropsychological measures of executive functioning. Regression analyses indicated that, although both depression and anxiety independently predicted performance on an index of executive functioning, anxiety was uniquely associated with cognitive functioning in MS, above and beyond depression. These results suggest that consideration of anxiety in the assessment and treatment of MS patients is warranted.

Information-processing speed is the primary deficit underlying the poor performance of multiple sclerosis patients in the Paced Auditory Serial Addition Test (PASAT)

The aims of this study were to determine which cognitive domains are evaluated by the Paced Auditory Serial Addition Test (PASAT) and to identify which of them are responsible for the poorer performance displayed by multiple sclerosis (MS) patients in this task. A total of 30 healthy controls and 30 MS patients completed the PASAT task as well as the different tests contained in the Brief Repeatable Battery of Neuropsychological Tests (BRB-N), some Wechsler Adult Intelligence Scale (WAIS-III) subtests, the Spanish version of the Chicago Multiscale Depression Inventory (CMDI), and a new PASAT-based task (ADD1) that was specifically designed for this study. Analysis of covariance and regression-based analyses were performed to identify the predictors that are most strongly associated with the PASAT scores and the between-groups differences in the performance of this task. PASAT execution was associated with scores of the Digit Backward test, Symbol Digit Modality Test (SDMT), and measures of working memory and information-processing speed. On the other hand, differences between healthy volunteers and MS patients were mainly associated with the SDMT scores. MS patients also exhibited poorer execution than controls in the ADD1 task. Our results suggest that reduced information-processing speed (and not working memory) is the primary alteration underlying the lower scores in the PASAT task (and probably other cognitive deficits) that characterize MS patients. Based on these results, we suggest that tests that capitalize the role of information-processing speed may be of special relevance in the neuropsychological assessment of this clinical population.

Longitudinal course of depression symptoms in multiple sclerosis

Background: Despite the high lifetime prevalence of depression in multiple sclerosis (MS), its longitudinal course is poorly understood. Objective: To examine the longitudinal course of and reliable change in different...