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.

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).

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.

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.

Nearly 85% of adults on the autism spectrum are unemployed, although nearly 70% of those who are unemployed express a desire and willingness to work. The job interview has been identified as a significant obstacle to obtaining employment by young adults on the spectrum. A growing field of research has been focused on evaluating innovative training tools to improve interview skills. Our previous work shows that a virtual reality job interview training (VR-JIT) tool improves certain job interview skills (such as sounding professional, establishing rapport), but does not improve the ability to speak about personal strengths and abilities. The current study combined VR-JIT with a new training tool: Kessler Foundation Strength Identification and Expression (KF-STRIDE), an intervention grounded in principles of positive psychology. KF-STRIDE targets identification of personal character strengths and expressing those strengths to employers in a socially appropriate way.

The current study evaluated data from 20 autistic youth, randomized to an experimental group (n=10) and a services-as-usual (SAU) control group (n=10). Those in the experimental group participated in a 12 session intervention (9 sessions using VR-JIT and 3 sessions in KF-STRIDE). Each session was roughly one hour. Job interview performance was assessed by video-recorded mock job interviews rated by blinded assessors pre- and post- the intervention. Paired samples t-tests were conducted to examine differences in job interview skills from baseline to follow up in both groups.

The intervention group showed a significant improvement from baseline to follow-up in job interview skills in general (p = .004), and specifically sharing strengths about themselves to a future employer (p = .004). No significant differences were seen from baseline to follow-up in the SAU group. Conclusions: Individuals on the autism spectrum are significantly underemployed, which negatively impacts one’s ability to lead an independent life. Two innovative tools: VR-JIT and KF-STRIDE successfully improved job interview skills, including the ability to identify and express personal strengths. These findings indicate that these combined tools may help to improve employment skills for individuals on the autism spectrum.

Multiple sclerosis (MS) has historically been considered a syndrome that primarily affects White persons of northern European ancestry. This has been strongly disproven in recent decades with prevalence/incidence studies showing that MS impacts individuals from diverse backgrounds. The few studies available investigating clinical characteristics of MS across diverse groups have shown that Hispanic/Latinx/e (Latinx) and non-Hispanic Black/African American (NHB) persons with MS (pwMS) have more severe disease trajectories compared to non-Hispanic Whites (NHW), including an earlier age of disease onset, greater disability, and more severe symptoms overall. Changes in brain structure have been linked outcomes and MS-itself, but what remains understudied is how brain structure differs across race/ethnicity. As such, the current study aims to investigate volumetric brain differences in a diverse sample of pwMS.

The sample (n=79) was compiled from multiple neuroimaging datasets and divided into three groups- Latinx (n=19), NHB (n=29), and NHW (n=32)- based on self-reported race/ethnicity. Participants completed demographic interviews and structural magnetic resonance imaging (MRI) scans. Neuroimaging data was visually inspected and processed in FreeSurfer (7.3.2). Volumetric measures for total gray matter, cortical gray matter, total white matter, and subcortical gray matter were used as the primary outcome measures.

A multivariate general linear model was used to examine volumetric brain differences across groups. Age and total intracranial volume were included as covariates. Results showed a significant effect of race/ethnicity (Pillai’s Trace=0.175, F(6, 148)=2.36, p=.033), indicating significant differences in volumetric brain metrics across race/ethnicity, namely for subcortical gray matter, total gray matter, and total white matter volumes. Post-hoc testing showed the Latinx group to have less subcortical gray matter, total gray matter, and total white matter than NHWs. There was a trend for the NHB versus NHW, with NHBs having less brain volume. No significant differences were observed between the Latinx and NHB groups. Lesion volume and regional gray matter volumes were also examined.

To the authors’ knowledge, this is among the first studies to investigate structural brain differences across race/ethnicity in pwMS. Results point to disparities in brain volume across racial/ethnic groups with MS. These differences may partially underlie the differing trajectories observed in clinical characteristics across race/ethnicity. Future studies should include larger samples of diverse pwMS and examine the intersection of psychosocial and systemic factors (i.e., social determinants of health) and brain metrics to better understand the divergent disease trajectories observed across groups.

The current study aimed to examine real-time associations between non-cognitive symptoms and cognitive dysfunction (latter measured both objectively and subjectively in real-time) using ecological momentary assessment (EMA).

Forty-five persons with MS completed EMA four times per day for three weeks. For each EMA, participants completed mobile versions of the Trail-Making Test part B (mTMT-B) and a finger tapping task, as well as surveys about symptom severity. Trait (usual levels of a symptom) and state (when symptom level was higher or lower than the individual's usual levels) aspects of each symptom's severity were calculated. Multilevel models were conducted to account for within-person clustering, with performance on the mTMT-B and self-reported rating of cognitive dysfunction as primary outcomes.

A total of 3,174 EMA sessions were collected; compliance rate was 84%. There was significant intra-day variability in mTMT-B performance, anxiety, fatigue, and pain. More severe state depressive symptoms predicted lower performance on the mTMT-B in real-time. Self-reported difficulties with sleeping the night before predicted mTMT-B performance the following day. In contrast, state (but not trait) fatigue, depression, anxiety, and pain all predicted self-reported cognitive dysfunction in real time. Further, state self-reported cognitive dysfunction (but not mTMT-B performance) was associated with a higher perceived sense of accomplishment.

Self-reported cognitive dysfunction was more susceptible to influences of other MS symptoms (especially when the symptom is more severe than the individual's usual levels) and better predicted perceived sense of accomplishment than objectively measured executive functioning in real-time. Objective executive functioning performance was sensitive to effects of depressive symptoms and sleep difficulties. The current study demonstrated the feasibility of assessing real-time associations among MS symptoms using smartphone-administered EMA.

Cognitive impairment is observed in up to two-thirds of persons with Multiple Sclerosis (MS). Impairments in cognitive processing speed (PS) is the most prevalent cognitive disturbance, occurs early in the course of disease and is strongly associated with disease progression, various brain parameters and everyday life functional activities. As such, cognitive rehabilitation for PS impairments should be an integral part of MS treatment and management. The current study examines the efficacy of Speed of Processing Training (SOPT) to improve processing speed (PS) in individuals with Multiple Sclerosis (MS). SOPT was chosen because of its significant positive results in the aging populations.

This double-blind, placebo-controlled randomized clinical trial included 84 participants with clinically definite MS and impaired PS, 43 in the treatment group and 41 in the placebo control group. Outcomes included changes in the Useful Field of View (UFOV) and neuropsychological evaluation (NPE) including measure of PS (e.g., Pattern Comparison and Letter Comparison). Participants completed a baseline NPE and a repeat NPE post-treatment. Treatment consisted of 10 sessions delivered twice per week for 5 weeks. After the 5 weeks, the treatment group was randomized to booster sessions or no contact. Long-term follow-up assessments were completed 6 months after completion of treatment. The primary outcome were tests of PS including UFOV and neuropsychological testing.

A significant effect of SOPT was observed on both the UFOV (large effect) and Pattern Comparison with a similar pattern of results noted on Letter Comparison, albeit at a trend level. The treatment effect was maintained 6-months later. The impact of booster sessions was not significant. Correlations between degree of improvement on the UFOV and the number of levels completed within each training task were significant for both Speed and Divided Attention indicating that completion of more levels of training correlated with greater benefit.

SOPT is effective for treating PS deficits in MS with benefit documented on both the UFOV and a neuropsychological measure of PS. Less benefit was observed as the outcome measures became more distinct in cognitive demands from the treatment. Long-term maintenance was observed. The number of training levels completed within the 10-sessions exerted a significant impact on treatment benefit, with more levels completed resulting in greater benefit.

To further investigate objective measures of cognitive fatigue (CF), defined as the inability to sustain performance over time, in newly diagnosed multiple sclerosis (MS) patients, by conducting a performance analysis on the Paced Auditory Serial Addition Test (PASAT) based on the type of errors (omissions vs. incorrect responses) committed.

Sixty-two newly diagnosed patients with MS (pwMS) and 41 healthy controls (HC) completed the PASAT. Analysis of the change in performance during the test was performed by comparing the number of correct responses, incorrect responses, and omissions in the 1st versus the 3rd tertile of the PASAT.

A significant decline in accuracy over time was observed to be related to an increment in the number of omissions, significantly more pronounced in pwMS than in HC. No change in the number of incorrect responses throughout the PASAT was observed for either group.

CF can be detected even in newly diagnosed pwMS and might objectively manifest as a progressive increase in omissions during a sustained highly demanding task (i.e., PASAT). This pattern may reflect slowed processing speed and increased fatigue in pwMS. Focusing on omissions on the PASAT instead of correct responses only may improve its specificity as an objective measure of CF.

Persons with multiple sclerosis (MS) often report prospective memory (PM) failures that directly impact their everyday life. However, it is not known whether PM deficits confer an increased risk of poorer everyday functioning. The aims of this study were to: (1) compare time- (Time-PM) and event-based PM (Event-PM) performance between persons with MS and healthy controls (HCs), (2) examine the neuropsychological correlates of PM in MS, and (3) examine the relationship between PM and everyday functioning in MS.

A between-subjects design was used to examine 30 adults with MS and 30 community-dwelling HC. Participants were administered the Memory for Intentions Screening Test (MIST) to assess PM skills, the Actual Reality™ (AR) to assess everyday functioning, and a battery of cognitive tests.

The MS group performed significantly worse on Time-PM compared to HC but not on Event-PM tasks. While both Time-PM and Event-PM subscales were correlated with retrospective learning and memory, the MIST Time-PM subscale was correlated with executive functions. Significant correlations were observed between AR and the MIST Time-PM, but not Event-PM, subscales.

The results highlight the role of executive functions on Time-PM. Furthermore, significant relationships with AR extend the ecological validity of the MIST to MS populations.