MS Participants Research Articles

Taking the tester out of the SDMT: A proof of concept fully automated approach to assessing processing speed in people with MS

Background: One factor hindering the widespread use of cognitive testing for people with multiple sclerosis (pwMS) is the need for a tester to administer tests. Objective: To undertake a proof of concept study assessing the feasibility of a fully automated speech recognition version of the Symbol Digit Modalities Test (auto-SDMT) in detecting abnormalities in processing speed in pwMS. Methods: A sample of 50 pwMS and 32 matched healthy control (HC) subjects was tested with the auto-SDMT and the Brief International Cognitive Assessment for MS (BICAMS). Results: The percentages of MS participants impaired on the auto-SDMT and the traditional oral SDMT were 34% and 32%, respectively. Excellent convergent validity was found between the two tests (MS: r = −0.806, p < 0.001 and HC: r = −0.629, p < 0.001). The auto-SDMT had a similar sensitivity and specificity to the traditional oral SDMT in predicting overall impairment on the BICAMS. Conclusion: The auto-SDMT is a sensitive measure for detecting processing speed deficits in pwMS. The test, the first entirely computer administrated oral response version of the SDMT, uses speech recognition technology, thereby eliminating the need for a human tester. Replication of the results is required in a larger representative sample of pwMS.

Trunk control: The essence for upper limb functionality in patients with multiple sclerosis

BackgroundMultiple sclerosis (MS) involves impaired trunk control, leading to impaired upper-limb functionality, dexterity, and independence. Deciding early on a comprehensive approach pointing of functional disturbances and personal needs is essential for a multimodal, individualized, goal-oriented assessment and treatment program, recognizing the broad range of symptoms and disabilities associated with MS. In clinical practice, postural control of the trunk is purported to be an important contributor to voluntary upper-limb function, including motor control and dexterity. The objective of this study was to point out the impairments of and relationship between trunk control and comprehensive upper-limb functions in individuals with MS. MethodsTasks that were sought are optimal screening for deterioration in trunk control (Trunk Control Test [TCT] and Trunk Impairment Scale [TIS]) and upper-limb functionality by comparing them with the Expanded Disability Status Scale (EDSS), Nine Hole Peg Test (NHPT), Duruoz's Hand Index (DHI), and Functional Independence Measurement (FIM) results of 49 well-defined relapsing-remitting MS (RRMS) participants with those of 49 age-gender matched healthy subjects. ResultsSignificant differences between the groups were evident across all tasks of the clinical tests studied (p < 0.05), except the TCT-balance in sitting position subscore. EDSS, NHPT, DHI, and FIM scores were highly correlated with the TCT subscores (rolling to weak side, sitting up from lying down) and TCT-total score, as well as TIS subscores (dynamic and coordination) and TIS total score (p ≤ 0.005). While TIS subscores were highly correlated with almost all parameters, just TIS-static subscore did not correlate with the DHI and FIM-cognitive scores. Also, DHI-hygiene subscore correlated poorly just with the TIS-coordination and TCT-coming to sitting position (p < 0.05). ConclusionWe found that patients with MS would present impaired upper-limb movement and decreased trunk control with high correlation between them, even in RRMS and in the very mild form of the disease. Identifying trunk control deficits provides better insight into dexterous difficulties of patients with MS and allows a more targeted neurorehabilitation focusing on upper limbs. In future studies, it would be of interest to examine the prognostic value of trunk control and upper-limb functionality in patients with MS using a longitudinal approach.

Role of positive lifestyle activities on mood, cognition, well-being, and disease characteristics in multiple sclerosis

ABSTRACTMultiple sclerosis (MS) is a neurological condition associated with a wide variety of physical, cognitive, and mood-related symptoms. While disease-modifying treatment has been shown to reduce the severity and frequency of MS symptom relapses, engagement in certain daily activities holds promise as an adjunctive treatment to better manage disease sequelae. The present study sought to determine whether healthy nutritional choices, exercise, and social/intellectual engagement impacts functioning in individuals with MS. Two hundred and forty-eight (248) MS participants completed a questionnaire assessing factors related to cognitive health (Cognitive Health Questionnaire; CHQ). They also endorsed measures assessing disease symptoms and management, mood, and well-being/quality of life. A measure of information processing speed was administered to a subset of participants. Findings indicated that a previously derived CHQ factor comprised of healthy nutritional habits and exercise items was associated with less fatigue, better sleep, reduced pain, and improved mood and disease management. A factor with items assessing social and intellectual engagement correlated with mood, disease management, and well-being. Endorsement of items in both CHQ factors was associated with better information processing speed. Subsequent regression analyses indicated that education and mood were most predictive of nutritional habits and exercise, while MS self-efficacy was particularly associated with engagement in social and intellectual activities. In sum, these findings suggest that self-reported engagement in healthy lifestyle habits has far-reaching effects on multiple aspects of daily living and disease management in MS.

Yawning and cortisol levels in multiple sclerosis: Potential new diagnostic tool

Yawning is a significant behavioural response and, together with cortisol, is potentially a new diagnostic marker of neurological diseases. Evidence of an association between yawning and cortisol was found which supports the Thompson Cortisol Hypothesis and thermoregulation hypotheses, indication that brain cooling occurs when yawning. 117 volunteers aged 18–69 years were randomly allocated to experimentally controlled conditions to provoke yawning. Thirty-three had been diagnosed with multiple sclerosis. Saliva cortisol samples were collected before and after yawning or after stimuli presentation in the absence of yawning. Hospital Anxiety and Depression Scale, General Health Questionnaire, demographic and health details were collected. Comparisons were made of yawners and non-yawners, healthy volunteers and MS participants. Exclusion criteria: chronic fatigue, diabetes, fibromyalgia, heart condition, high blood pressure, hormone replacement therapy, stroke. Yawners had significant differences between saliva cortisol sample 1 and 2 among healthy participants (p < .007) and MS participants (p < .003). There was significant difference between the healthy versus MS non-yawners (P < .042) but not between yawners (p < .862). These results support the Thompson Cortisol Hypothesis suggesting that cortisol levels are elevated during yawning. Furthermore, this evidence suggests cortisol levels in the MS participants (non-yawners) are significantly different to those of healthy participants. Changes in cortisol levels may be similar in healthy and MS participants but when associated with observations of excessive yawning may become a new diagnostic tool in the early diagnosis of neurological symptoms. DRYAD DOI: https://doi.org/10.5061/dryad.r09m1.

Cognitive-motor interference in multiple sclerosis: What happens when the gait speed is fixed?

During the last decade, numerous studies have confirmed a coupling between walking performance and cognition in people with multiple sclerosis (PwMS). Our aim was to provide new insights into a walking-cognitive dual-task (DT) in PwMS. We tested the DT phenomenon by controlling the walking speed using an instrumented treadmill. Thirty PwMS (20 women) with a mean age 40.1 (SD=12.0) participated in the study. Twenty-one healthy subjects served as controls. Each subject completed a sequence of tests: a) Normal walking (ST) − the participant walked on the instrumented treadmill at a comfortable walking speed for 1min; b) Cognitive evaluation (ST) − subjects performed two cognitive tests while seated; c) DT cognitive tests performed while walking on the treadmill at the identical speed performed during normal walking. Outcome measures were spatio-temporal parameters of gait (mean and variability), the Word List Generation Test (WLG) and the Serial-3 Subtraction Test. MS participants significantly decreased their cadence while increasing their stride length during the DT condition compared to the ST condition. Non-significant differences were observed for the WLG and Serial-3 Subtraction Cognitive Tests between the ST condition and the DT condition in both the MS and healthy groups. In terms of gait variability parameters, MS subjects demonstrated a 2 to 3-fold greater gait variability compared to the healthy controls. Non-significant differences in gait variability parameters were observed between the ST and DT conditions in both the MS and control groups. This study provides new insights into the DT phenomenon in the MS population.

Optical coherence tomography and visual evoked potentials in pediatric MS.

Objective:To determine the relative ability of optical coherence tomography (OCT) and pattern-reversal visual evoked potentials (pVEPs) to detect visual pathway involvement in pediatric-onset MS.Methods:Pediatric-onset MS participants (onset <18 years) and healthy controls (HCs) underwent OCT (Cirrus HD-OCT) and pVEPs. Retinal nerve fiber layer (RNFL), ganglion cell layer to inner plexiform layer (GCL-IPL), and P100 pVEP latency were measured. Generalized estimating equation models were used to compare the groups, adjusting for age and intereye correlations.Results:Twenty-four pediatric MS participants, 14 with a history of remote (>6 months) optic neuritis (ON) in one eye (8 participants) or both the eyes (6 participants), and 24 HCs were enrolled. RNFL thinning (<83 μm, 2 SDs below HC eyes) occurred in 50% of ON eyes vs 5% of non-ON eyes. Prolonged VEP latency (>109 msec) occurred in 58% of ON eyes and 55% of non-ON eyes. A clinical history of ON predicted RNFL (p < 0.001) and GCL-IPL thinning (p = 0.011), whereas prolonged pVEP latency in children with MS occurred independent of ON history.Conclusions:OCT and pVEPs provide complementary but distinct insights. OCT is sensitive to retinal changes in the context of clinical ON, whereas pVEPs are useful to detect disseminated lesions of the visual pathway in children with MS.

Head Tracking Latency in Virtual Environments Revisited: Do Users with Multiple Sclerosis Notice Latency Less?

Latency (i.e., time delay) in a virtual environment is known to disrupt user performance, presence and induce simulator sickness. Thus, with emerging use of virtual rehabilitation, the target populations' latency perception thresholds need to be considered to fully understand and possibly control the implications of latency in a Virtual Rehabilitation environment. We present a study that quantifies the latency discrimination thresholds of a yet untested population-a specific subset of mobility impaired participants where participants suffer from Multiple Sclerosis-and compare the results to a control group of healthy participants. The study was modeled after previous latency discrimination research and shows significant differences in latency perception between the two populations with MS participants showing lower sensitivity to latency than healthy participants.

Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS): Canadian contribution to the international validation project

BackgroundGiven the high prevalence of cognitive dysfunction in people with multiple sclerosis (PWMS) and the lack of availability of specialized neuropsychological services in most MS Clinics, there is a need for a brief cognitive monitoring tool that can be easily administered by MS clinic staff. ObjectiveWe aimed to establish the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) as a feasible cognitive monitoring tool and provide Canadian data toward the international validation effort. Secondary considerations were to determine if BICAMS correlates with self-reported cognition and predicted vocational status. Methods57 PWMS were matched to 51 healthy controls (age, sex, education). Participants completed the BICAMS battery which includes the Symbol Digit Modalities Test, and the learning trials from the California Verbal Learning Test-II and the Brief Visuospatial Memory Test-Revised. Depression, self-reported cognition, and fatigue were assessed. Participants were re-tested 15.6 (SD 2.0) days later. ResultsWith impairment defined as “one or more abnormal tests,” 57.9% of MS sample was cognitively impaired. Participants were more likely to be impaired on the BVMT-R (43.9%). On the SDMT and CVLT-II, 28.1% and 26.3% of MS participants were impaired. Sensitivity and specificity were highest for the SDMT. The BICAMS was reliable over time (r value range from 0.69 for BVMT-R to 0.87 for SDMT) with the SDMT being most robust. There was no relationship between BICAMS and subjective cognition. The BVMT-R reliably predicted employment. ConclusionsThe BICAMS detected cognitive impairment to a comparable degree to more comprehensive neuropsychological batteries and is a valid measure of cognition in MS. Reliability of components varies, suggesting care be taken when interpreting serial testing results. The BICAMS is a feasible cognitive assessment tool in Canadians and yields comparable results to other cultures.

The “butterfly diagram”: A gait marker for neurological and cerebellar impairment in people with multiple sclerosis

People with multiple sclerosis (PwMS) frequently experience walking and balance impairments. In our previous report, we demonstrated that spatio-temporal gait parameters, collected by the Zebris FDM-T instrumented treadmill (Zebris Medical GmbH, Germany), serve as valid markers of neurological impairment in the MS population. In the current study, we focused on a unique outcome statistic of the instrumented treadmill, the “butterfly” diagram which reflects the variability of the center of pressure trajectory during walking. Therefore, the aim of the study was to examine the relationship between parameters related to the gait butterfly diagram and the level of neurological impairment in PwMS. Specifically we examined whether the gait butterfly parameters can differentiate between MS patients with normal cerebellar function and those suffering from ataxia. Demographic, neurological and gait parameters were collected from 341 PwMS, 213 women, aged 42.3 (S.D.=13.8). MS participants with ataxia demonstrated higher scores relating to the butterfly gait variability parameters compared to PwMS with normal or slightly abnormal cerebellar function. According to the results of the binary regression analysis, gait variability in the ant-post direction was found to explain 18.1% of the variance related to cerebellar function; R2=0.181, χ2(1)=67.852, P<0.001. Measurements derived from the butterfly diagram are proper estimators for important neurological functions in PwMS and should be considered in order to improve diagnosis and assessment of the MS population.

Symptom overlap in anxiety and multiple sclerosis

Background: The validity of self-rated anxiety inventories in people with multiple sclerosis (pwMS) is unclear. However, the appropriateness of self-reported depression scales has been widely examined. Given somatic symptom overlap between depression and MS, research emphasises caution when using such scales. Objective: This study evaluates symptom overlap between anxiety and MS in a group of 33 individuals with MS, using the Beck Anxiety Inventory (BAI). Methods: Participants underwent a neurological examination and completed the BAI. Results: A novel procedure using hierarchical cluster analysis revealed three distinct symptom clusters. Cluster one (‘wobbliness’ and ‘unsteady’) grouped separately from all other BAI items. These symptoms are well-recognised MS-related symptoms and we question whether their endorsement in pwMS can be considered to reflect anxiety. A modified 19-item BAI (mBAI) was created which excludes cluster one items. This removal reduced the number of MS participants considered ‘anxious’ by 21.21% (low threshold) and altered the level of anxiety severity for a further 27.27%. Conclusion: Based on these data, it is suggested that, as with depression measures, researchers and clinicians should exercise caution when using brief screening measures for anxiety in pwMS.

Self-reported sleep problems, but not fatigue, lead to decline in sustained attention in MS patients

Objective: According to the compensation theory, fatigue in MS results from efforts to compensate for a reduction in capacity due to demyelination or neurodegeneration. Recently, it has been argued that fatigue may result from poor sleep. Both explanations predict a worsening of fatigue and a cognitive decline during sustained attention tasks (higher fatigability). Method: We compared MS patients with and without self-reported cognitive fatigue, in three sessions with a two-back working memory task, registering hits and response latencies as well as changes in fatigue. In the two breaks between the sessions, either a video instruction to relax or a stimulating video was presented. Subsequently, patients were divided into those with and those without self-reported sleep problems and the analyses were repeated. Results: Patients with fatigue performed worse than healthy controls, irrespective of task duration and type of video during the break. The task-related increase of fatigue also did not differ between the groups and no differential effect of the videos was observed in the MS patients with fatigue. In contrast, patients with sleep problems did show a performance decline as predicted by the compensation theory. Conclusion: MS patients with fatigue were impaired in working memory, but did not show greater fatigability, whereas MS participants with self-reported sleep problems showed fatigability, which could be improved with a restorative rest period. Our data therefore do not support the compensation theory of fatigue, and we argue that sleep problems and fatigue in MS patients differ with respect to their functional consequences.

Mortality in Multiple Sclerosis in the United States (MIMS-US): A Retrospective, Cohort Study of Survival and Mortality Trends (P06.195)

Objective: To assess survival and all-cause mortality among MS patients in a large US database and a MS patient registry compared to a non-MS population. Background Although MS is a generally well-characterized condition, survival and cause of mortality data within US populations is limited. Design/Methods: 28,845 MS and 86,129 non-MS patients were selected from a large US claims database affiliated with i3. Inclusion in the MS cohort required ≥2 ICD-9-340 codes ≥30 days apart, or a combination of 1 ICD-9-340 and ≥1 disease modifying treatment (DMT) code, all with ≥3 consecutive months of database reporting. Inclusion in the non-MS cohort required absence of ICD-9-340 and DMT codes throughout the database reporting. Non-MS patients were matched based on age at index year (year subjects first identified as having MS), sex, and residence region at index year. From NARCOMS (a US volunteer-based MS registry), 34,777 MS participants were selected. Patients9 vital status was achieved by matching their information to the National Death Index (NDI) and the Social Security Administration Death Master File. Analyses focused on overall mortality rates and survival patterns since birth within and among populations. Results: In the i3-affiliated database, a K-M survival analysis showed that participants with MS had a significant survival disadvantage compared to non-MS controls (p Conclusions: Patients with MS have a significant survival disadvantage compared to non-MS populations and have mortality rates 2- to 3-fold higher than those without MS. Supported by: Bayer HealthCare Pharmaceuticals, Inc. Disclosure: Ms. Reshef has received personal compensation for activities with Bayer HealthCare Pharmaceuticals as an employee. Dr. Cutter has received personal compensation for activities with Sanofi-Aventis Pharmaceuticals, Inc., Cleveland Clinic, Daiichi Pharmaceutical Corporation, GlaxoSmithKline, Inc., Genmab Biopharmaceuticals, Eli Lilly & Company, Medivation, Modigenetech, Ono Pharmaceutical, PTC Therapeutics, Teva Neuroscience, Vivus, University of Pennsylvania, NHLBI, NINDS, NMSS, Alexion, Bayhill Therapeutics, Bayer Pharmaceuticals Corporation, Celgene, Novartis, Consortium of MS Centers, Genzyme Corporation, Klein-Buendel Incorporated, Nuron Biotech, Peptimmune, Somnus Pharmaceuticals, Sandoz, University of Texas Southwestern and Visioneering Technologies, Inc. Dr. Cutter has received compensation for serving on the board of Pythagoras, INC. Dr. Cutter has received research support from various pharmaceutical corporations. Dr. Golub has received personal compensation for activities with Bayer Pharmaceuticals Corporation. Dr. Brueckner has received personal compensation for activities with Bayer HealthCare Pharmaceuticals as an employee. Dr. Knappertz has received personal compensation for activities with Bayer Pharmaceuticals Corporation as an employee.

Presentation and Validation of the Multiple Sclerosis Depression Rating Scale: A Test Specifically Devised to Investigate Affective Disorders in Multiple Sclerosis Patients

Accurate diagnosis of depression in patients affected by MS is important, as it may be a cause of reduced quality of life and increased suicide risk. We present a new scale, the Multiple Sclerosis Depression Rating Scale (MSDRS), and assess its diagnostic accuracy in comparison to the Beck Depression Inventory (BDI). A total of 94 MS participants were classified as non-depressed (N = 44) or affected by mood disorder associated to MS with depressive manifestations (MSD-MDDM; N = 37) or with a major depression-like episode (MSD-MDL; N = 13). Each participant underwent a psychiatric interview, MSDRS, and BDI; diagnostic accuracy was evaluated using area under the ROC curve (AROC). The diagnostic accuracy of MSDRS and BDI was comparable when diagnosing both MSD-MDDM and MSD-MDL (AROC respectively 0.8998 and 0.8659); the MSDRS showed higher accuracy for the diagnosis of MSD-MDL (AROC respectively 0.9278 and 0.8314; p = .038). The MSDRS may be a reliable tool for the diagnosis of depression in MS.

Diffusion tensor imaging and cognitive speed in children with multiple sclerosis

Objectives To compare white matter (WM) integrity in children with MS and healthy children using diffusion tensor imaging (DTI), and correlate DTI findings with disease activity, lesion burden, and cognitive processing speed. Methods Fractional anisotropy (FA) and mean diffusivity (MD) in normal-appearing white matter (NAWM) were measured in four corpus callosum (CC), eight hemispheric regions, and the normal-appearing thalamus of 33 children and adolescents with MS and 30 age-matched healthy controls. Images were acquired on a GE LX 1.5 T scanner. DTI parameters used were 25 directions, b = 1000 s/mm 2, and 5 mm slice thickness. MS patients had T2 lesion volumes and Expanded Disability Status Scale (EDSS) scores were measured; all participants underwent two speeded cognitive tasks (Visual Matching and Symbol Digit Modalities Test (SDMT)). Results MS participants displayed lower FA values in the genu (p < 0.005), splenium (p < 0.001) and in NAWM of bilateral parietal, temporal, and occipital lobes (p < 0.001) versus controls. FA and MD in the thalamus did not differ between groups. Higher lesion volumes correlated with reduced FA in CC and hemispheric NAWM. DTI metrics did not correlate with EDSS. FA values in CC regions correlated with Visual Matching (p < 0.001) and SDMT (p < 0.005) in MS participants only. Interpretation DTI analyses indicate widespread NAWM disruption in children with MS—with the degree of abnormality correlating with impaired cognitive processing speed. These findings support an early onset tissue pathology in MS and illustrate its functional consequence.

Speed- and cane-related alterations in gait parameters in individuals with multiple sclerosis

Previous literature reporting gait parameters in the MS population has largely focused on preferred walking speed without the use of an assistive device. However, these data may not fully represent daily activity, as individuals with MS vary their speed or use a cane when walking. In this exploratory study, 11 MS participants and 13 controls walked at both maximal and preferred speed for a distance of 25-feet. Participants with MS that used a cane daily (n=6) were asked to complete additional trials with their cane. When walking unassisted at both speeds, MS participants displayed significantly reduced velocity, cadence, stride length, step length ratio, single support and swing time, as well as increased double support and stance time compared to controls. Cane use resulted in significantly higher velocities when walking at maximal speeds, and showed significantly improved variability, gait asymmetry, and bilateral coordination at preferred walking speed. In conclusion, the use of a cane may significantly improve gait for individuals with MS. Furthermore, gait parameters should be measured at both maximal and preferred speeds, with and without a cane, as its use may mask underlying gait impairment.

Deficient Inhibition of Return for Emotional Faces in Depression

Depression is a commonly-occurred mental disorder. Researchers have highlighted the attentional bias of depressive disorders,although results have been mixed. The cue-target task has often been used to explore attentional bias; a particular phenomenon revealed by such studies is the inhibition of return (IOR). However,cue-target task has seldom been used so far in the study of depressed patients. The aim of the present study was to investigate the IOR phenomenon in depressed individuals in cue-target task using emotional faces as cues. Control participants who had never suffered depression (NC),participants who had experienced at least two depressive episodes in their lives but were currently remitted (RMD),and participants diagnosed with a current major depressive disorder (MDD),were recruited using BDI,SDS,HAMD and CCMD-3 as tools. Seventeen participants in each group completed a cue-target task in a behavioral experiment that comprised three kinds of experimental condition,two cue types and four face types. Each participant also completed a simpler cue-target task in an event-related potential (ERP) experiment. In this task,a target appeared after a cue and the participant responded to its location. In the behavioral experiment,it was found that when the stimulus onset asynchrony (SOA) was 14 ms,the NC and RMD participants had IOR effects for all faces and MDD participants for angry and sad faces. When the SOA was 250 ms,all three groups all had cue validity for sad faces but the effect was much more marked for the MDD group. When the SOA was 750 ms,the NC participants had an IOR effect for sad faces,the RMD participants had cue validity for angry,happy and sad faces,and the MDD participants had cue validity for sad faces and an IOR effect for angry faces. In the ERP experiment,the NC participants showed a bigger P3 amplitude for happy cue than the other groups,a smaller P1 amplitude for happy faces in the invalid cue condition than for other faces,a smaller P1 amplitude for sad faces in the valid cue condition than for other faces,a bigger P3 amplitude for happy faces in the valid cue condition compared with MDD participants,and a bigger P3 amplitude for sad faces in the invalid cue condition compared with other groups. The RMD participants had larger P3 amplitude for sad cue than for other faces,larger P3 amplitude for happy faces in the valid cue condition compared with MDD participants,and smaller P3 amplitude for sad faces in the invalid cue condition compared with NC participants. The MDD participants had a larger P1 amplitude for sad cue compared with other groups,a larger P3 amplitude for sad cue than for other face cues,a smaller P3 amplitude for sad faces in the invalid cue condition compared with NC participants,and a smaller P3 amplitude for happy faces in the valid cue condition compared with other groups. It can be concluded that the MDD participants had cue validity and deficient IOR for negative stimuli. The deficient inhibition of negative stimuli renders them unable to eliminate the interference of negative stimuli and causes the maintenance and development of depression. The RMD participants had cue validity and deficient IOR for both positive and negative stimuli,which enables them to perceive positive and negative stimuli sufficiently and to maintain emotional balance.

Terror Management in a Predominantly Muslim Country

The mortality salience hypothesis of terror management theory was tested in a predominantly Muslim country. In Study 1a, private university students primed with thoughts of death reported more negative evaluations of a paragraph arguing state universities’ superiority to private ones, compared to a control condition in which “death” was replaced by “an important exam.” Study 1b conceptually replicated this finding at a state university. Study 2 found that MS participants wanted their home country to have stronger relations with Turkmenistan and weaker relations with England and Greece. Results were discussed with reference to university and national identity, and implications for future research were noted.

Deficient inhibition of return for emotional faces in depression

Depression is a commonly-occurred mental disorder. Researchers have highlighted the attentional bias of depressive disorders, although results have been mixed. The cue-target task has often been used to explore attentional bias; a particular phenomenon revealed by such studies is the inhibition of return (IOR). However, cue-target task has seldom been used so far in the study of depressed patients. The aim of the present study was to investigate the IOR phenomenon in depressed individuals in cue-target task using emotional faces as cues. Control participants who had never suffered depression (NC), participants who had experienced at least two depressive episodes in their lives but were currently remitted (RMD), and participants diagnosed with a current major depressive disorder (MDD), were recruited using BDI, BAI, HDRS and DSM-IV as tools. Seventeen participants in each group completed a cue-target task in a behavioral experiment that comprised three kinds of experimental condition, two cue types and four face types. Each participant also completed a simpler cue-target task in an event-related potential (ERP) experiment. In cue-target task, a target appeared after a cue and the participant responded to its location. In the behavioral experiment, it was found that when the stimulus onset asynchrony (SOA) was 14 ms, the NC and RMD participants had IOR effects for all faces and MDD participants for angry and sad faces. When the SOA was 250 ms, all three groups all had cue validity for sad faces but the effect was much more marked for the MDD group. When the SOA was 750 ms, the NC participants had an IOR effect for sad faces, the RMD participants had cue validity for angry, happy and sad faces, and the MDD participants had cue validity for sad faces and an IOR effect for angry faces. In the ERP experiment, the NC participants showed bigger P3 amplitude for happy cue compared with the other groups, smaller P1 amplitude for happy faces in the invalid cue condition than for other faces, smaller P1 amplitude for sad faces in the valid cue condition than for happy faces, bigger P3 amplitude for happy faces in the valid cue condition compared with MDD participants, and bigger P3 amplitude for sad faces in the invalid cue condition compared with other groups. The RMD participants had larger P3 amplitude for sad cue than for other faces, larger P3 amplitude for happy faces in the valid cue condition compared with MDD participants, and smaller P3 amplitude for sad faces in the invalid cue condition compared with NC participants. The MDD participants had larger P1 amplitude for sad cue compared with other groups, larger P3 amplitude for sad cue than for other face cues, smaller P3 amplitude for sad faces in the invalid cue condition compared with NC participants, and smaller P3 amplitude for happy faces in the valid cue condition compared with other groups. It can be concluded that the MDD participants had cue validity and deficient IOR for negative stimuli. The deficient inhibition of negative stimuli renders them unable to eliminate the interference of negative stimuli and causes the maintenance and development of depression. The RMD participants had cue validity and deficient IOR for both positive and negative stimuli, which enables them to perceive positive and negative stimuli sufficiently and to maintain emotional balance.

Evidence for deficits in facial affect recognition and theory of mind in multiple sclerosis

Multiple sclerosis (MS) is a white matter disease associated with neurocognitive difficulties. More recently the potential for white matter pathology to also disrupt important aspects of emotion understanding has been recognized. However, no study to date has assessed whether capacity for facial affect recognition and theory of mind (ToM) is disrupted in MS, or whether any observed deficits are related to more general cognitive impairment. In the present study MS participants (n = 27) and nonclinical controls (n = 30) were administered measures of facial affect recognition, ToM, and cognitive functioning. MS participants were significantly impaired on the ToM task, and also presented with specific deficits decoding facial emotions of anger and fear. Performance on the measures of facial affect recognition and ToM were related to general cognitive functioning, and in particular, measures sensitive to executive dysfunction and information processing speed. These data highlight the need for future research to more fully delineate the extent and implications of emotion understanding difficulties in this population.

Wagering demonstrates subconscious processing in a binary exclusion task

We briefly presented either the letter ‘b’ or the letter ‘h’ to participants who were instructed to respond by saying the letter that was not shown. This binary version of the exclusion task avoids problems with assessing baseline completion rates. When the letters were shown for 5–10 ms participants erroneously responded with the shown letter at a rate greater than chance. They were capable of following the instructions when the letter was shown for longer (15 ms). Given the chance to wager low or high on their choices after short duration stimuli, participants declined to wager high even when they were correct. Taken together these results suggest that the briefly presented stimuli were processed subconsciously.