Cognitive function in multiple sclerosis: A long-term look on the bright side.

BACKGROUND: Multiple sclerosis (MS) may lead to cognitive decline over-time. OBJECTIVES: Characterize cognitive performance in MS patients with long disease duration treated with disease modifying drugs (DMD) in relation to disability and determine the prevalence of cognitive resilience. METHODS: Cognitive and functional outcomes were assessed in 1010 DMD-treated MS patients at least 10 years from onset. Cognitive performance was categorized as high, moderate or low, and neurological disability was classified according to the Expanded Disability Status Scale (EDSS) as mild, moderate or severe. Relationship between cognitive performance and disability was examined. RESULTS: After a mean disease duration of 19.6 (SD = 7.7) years, low cognitive performance was observed in 23.7% (N = 239), moderate performance in 42.7% (N = 431), and 33.7% (N = 340) had high cognitive performance, meeting the definition of cognitively resilient patients. Within the group of patients with low cognitive performance, severe disability was observed in 50.6% (121/239), while in the group of patients with high cognitive performance, mild disability was observed in 64.4% (219/340). Differences between the group of patients with high cognitive performance and severe disability (4.5%) and the group of patients with low cognitive performance and mild disability (5.0%) were not accounted for by DMD treatment duration. CONCLUSIONS: The majority of DMD treated MS patients did not have cognitive decline that could impair their quality of life after disease of extended duration.

Hope, dispositional optimism and severity of depression following traumatic brain injury.

PRIMARY OBJECTIVE: To investigate the extent in which two coping variables-hope and dispositional optimism-are related to depression severity amongst individuals who have sustained traumatic brain injury (TBI). METHODS AND PROCEDURES: Sixty-five participants were administered the Beck Depression Inventory (BDI), the Adult Hope Scale (AHS), the Life Orientation Test-Revised (LOT-R) and a demographic and injury-related data questionnaire. In addition, relevant injury-related data was collected from the medical records. MAIN OUTCOMES AND RESULTS: High levels of depression were experienced in the study sample, while hope and dispositional optimism were significantly lower in comparison to the general population. The correlation patterns indicate that both hope and dispositional optimism negatively correlated with participants' depression levels and that they showed significant positive correlations with each other. In the case of mild depression, the hope-Pathways sub-scale of the AHS was the only variable negatively correlated to it, while in moderate-to-severe depression all coping variables were negatively correlated to it. Regression analysis revealed that the AHS and LOT-R, but not the demographic and injury-related variables, predicted depression severity. CONCLUSIONS: Clinical implications in referring persons with TBI with mild vs. severe depression to rehabilitation programmes are discussed.

Single dose of methylphenidate improves cognitive performance in multiple sclerosis patients with impaired attention process.

BACKGROUND AND PURPOSE: Attention is one of the major cognitive domains adversely affected in multiple sclerosis (MS). The aim of the current study was to determine the effect of a single dose of methylphenidate on cognitive performance of MS patients with significant attention deficit. METHODS: In a double-blind placebo-controlled study design, 26 MS patients with impaired attention were randomly assigned to receive a single dose of 10 mg methylphenidate or placebo. Attention was assessed using the paced auditory serial addition test for 3 and 2 s (PASAT3'' and PASAT2'') at baseline and 1 h after drug/placebo administration. RESULTS: Methylphenidate significantly improved performance of both PASAT3'' and PASAT2'' tests by 22.8% and 25.6% respectively (p<0.001), while no significant changes were observed in placebo treated patients. CONCLUSION: Administration of a single dose of methylphenidate significantly improved attention in MS patients with considerable attention deficit.

Dysregulation of affect in multiple sclerosis: new phenomenological approach.

Disorders involving regulation of affect commonly occur in multiple sclerosis (MS). These include various clinical presentations with inconsistent definitions that lead to many nomenclatures. In order to simplify the clinical approach to dysregulation of affect (DyA) a phenomenological definition was applied that unifies and combines the current classifications. Accordingly, the prevalence of DyA was determined in MS patients and comorbidity was evaluated with psychiatric disorders. Using the Structured Clinical Interview for DSM-III-R (SCID), 651 consecutive MS patients were assessed (474 female, 177 male, mean age 43.6 years, mean disease duration 11.5 years) and it was found that the prevalence of DyA was 6.5% (n = 42). In 14 patients (33.3% of DyA patients) there was no associated psychiatric comorbidity, while in 28 patients (66.6%) there was comorbid psychopathology; 12 had been suffering from psychosis (28.6%), eight from mood disorders (19%), six from cognitive decline (14.3%) and two from personality disorder (4.7%). In 15 patients (35.7%) the DyA was ego-dystonic and in 27 patients (64.3%) the symptoms of DyA were ego-syntonic. All patients with comorbid psychosis had ego-syntonic DyA. In 14.3% of patients the DyA symptomatology preceded the appearance of MS. It is concluded that the new phenomenological definition of DyA aids in distinguishing this symptom from other psychopathologies and can serve as a tool for neurologists in defining this unique entity.