Background: Anxiety, which is very prevalent in multiple sclerosis (MS) but understudied, has been shown to negatively affect cognition in many different populations. Slowed information processing speed underlies most cognitive impairments in MS, including verbal learning. The aim of this study was to look at how anxiety influences cognition—specifically processing speed and verbal learning—in MS. Methods: Eligibility criteria were adults (≥18 years) who had a diagnosis of clinically definite MS and had participated in neuropsychological research projects. A retrospective medical record review was conducted on the neuropsychological testing data. Two hierarchical multiple regressions were conducted to determine the unique contributions of processing speed and anxiety on verbal learning in MS, after adjusting for demographic and disability variables. Two separate mediation analyses were conducted to determine the relationship between processing speed, verbal learning, and anxiety. Results: Participants (N = 141) ranged in age from 18–91 years. Based on the multiple regression analyses, processing speed (β = 0.55, ΔR2 = 0.27, P < .001) and anxiety (β = −0.34, ΔR2 = 0.11, P < .001) were uniquely significant predictors of verbal learning. Based on the mediation analyses, there was a significant indirect effect of anxiety on verbal learning through processing speed (ab = −0.31, 95% CI = −0.60 to −0.09). There was also a significant indirect effect of processing speed on verbal learning through anxiety (ab = −0.05, 95% CI = 0.01 to 0.12). Conclusions: Results suggest a bidirectional relationship of anxiety and processing speed on verbal learning in MS. Anxiety has a significant effect on cognition and should not be overlooked. Interventions targeting anxiety may improve cognition in MS.
Background: Adherence to nonmedication recommendations is typically low, as seen in various health populations. Because literature on adherence to treatment recommendations made after neuropsychological testing in multiple sclerosis (MS) is lacking, this study evaluated adherence and reasons for nonadherence. Relationships between adherence to recommendations and various other factors in patients with MS were also evaluated. Methods: Of 66 adult patients seen for neuropsychological testing at an MS center, 55 were eligible for this study. Forty-five patients (mean age, 43.4 years; 75.6% women) were reached by phone, and all agreed to an interview involving questions regarding adherence to treatment recommendations. Other information was obtained through retrospective medical record review. Results: Overall self-reported adherence to recommendations made from neuropsychological testing was 38%. Adherence rates varied by recommendation type: psychopharmacological management had the highest rate (80%), and referrals for cognitive rehabilitation had the lowest (6.5%). Reasons for nonadherence included needing more information and wanting to speak with one's physician regarding the recommendations. Adherence was associated with patients' ability to spontaneously recall at least some of their recommendations and with receiving both a written report and a phone call with test results. Conclusions: Adherence to recommendations made after neuropsychological testing for patients with MS is low. Points of intervention may be to give directed feedback for each recommendation and to provide both a written report and a phone call with results and recommendations. Asking patients to repeat back the recommendations may be a simple and efficient way to increase understanding and improve adherence.
Background. Sexual dysfunction is a common problem in women with multiple sclerosis (MS). The Multiple Sclerosis Intimacy and Sexuality Questionnaire-19 (MSISQ-19) is a specific instrument to evaluate sexual dysfunction in MS patients. The purpose of the study was to translate and validate the Ukrainian version of the MSISQ-19. Materials and methods. The original version of MSISQ-19 was translated under a standard procedure. A sample of 126 females with MS completed the questionnaire. Internal consistency was evaluated using Cronbach's alpha. Convergent validity was established using correlation with the Multiple Sclerosis Quality of Life-54 (MSQOL-54) and the Expanded Disability Status Scale (EDSS). Results. Total scale reliability (Cronbach's α = 0.943) and reliability for the primary (Cronbach's α = 0.901), secondary (Cronbach's α = 0.875), and tertiary subscales (Cronbach's α = 0.918) were high. Disability level, measured with the EDSS, and quality of life, measured with the MSQOL-54, significantly correlated with MSISQ-19 total score. Both physical and mental health-related quality of life on the MSQOL-54 significantly correlated with MSISQ-19 total score, and with primary, secondary, and tertiary sexual dysfunction. Satisfaction with sexual function significantly correlated with MSISQ-19 total score, and with primary, secondary, and tertiary sexual dysfunction. Conclusions. The study findings suggest that the Ukrainian version of the MSISQ-19 is a reliable and valid instrument for sexual function assessment in Ukrainian women with MS. It can be used during routine counseling to introduce the theme of sexuality, to detect sexual dysfunction, provide treatment, and prevent the development of more severe problems and therefore preserve the proper quality of life for MS patients.
Objective: To evaluate feasibility and acceptability of a neuropsychologically-based vocational intervention with increased follow-up support for women with multiple sclerosis. Design: Single-blinded parallel-group randomized controlled trial with 12-month follow-up. Setting: Tertiary-care multiple sclerosis center. Participants: Forty-nine employed women with multiple sclerosis meeting criteria on measures of cognitive dysfunction (Symbol Digit Modalities Test), fatigue (Fatigue Severity Scale), and/or depression (Beck Depression Inventory/Patient Health Questionnaire). Interventions: Participants received either neuropsychological testing and phone feedback regarding findings and tailored recommendations (standard-care treatment), or testing, in-person feedback, and two calls from a care-coordinator (experimental treatment). Measures: Feasibility measures included enrollment and attrition rates, and compliance to recommendations at 12-months between groups. Acceptability was evaluated by participants’ report of benefit from interventions. Secondary analyses included evaluation of symptom changes (cognition, fatigue, depression) from baseline to 12-months. Results: Of 49 women meeting screening measure thresholds, 44 were randomized to treatment groups (attrition: standard-care = 8, experimental = 6), and 30 completed the study (standard-care = 14, experimental = 16). Recommendation adherence rates did not significantly differ between standard-care and experimental groups (31% vs 49%). However, 16/16 experimental participants at least partially completed given recommendations as compared to 8/14 in the standard-care group. Participants across groups (97%) reported benefit from participation. No significant differences in symptom outcomes between groups at 12-months. Conclusion: In-person feedback and care-coordinator calls were feasible and acceptable additions to a neuropsychological intervention and may serve to increase recommendation adherence. Given high drop-out rate, particularly prior to testing, future research may explore avenues to improve completion rates and maximize benefits of such interventions.
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