MS Participants Research Articles

Auditory Test of Processing Speed: Preliminary validation of a smartphone-based test of mental speed

Background: The Symbol Digit Modalities Test (SDMT) is a gold-standard measure of cognitive efficiency and processing speed for people with multiple sclerosis (PwMS) but relies on vision and oculomotor function. Objectives: To develop and validate a new processing speed test with minimal memory involvement and no eye function requirements. Methods: We created an Auditory Test of Processing Speed (ATOPS). A total of 122 PwMS, of whom 33 were severely disabled (median Expanded Disability Status Scale 8.0) and 37 healthy volunteers (HVs), were enrolled. We assessed sensitivity to discriminate MS participants from HVs, convergent validity between ATOPS and SDMT, sensitivity to discriminate between cognitively impaired (CI) and cognitively preserved (CP) MS participants, and correlations with MS pathology (overall brain lesion burden). Acceptability was examined with completion rates and participant ratings of ATOPS. Results: ATOPS discriminated PwMS from HVs (d = 0.739–0.856), correlated with SDMT (|r| = 0.528–0.587), discriminated between CI and CP PwMS (d = 0.623–0.776), and correlated with lesion burden (r = 0.332–0.436). All groups indicated high favorability of ATOPS and severely disabled MS patients could be assessed by ATOPS more frequently than by SDMT (100% vs. 72.4% completion). Conclusions: ATOPS is a novel, accessible, and acceptable cognitive processing speed test that may be useful in clinical and/or research settings.

Ankle dorsiflexion asymmetry and the relationship with walking performance in people with multiple sclerosis

BackgroundMultiple sclerosis (MS) is a neurological disease characterized by demyelination disrupting the central nervous system. Persons with MS may exhibit symptomatic strength asymmetry (SA) that impacts motor gait and ankle mobility. The purpose of the present study was to investigate ankle dorsiflexion SA in people with MS and its relationship to functional performance. Research QuestionIs their a difference in dorsiflexion SA in MS participants compared to healthy individuals and does it impact functional performance? Methods13 MS participants (EDSS 3.5 + 1.8) and 13 age matched NON-MS participants underwent maximal isometric (MVC) dynamometry testing for ankle dorsiflexion in both limbs to determine SA. Participants performed three functional tasks of walking performance. ResultsThere was a significant intra-limb MVC difference in the MS group, and significantly greater isometric SA (p < 0.007) and isokinetic SA (p < 0.04) in the MS group compared to healthy individuals. The MS group exhibited significant correlations between outcomes of functional walking performance with isokinetic but not isometric SA. There was no significant correlation between disability status and functional task performance. SignificanceAnkle dorsiflexion SA is negatively correlated with functional performance in MS participants. MS disability status was not a predictor of functional task performance, and symptom testing may be appropriate to assess walking ability in persons with MS.

Oculomotor analysis to assess brain health: preliminary findings from a longitudinal study of multiple sclerosis using novel tablet-based eye-tracking software.

A growing body of evidence supports the link between eye movement anomalies and brain health. Indeed, the oculomotor system is composed of a diverse network of cortical and subcortical structures and circuits that are susceptible to a variety of degenerative processes. Here we show preliminary findings from the baseline measurements of an ongoing longitudinal cohort study in MS participants, designed to determine if disease and cognitive status can be estimated and tracked with high accuracy based on eye movement parameters alone. Using a novel gaze-tracking technology that can reliably and accurately track eye movements with good precision without the need for infrared cameras, using only an iPad Pro embedded camera, we show in this cross-sectional study that several eye movement parameters significantly correlated with clinical outcome measures of interest. Eye movement parameters were extracted from fixation, pro-saccade, anti-saccade, and smooth pursuit visual tasks, whereas the clinical outcome measures were the scores of several disease assessment tools and standard cognitive tests such as the Expanded Disability Status Scale (EDSS), Brief International Cognitive Assessment for MS (BICAMS), the Multiple Sclerosis Functional Composite (MSFC) and the Symbol Digit Modalities Test (SDMT). Furthermore, partial least squares regression analyses show that a small set of oculomotor parameters can explain up to 84% of the variance of the clinical outcome measures. Taken together, these findings not only replicate previously known associations between eye movement parameters and clinical scores, this time using a novel mobile-based technology, but also the notion that interrogating the oculomotor system with a novel eye-tracking technology can inform us of disease severity, as well as the cognitive status of MS participants.

Eye movements in patients with post-COVID condition.

Eye movement control is impaired in some neurological conditions, but the impact of COVID-19 on eye movements remains unknown. This study aims to investigate differences in oculomotor function and pupil response in individuals who suffer post-COVID-19 condition (PCC) with cognitive deficits. Saccades, smooth pursuit, fixation, vergence and pupillary response were recorded using an eye tracker. Eye movements and pupil response parameters were computed. Data from 16 controls, 38 COVID mild (home recovery) and 19 COVID severe (hospital admission) participants were analyzed. Saccadic latencies were shorter in controls (183 ± 54 ms) than in COVID mild (236 ± 83 ms) and COVID severe (227 ± 42 ms) participants (p = 0.017). Fixation stability was poorer in COVID mild participants (Bivariate Contour Ellipse Area of 0.80 ± 1.61°2 vs 0.36 ± 0.65 °2 for controls, p = 0.019), while percentage of pupil area reduction/enlargement was reduced in COVID severe participants (39.7 ± 12.7%/31.6 ± 12.7% compared to 51.7 ± 22.0%/49.1 ± 20.7% in controls, p < 0.015). The characteristics of oculomotor alterations found in PCC may be useful to understand different pathophysiologic mechanisms.

Neurophysiological and clinical biomarkers of secondary progressive multiple sclerosis: A cross-sectional study.

Timely diagnosis of secondary progressive multiple sclerosis (SPMS) represents a clinical challenge. The Frailty Index, a quantitative frailty measure, and the Neurophysiological Index, a combined measure of sensorimotor cortex inhibitory mechanism parameters, have recently emerged as promising tools to support SPMS diagnosis. The aim of this study was to explore the possible relationship between these two indices in MS. MS participants underwent a clinical evaluation, Frailty Index administration, and neurophysiological assessment. Frailty and Neurophysiological Index scores were found to be higher in SPMS and correlated with each other, thus suggesting that they may capture similar SPMS-related pathophysiological mechanisms.

Combining retinal neuronal and microvascular measurements improves discriminative power for multiple sclerosis patients without previous optic neuritis

AbstractPurpose: Quantitative thinning of optic nerves and changes in retinal microvasculature have been detected in multiple sclerosis patients without optic neuritis (MSNON). However, data on how both retinal neuronal and microvascular parameters jointly influence the diagnostic performance is lacking. To investigate the diagnostic performance of neuronal and microvascular changes to detect the presence of MSNON from normal controls.Methods: This is a cross‐sectional study of 51 MS participants (n = 76 eyes) and 71 age‐ and sex‐matched healthy controls (n = 117 eyes). Retinal macular ganglion cell complex (GCC) and retinal nerve fibre layer (RNFL) thicknesses and capillary densities from the superficial (SCP) and deep capillary plexuses (DCP) were obtained from the optical coherence tomography (Cirrus AngioPlex model HD‐OCT 5000). We also compensated RNFL thickness for ocular anatomical factors. Thickness and vascular measurements and their corresponding areas under the receiver operating characteristic curves (AUCs) were compared between groups.Results: All retinal structural and vascular parameters were significantly altered in MS (p ≤ 0.012). The best neuronal parameter for detecting MS was compensated RNFL from the optic nerve head region (AUC = 0.85), followed by GCC from the macular region (AUC = 0.79) while the best microvasculature parameter was the SCP (AUC = 0.66). Combining retinal neuronal and microvascular parameters improved its diagnostic performance for MS detection (AUC = 0.90; P &lt; 0.001). The joint model including both neuronal and microvasculature significantly improved the discrimination between MS and normal compared with each parameter separately (p = 0.027).Conclusions: Combining retinal neuronal and microvasculature parameters improved the discrimination of MSNON. Further studies may be warranted to evaluate the clinical utility of retinal parameters in risk prediction for disease progression.

Associations of sNfL with clinico-radiological measures in a large MS population.

Evaluation of serum neurofilament light chain (sNfL), measured using high-throughput assays on widely accessible platforms in large, real-world MS populations, is a critical step for sNfL to be utilized in clinical practice. Multiple Sclerosis Partners Advancing Technology and Health Solutions (MS PATHS) is a network of healthcare institutions in the United States and Europe collecting standardized clinical/imaging data and biospecimens during routine clinic visits. sNfL was measured in 6974 MS and 201 healthy control (HC) participants, using a high-throughput, scalable immunoassay. Elevated sNfL levels for age (sNfL-E) were found in 1238 MS participants (17.8%). Factors associated with sNfL-E included male sex, younger age, progressive disease subtype, diabetes mellitus, impaired renal function, and active smoking. Higher body mass index (BMI) was associated with lower odds of elevated sNfL. Active treatment with disease-modifying therapy was associated with lower odds of sNfL-E. MS participants with sNfL-E exhibited worse neurological function (patient-reported disability, walking speed, manual dexterity, and cognitive processing speed), lower brain parenchymal fraction, and higher T2 lesion volume. Longitudinal analyses revealed accelerated short-term rates of whole brain atrophy in sNfL-E participants and higher odds of new T2 lesion development, although both MS participants with or without sNfL-E exhibited faster rates of whole brain atrophy compared to HC. Findings were consistent in analyses examining age-normative sNfL Z-scores as a continuous variable. Elevated sNfL is associated with clinical disability, inflammatory disease activity, and whole brain atrophy in MS, but interpretation needs to account for comorbidities including impaired renal function, diabetes, and smoking.

Acute Exercise Increases Attentional Bias Towards Food Cues

Although exercise is a common weight loss strategy, the amount of weight loss resulting from exercise training is often less than expected. This is often attributed to exercise promoting greater energy intake, resisting the exercise-induced negative energy balance required for weight loss. Prior research on how exercise can influence hormonal mediators of appetite offer conflicting results, with some demonstrating longitudinal exercise increases the satiety response to a meal and changes in hunger hormones do not predict weight loss. Research on other underlying mechanisms working to promote energy intake during exercise is scarce. PURPOSE: To determine if acute exercise influences attentional bias towards food cues. METHODS: Thirty (30) participants (BMI ≥ 25, aged 18-50 years) completed the Dot-Probe task before and 15 minutes after a bout of aerobic exercise where they expended an estimated 500 kcal and before and after a 60-minute bout of television watching (sedentary condition) on separate sessions. Sessions were separate by one week and order was counterbalanced across participants. The Dot-Probe task uses an eye-tracking device to measure the amount of time (ms) participants spent fixated on image pairs projected on a computer screen. Images included either highly appealing food (critical task stimuli) or neutral (non-food) images. Images were presented for 3,000 ms. A yellow dot appeared on either side of the screen in place of one of the previously presented images. Participants responded as quickly as possible to indicate which side the probe appeared by pressing a corresponding computer key. Mean fixation time (amount of time looking at each image) was recorded in ms. RESULTS: A condition (exercise vs sedentary) by time (pre vs post) interaction (p = 0.001) was observed where the percent of time fixated on food cues increased from 48.3% pre to 56.6% post-exercise while fixation percent changed from 50.6% pre to 49.7% post-sedentary. CONCLUSION: Acute aerobic exercise increases the environmental salience of food cues, which may increase the motivational drive to eat and resist an exercise-induced energy deficit. Attentional bias training has been successfully used to change eating behaviors and may represent a novel adjunct therapy to increase the success of an exercise for weight loss intervention.

The metabolic potential of the paediatric-onset multiple sclerosis gut microbiome

BackgroundThe aim of this study was to examine the gut microbiome's metabolic potential in paediatric-onset MS patients (symptom onset <18 years). MethodsWe included 17 MS participants and 20 controls similar for sex, age, race, and stool consistency from the Canadian Paediatric Demyelinating Disease Network study. Stool-derived gut metagenome gene abundances were used to estimate relative abundances and turnover scores of individual microbial metabolites and the composition and diversity of carbohydrate-active enzymes (CAZymes). MS participants and controls were compared using the Wilcoxon rank-sum test, as were the disease-modifying drug (DMD) exposed and naïve MS participants. ResultsThe median age(s) at MS symptom onset=16.1 years (interquartile range [IQR]=1.7), and at stool sample procurement=16.9/15.8 years (IQR=2.0/1.4), for the MS participants/controls. Most MS and control participants were girls (80–82%). Five (29%) of the MS participants had never been exposed to a DMD pre-stool sample and 12 (71%) had (7 to beta-interferon and 5 glatiramer acetate). While the relative abundance of metabolites did not differ between MS participants and controls, turnover scores did. MS participants had a greater potential to metabolize lipopolysaccharides than controls (score difference=1.6E-04, p = 0.034) but lower potential to metabolize peptidoglycan molecules and starch (score differences<2.2E-02, p<0.040). Further, although CAZymes diversity did not differ (p>0.050), starch-degrading subfamilies were underrepresented in MS participants versus controls (relative abundance differences >-0.34, p<0.040) and in the DMD exposed verses DMD naïve MS participants (relative abundance differences>-0.20, p<0.049). ConclusionPaediatric-onset MS participants had an altered gut microbiome-related metabolic potential compared to controls, including higher breakdown of lipopolysaccharide molecules, but lower resistant starch metabolism.

Quantification of smooth pursuit dysfunction in multiple sclerosis

Background: Smooth pursuit dysfunction is common in MS, but rarely quantified and may be missed on exam. Methods: NeuroFitONE™ smooth pursuit performance measures were compared between MS (n = 20) and healthy control (n = 19) participants. Results: Compared to controls, MS patients had lower proportion of smooth pursuit (0.63 vs. 0.73; p = 0.047), increased directional (10.1 vs. 8°; p = 0.014) and speed noise (4.3 vs. 3.1°/sec; p = 0.021) and reduced initiation acceleration (96.83 vs. 115.33°/sec2; p = 0.061). Significant univariate correlations with clinical scores (EDSS, T25-FW) were observed. Conclusion: Smooth pursuit dysfunction in MS can be readily quantified and distinguishes MS eyes from healthy controls.

Associations between fatigue and physical behavior in patients with multiple sclerosis with no or minimal disability

ABSTRACT Objectives Fatigue and physical behavior are essential factors affecting disability levels in people with multiple sclerosis. The relationship between fatigue and physical behavior has not been investigated systematically. The aim of the study was to determine the associations between fatigue severity and physical behavior in MS and compare fatigue and physical behavior of MS patients with healthy controls. Method: Forty individuals with MS with an Expanded Disability Status Scale ≤2 and 30 healthy controls were included in this cross-sectional study. Fatigue was evaluated with the Fatigue Severity Scale (FSS). The effects of fatigue on daily function were assessed by the Fatigue Impact Scale (FIS). Physical behavior was measured with an accelerometer, and outcomes were categorized by the amount of activity, activity category, and energy consumption. Results MS subjects reported more fatigue as compared to healthy controls on the FSS (p = 0.000), and fatigue affected daily function more in MS as compared to controls (FIS: p = 0.000). MS participants showed lower scores on all dimensions of physical behavior (p < 0.05). Fatigue was associated with functional limitations (p < 0.05), objective physical activity level, sedentary and moderate activities (p < 0.05), and energy consumption (p < 0.05) in MS. Conclusions Individuals with MS with no or minimal disability reported more fatigue and less active physical behaviors than healthy controls. Fatigue was inversely associated with physical activity level, moderate activity and, energy consumption. Fatigue was positively associated with sedentary activity and functional limitations in MS. Clinicians should be aware of these relationships when planning rehabilitation strategies. Trial registration: ClinicalTrials.gov identifier: NCT03255460.

Exercise-induced changes in gait kinematics in multiple sclerosis with minimal neurological disability

BackgroundExercise-induced gait deterioration is a frequently encountered symptom that limits ambulation throughout the clinical course, becoming more prominent with increasing neurological disability in people with MS (pwMS). ObjectiveWe attempted to objectively document exercise-induced gait changes in pwMS with minimal neurological disability and stable disease. MethodsGait kinematics and spatio-temporal parameters were recorded using 3D motion analysis before and after a 20-minute treadmill walk (Group A, n=15)/run (Group B, n=15) at a self-selected speed in pwMS and compared with healthy controls (n=15). ResultsGait analysis revealed a significant decrease in peak ankle dorsiflexion in swing of the most affected leg, post-exercise task, in both Group A (EDSS 2.5-3.5) and Group B (EDSS 1-2.5) and not in healthy controls. Fourteen out of 30 MS participants showed an exercise-induced gait deterioration, based on minimal detectable change. Pre-exercise gait parameters in Group A showed a significantly higher peak dorsiflexion in swing with shorter step length and higher cadence, whereas Group B was comparable to healthy controls. ConclusionThe detection of exercise-induced gait deterioration (foot drop) in pwMS with minimal neurological disability and stable disease indicates the potential of gait kinematics, before and after an exercise task, to monitor subtle neurological deficits from an early stage of MS.

Characterizing Long-Term Disability Progression Outcomes in NARCOMS Registry MS Participants Taking Dimethyl Fumarate (829)

Characterizing Long-Term Disability Progression Outcomes in NARCOMS Registry MS Participants Taking Dimethyl Fumarate (829)

Restless legs syndrome among multiple sclerosis patients in Lebanon

BackgroundMultiple sclerosis (MS) is often associated with fatigue, with an increased prevalence of sleep disorders compared to the general population, notably restless legs syndrome (RLS). The aim of this study was to evaluate the prevalence and severity of RLS as well the co-occurrence of spinal demyelination lesions in patients with MS in Lebanon. MethodsIn this cross-sectional study, we consulted the MS database of the Lebanese association against Multiple Sclerosis and sent out questionnaires to 300 MS patients to screen then confirm the presence of RLS. The final sample included 28 MS participants with confirmed RLS. We conducted further questionnaires to collect demographic data, screen for comorbidities, gather spinal MRI results, and evaluate the severity of both diseases (using the EDSS and the JHRLSS). ResultsPrevalence of RLS was 15% among MS patients in our study. 46.4% of RLS-affected MS patients had spinal cord demyelination lesions on their MRIs. Participants with MRI lesions had a lower severity score on the JHRLSS (p = 0.088). No association was found between the EDSS results and JHRLSS, demographic data, or comorbidities. ConclusionRestless legs syndrome is commonly found among patients with multiple sclerosis in Lebanon, is underdiagnosed, and ought to be systematically evaluated for in order to improve the patients’ quality of life.

OnabotulinumtoxinA treatment for MS-tremor modifies fMRI tremor response in central sensory-motor integration areas

BackgroundTreatment of tremor in MS is an unmet need. OnabotulinumtoxinA (BoNT-A) has shown promising results; however, little is known regarding its effects on the brain. The clinical presentation of tremor MS is shown to depend on subcortical neural damage and cortical neural plasticity. This study aimed to identify effects of onabotulinumtoxinA (BoNT-A) on brain activation in MS and upper-limb tremor using functional MRI. MethodsForty-three MS participants with tremor were randomized to receive intramuscular injections of placebo (n = 22) or BoNT-A (n = 21). Tremor was quantified using the Bain score (0–10) for severity, handwriting and Archimedes drawing at baseline, 6 weeks and 12 weeks. Functional MRI activation within two previously identified clusters, ipsilateral inferior parietal cortex (IPL) and premotor/supplementary motor cortex (SMC) of compensatory activity, was measured at baseline and 6 weeks. ResultsTreatment with BoNT-A resulted in improved handwriting tremor at 6 weeks (p = 0.049) and 12 weeks (p = 0.014), and tremor severity -0.79 (p = 0.007) at 12 weeks. Furthermore, the patients that received BoNT-A showed a reduction in activation within the IPL (p = 0.034), but not in the SMC. The change in IPL activation correlated with the reduction in tremor severity from baseline to 12 weeks (β = 0.608; p = 0.015) in the BoNT-A group. No tremor and fMRI changes were seen in the placebo treated group. ConclusionWe have shown that reduction in MS-tremor severity after intramuscular injection with BoNT-A is associated with changes in brain activity in sensorimotor integration regions.

Myelin Water Imaging and Transcranial Magnetic Stimulation Suggest Structure-Function Relationships in Multiple Sclerosis

Demyelination can be assessed structurally by magnetic resonance imaging and functionally with transcranial magnetic stimulation. Here we combined these techniques to investigate demyelination of the corpus callosum in multiple sclerosis. Our objective was to determine if corpus callosal demyelination impacts transcallosal inhibition (TCI). TCI is a brief suppression of voluntary activity in the primary motor cortex elicited by stimulation of the homologous region of the contralateral hemisphere, which is assumed to be transmitted via the corpus callosum. Magnetic resonance imaging and transcranial magnetic stimulation were performed in 26 participants with MS and 10 controls. Myelin water fraction (MWF) was measured in five regions of the corpus callosum and compared with the onset latency, duration, and depth of TCI as measured by electromyography at the forearm. Callosal MWF was greatest posteriorly compared to other regions of the corpus callosum. Lower MWF in MS compared to controls was more pronounced in the posterior corpus callosum. MS participants had a prolonged TCI duration (p=0.016), which correlated with EDSS (p=0.020) and disease duration (p=0.045). In MS, TCI depth correlated negatively with the MWF of the posterior callosal midbody (p=0.039), a region thought to mediate TCI transmission. In summary, TCI duration was increased in MS and demyelination of the posterior corpus callosum midbody was associated with measurable functional changes. This work demonstrates the potential for combining magnetic resonance imaging and transcranial magnetic stimulation with electromyography to draw insights about structure-function relationships in MS pathophysiology.

B-12 Cognitive Resilience in MS: Associations with Lesion Volume, Pain, and Smoking Status

Abstract Objective Cognitive dysfunction is common in people with MS (pwMS), but relatively little is known about those with no objective or subjective impairment. We sought to further examine a previously characterized cognitively resilient group of pwMS (MS-RES)—individuals without cognitive impairment, without subjective cognitive complaints, and without informant-reported cognitive difficulties—and considered neuroimaging, pain-related, and smoking correlates in this group. Method We derived two groups of pwMS: cognitively resilient (MS-RES; N = 15) and other MS (N = 85). MS groups showed equivalent education, gender, symptom and diagnosis duration, MS subtype, EDSS rating, and reported hours of sleep, and endorsed no more than mild depression. Both MS groups were compared to age- and gender-matched healthy controls (N = 31) on appropriate variables, and MS groups were compared on lesion volume, pain, and smoking variables. Results Despite showing intact subjective and objective cognition, the MS-RES group had lesion volume comparable to other MS participants. The MS-RES group also reported less of an impact of pain on overall functioning, recreational activities, and life enjoyment compared to other MS participants (p &lt; .05), and were comparable to healthy controls. There was a trend toward MS-RES participants being less likely to be current smokers than others with MS (p = .09), and MS-RES and healthy controls showed comparable smoking status. Conclusions We found that cognitively resilient pwMS have unique clinical features that differentiate them from others with MS despite similar lesion volumes. A more complete understanding of cognitively resilient pwMS may inform interventions that promote MS symptom management and general resilience.

Selective Colour Vision Deficits in Multiple Sclerosis at Different Temporal Stages

ABSTRACTMultiple sclerosis (MS) without optic neuritis causes color-vision deficit but the evidence for selective color deficits in parvocellular-Red/Green (PC-RG) and koniocellular-Blue/Yellow (KC-BY) pathways is inconclusive. We investigated selective color-vision deficits at different MS stages. Thirty-one MS and twenty normal participants were tested for achromatic, red-green and blue-yellow sinewave-gratings (0.5 and 2 cycles-per-degree (cpd)) contrast orientation discrimination threshold. Red-green mean threshold at 0.5cpd in established-MS and blue-yellow mean threshold in all MS participants were abnormal. These findings show blue-yellow versus red-green color test is useful in differentiating MS chronicity, which helps to better understand the mechanism of colour-vision involvement in MS.

Montreal Cognitive Assessment in a Greek sample of patients with multiple sclerosis: A validation study

The Montreal Cognitive Assessment (MoCA) is a brief cognitive instrument for the measurement of dementia. The aim of the present study was to measure the sensitivity of this test in a group of Greek speaking participants diagnosed with multiple sclerosis. 40 MS participants complaining for cognitive dysfunction were matched in age and education to 490 healthy participants. The MoCA test and a neuropsychological test battery were administered to both groups. The MoCA test was found to differentiate the MS from the controls (U = 3761.00, p < .001) and it was correlated with all neuropsychological tests (digit span: r = 0.454, p < .0001; phonemic verbal fluency: r = 0.390, p < .0001; semantic verbal fluency: r = 0.319, p < .0001; Color Trails Test 1 (CTT1): r = −.256, p < .0001; Color Trails Test 2 (CTT2): r = −.321, p < .0001). Multiple regression analysis showed that 10.3% of the variation in the MoCA score was accounted for by the Expanded Disability Status Scale (EDSS) total score. Also, the test showed high discriminant validity (optimal screening cut off point 25, sensitivity 0.68, specificity 0.89). MoCA is a sensitive test to differentiate cognitive impairment in Greek speaking MS participants from healthy controls. Further research is needed to use it in larger clinical samples and in different subtypes of the disease.

Can emotional content be extracted under interocular suppression?

Previous studies showed that emotional faces break through interocular suppression more easily compared to neutral faces under the continuous flash suppression (CFS) paradigm. However, there is controversy over whether emotional content or low-level properties contributed to the results. In this study, we directly manipulated the meaningfulness of facial expression to test the role of emotional content in breaking CFS (b-CFS). In addition, an explicit emotion judgment for different facial expressions (happy, neutral, and fearful) used in the b-CFS task was also conducted afterwards to examine the relationship between b-CFS time and emotion judgment. In Experiment 1, face orientation and luminance polarity were manipulated to generate upright-positive and inverted-negative faces. In Experiment 2, Asian and Caucasian faces were presented to Taiwanese participants so that these stimuli served as own-race and other-race faces, respectively. We found robust face familiarity effects in both experiments within the same experimental framework: upright-positive and own-race faces had shorter b-CFS times than inverted-negative and other-race faces, respectively. This indicates potential involvement of high-level processing under interocular suppression. In Experiment 1, different b-CFS times were found between emotional and neutral faces in both upright-positive and inverted-negative conditions. Furthermore, with sufficient duration (1000 ms) participants could still extract emotional content in explicit valence judgment even from inverted-negative faces, though with a smaller degree than upright-positive faces. In Experiment 2, differential b-CFS times were found between emotional and neutral faces with own-race but not other-race faces. Correlation analyses from both experiments showed that the magnitude of emotion judgment was correlated with b-CFS time only for familiar (upright-positive / own-race) but not unfamiliar (inverted-negative / other-race) faces. These results suggest that emotional content can be extracted under interocular suppression with familiar faces, and low-level properties in unfamiliar faces may play a major role in the b-CFS time.