While many studies have demonstrated a relationship between depression and cognitive deficits, most have neglected to include measurements of performance validity. This study examined the relationship between depression and cognition after accounting for noncredible performance. Participants were veterans referred for outpatient clinical evaluation. The first set of regression analyses (N = 187) included age, sex, and education in Model 1, Beck Depression Inventory-2 (BDI-2) added in Model 2, and pass/failure of Test of Memory Malingering (TOMM) added in Model 3 as predictors of 12 neuropsychological test indices. The second set of analyses (N = 559) mirrored the first but with Major Depressive Disorder (MDD) diagnosis in Models 2 and 3. In the first analyses, after including TOMM in the model, only the relationship between BDI-2 and verbal fluency remained significant, but this did not survive a Bonferroni correction. In the second analyses, after including TOMM and Bonferroni correction, MDD diagnosis was a significant predictor only for CVLT-II Short Delay Free Recall. Therefore, the relationship between depression and cognition may not be driven by frank cognitive impairment, but rather by psychological mechanisms, which has implications for addressing depressed individuals' concerns about their cognitive functioning and suggest the value of providing psychoeducation and reassurance.

Introduction: Providing doctoral internship stipends below living wages may harm interns, the clinical services they provide, and the field of health service psychology as a whole. This study evaluated the extent to which doctoral psychology internship stipends from the 2021-2022 training year for APA-accredited, APPIC-member programs in the US are consistent with living wages in the geographic region where sites are located. Methods: We obtained data reflecting internship sites’ geographic location and stipends for the 2021-2022 academic year. Using the Massachusetts Institute of Technology Living Wage Calculator, we computed a living wage for the county in which each internship site is located. Descriptive statistics, discrepancies, ratios, and correlations were calculated to reflect the associations between internship sites’ stipends and their local living wages.Results: The mean internship stipend was 31,783 US dollars (USD), which was lower than the mean living wage by 2,091 USD. Stipends ranged widely, from a low of 15,000 to a high of 94,595 USD–reflecting a six-fold difference in wages. Although internship sites in higher cost of living areas paid higher stipends, over two-thirds (67.0%) of sites did not pay a stipend that equaled or exceeded a living wage. Ninety-eight sites (15.3%) had deficits of over 10,000 USD when comparing their stipends to local living wages, with 33,240 USD as the highest deficit.Discussion: Eliminating obstacles to educating health service psychologists by decreasing the financial burden of training will likely have subsequent critical benefits towards bridging the workforce gap between mental healthcare service needs and available providers, ultimately leading to improved population health.

The purpose of this exploratory study was to examine interactive relationships between a common brain-derived neurotrophic factor (BDNF) polymorphism (Val66Met) and biological sex on cognitive functioning in a sample of healthy adolescent athletes. Participants included 82 student athletes (age: M = 12.85 years, SD = 1.13) who were involved in a clinically-based sports-concussion management program. Athletes completed the ImPACT computerized battery at baseline and provided buccal samples for determination of their BDNF genotype. Two-way ANOVAs were used to evaluate the effect of BDNF genotype (Met+ vs. Met-) and sex (male vs. female) on cognitive functioning (subgroup n's: Female/Met+ = 12, Female/Met- = 26, Male/Met+ = 12, Male/Met- = 32). ANOVAs revealed non-significant main effects for both BDNF genotype and sex across all four cognitive composites. However, there was a significant BDNF genotype by sex interaction for the visual-motor speed composite (p = .015; ηp2 = .073), such that female Met carriers demonstrated better performance than male Met carriers. In contrast, no differences were found on visual-motor speed performance between females and males without a Met allele. Although these results will need to be replicated using larger samples, our preliminary findings lend support to the view that the Met allele may be somewhat neuroprotective in healthy adolescent females.

Sport-related concussion is associated with deficits in numerous domains of cognition and an increase in symptom reporting on postconcussion symptom scales. However, previous research has indicated that mood disturbance also impacts performance and symptom reporting at baseline. To fully grasp the potential impact of mood disturbance on cognitive performance, the current study aims to compare athletes with affective comorbidity (depression/anxiety) at baseline to those without mood disturbance following concussion. One hundred nineteen athletes completed a comprehensive neuropsychological battery at baseline and/or within 14 days postconcussion. Athletes were separated into 2 groups (Baseline Comorbid Depression/Anxiety and Postconcussion Healthy Mood) based on affective symptomatology and injury status. Groups were compared on mean neurocognitive performance scores and algorithm-derived classifications of neurocognitive impairment. Groups were also compared on Post-Concussion Symptom Scale (PCSS) symptom reporting, both total score and by symptom cluster. We found no significant differences in neurocognitive performance between groups. The Baseline Comorbid Depression/Anxiety group reported significantly more total symptoms, and more affective and sleep symptoms, compared to the postconcussion group. Neurocognitively, athletes with mood disturbance at baseline looked comparable to athletes who recently sustained concussion. Surprisingly, the Baseline Comorbid Depression/Anxiety group reported greater levels of symptomatology on the PCSS despite not experiencing recent concussion. These findings highlight the importance of screening for affective symptoms at baseline to identify athletes with underlying conditions that may be comorbid with future concussion. Without accurate baseline data, postconcussion assessments may be skewed and may lead to these athletes being withheld from activity longer than necessary.

Comparing preinjury baseline neuropsychological testing with postconcussion testing has become the standard in sports concussion management. However, limitations to this model have led to calls for the development of approaches that only require postconcussion testing. The present study tested evidence-based postconcussion algorithms using a hybrid neuropsychological test battery. "Recovered " and "Not Recovered " groups of concussed collegiate athletes were identified using base rate of impairment algorithms (Arnett et al., 2016). This yielded 145 Recovered and 27 Not Recovered athletes in each of 2 algorithms, and 140 Recovered and 32 Not Recovered athletes based on the combined algorithm. Outcome variables included postconcussion symptom factor scores (ImPACT Post-Concussion Symptom Scale (PCSS)), and indices of cognitive variability (Intra-Individual Standard Deviation and Maximum Discrepancy scores) across the 17 indices. Across algorithms, results consistently showed that, compared with the Recovered group, the Not Recovered group reported significantly higher Headache, Sleep, and Cognitive scores on PCSS factor scores; they also showed significantly greater cognitive variability. Inconsistent with predictions, the groups did not differ significantly on the Affective PCSS factor; results for the Physical factor were mixed. Sex differences were also observed, with more than twice the proportion of females falling in the Not Recovered compared with the Recovered groups; these sex differences did not result in any changes in the group results when controlled for statistically. Our study provides evidence for the validity of base rate of impairment algorithms for collegiate athletes postconcussion who have not had baseline testing.What is the significance of this article for the general public?Nearly 4 million traumatic brain injuries (TBI) are estimated to occur annually (Langlois et al., 2006), with direct and indirect costs estimated at $60 billion (Daneshvar et al., 2011), highlighting that TBI is a significant public health concern. The majority of TBIs are mild (also known as concussions), and within this, many occur in the context of sports. Determining whether or not someone has recovered from a sports-related concussion is critical, as returning someone to play too soon can exacerbate existing symptoms and increase the risk of a second concussion. Many current models favor costly and time-consuming neurocognitive and symptom report baseline testing for purposes of comparing athletes' preinjury reports and performance with postinjury variables. Beyond cost and time, baseline models have also been criticized for being susceptible to changes in motivation from pre- to postinjury, practice effects, and test-retest reliability issues, among others. In the present study, we test an algorithm derived from base rates of impairment in healthy athletes to determine whether just testing athletes postconcussion and applying an existing algorithm (without benefit of baseline) is a feasible way of identifying those who have recovered versus not recovered. We found that, compared with those athletes identified as "recovered " by our algorithm, "not recovered " athletes showed more indicators that they were in fact not recovered, supporting the validity of the algorithm. Our results suggest that application of such an algorithm could result in significant time and cost savings over existing baseline models, while still being able to identify athletes who have not sufficiently recovered from their concussions to return to play.

To examine the relationship between neuropsychological test performance and mood symptoms and increases in postconcussion-like symptom reporting following cognitive exertion via a hybrid neuropsychological assessment. Collegiate athletes (N = 233; male = 171, female = 62) were assessed at baseline. A 21-item postconcussion scale (PCS) was administered at the beginning (pre-PCS) and the end (post-PCS) of baseline. A difference score was calculated by subtracting post-PCS from pre-PCS. Athletes were categorized as being in a stable symptoms group (N = 164; experiencing no change or a decrease in symptoms) or increased symptoms group (N = 69). Self-reported significant depression symptomatology on the Beck Depression Inventory-Fast Screen (Beck et al., 2000) score (>= 4) and significant anxiety symptomatology on the NEO-Five Factor Inventory (McCrae & Costa, 2004) Anxiety Subscale score (>= 10) were measured. Two neurocognitive composites were created (memory and attention/processing-speed) from indices on the hybrid neuropsychological test battery. There were no significant differences between the two groups on memory or attention/processing-speed composite performance (p > .05) or proportion of athletes reporting significant anxiety symptomatology (p > .05). However, a significantly greater proportion of athletes in the increased symptoms group reported significant depression symptomatology (11.59%) compared to the stable symptoms group (3.05%), x(2)(1, N = 233) = 6.72, p = .009, phi = .17. Self-reported depression symptomatology, but not self-reported anxiety symptomatology, is associated with an increase in postconcussion-like symptoms during the cognitive exertion associated with a typical baseline concussion assessment. Subjectively increased postconcussion-like symptoms are not associated with objective cognitive performance at baseline.

Objective: While much research has demonstrated a relationship between depression and cognitive deficits, most studies have neglected to include measurements of performance validity. The very small number of studies that have examined this relationship when accounting for performance validity have found that the relationship between depression and cognition is small or nonsignificant. The current study examined the relationship between depression (assessed through both clinical interview and self-report symptom measures) and multiple domains of cognition after accounting for noncredible performance on neuropsychological testing. Participants and Methods: Participants were veterans referred for outpatient clinical evaluation. Among other tests that varied across patients, the neuropsychological battery included: California Verbal Learning Test - second edition (CVLT-II) total immediate recall across trials 1–5, short delay free recall, and long delay free recall; Trail Making Test; FAS and Animal Fluency; Rey–Osterrieth Complex Figure Test (ROCF) copy and 3-minute delay recall; and Wisconsin Card Sorting Test (WCST) categories completed, total errors, and percent perseverative errors. These tests represent domains that have previously been examined in relation to depression (e.g., memory, processing speed, executive functioning). Evaluations were conducted for clinical purposes, so that some individuals who were not administered certain tests have missing data. The first set of regression analyses (N=206) included age, sex, and education at Step 1, Beck Depression Inventory-2 (BDI-2) total score at Step 2, and pass or failure of Trial 1 of the Test of Memory Malingering (TOMM) at Step 3 as predictors of performance on the 12 test indices. The second set of regression analyses (N=559) mirrored the first but with Major Depressive Disorder (MDD) diagnosis at Step 2 instead. Results: In the first set of analyses, after including TOMM in the model, only the relationship between BDI-2 and verbal fluency remained significant, but did not survive Bonferroni correction (p<.004). In the second set of analyses, before including the TOMM, MDD diagnosis was significantly related only to worse performance on Trails A and CVLT-II Short and Long Delay Free Recall, with small effect sizes (rp=.06–.15). When TOMM Trial 1 was included in the model, MDD diagnosis became a nonsignificant predictor of CVLT-II Long Delay Free Recall but remained a significant predictor for Trails A and CVLT-II Short Delay Free Recall (p<.05). After Bonferroni correction (p<.004), with TOMM Trial 1 included in the model, MDD diagnosis remained a significant predictor only of CVLT-II Short Delay Free Recall, with a small effect size (rp=.17). Conclusions: After accounting for noncredible performance, there was little evidence for a relationship between depression diagnosis or symptoms and many cognitive domains. These results suggest that previously reported effects of depression on cognition are not mainly due to underlying neurological mechanisms, but rather to motivational factors. Future research could focus on the potential psychological mechanisms (e.g., negative attitudes, expectancy bias, low motivation, etc.) driving the relationship between depression and low effort on cognitive testing. If replicated, the current findings could be valuable to clinicians treating depressed individuals who have concerns about their cognitive functioning, by indicating psychoeducation and reassurance.

Research indicates that premorbid IQ impacts the rate of impairment across neuropsychological domains. This study explored whether premorbid IQ is a factor in assessing cognitive impairment utilizing a concussion battery and whether a clinical algorithm should be updated based on premorbid IQ. Seven hundred seventy-one student athletes (572 male, 199 female) completed a comprehensive baseline concussion battery. Individuals were grouped as low (<= 99), mid (100-107), and high (108 thorn ) based on the Wechsler Test of Adult Reading full-scale IQ quartiles. A oneway analysis of variance determined whether the three groups differed on the number of scores falling below the 10th percentile (borderline) and at or below the second percentile (impaired). The groups differed significantly on number of borderline scores. Individuals in the low group had more borderline impaired scores than the mid group and the high group. The mid group also had significantly more borderline impaired scores than the high group. Additionally, there was a significant difference between groups on number of impaired scores. Individuals in the low group had significantly more impaired scores than the mid and high groups. The mid and high groups did not significantly differ. These results indicate that college athletes at baseline are likely to have different base rates of borderline and impaired scores based on their premorbid IQ. Different cutoffs are thus needed to classify athletes as recovered or not recovered following concussion, which is reflected in the updated clinical algorithm. This work helps to ensure that the normative data used to make clinical decisions in concussion evaluations are accurate.

CONTEXT:Poor sleep is common in collegiate student-athletes and is associated with heterogeneous self-reported complaints at baseline. However, the long-term implications of poor sleep at baseline have been less well studied. OBJECTIVE:To examine the implications of insufficient sleep at baseline, as well as factors such as symptom reporting and neurocognitive performance at baseline associated with insufficient sleep, for the risk of sport-related concussion (SRC). DESIGN:Cross-sectional study. SETTING:Undergraduate institution. PATIENTS OR OTHER PARTICIPANTS:Student-athletes (N = 614) were divided into 2 groups based on the hours slept the night before baseline testing: sufficient (>7.07 hours) or insufficient (≤5.78 hours) sleepers. Athletes who went on to sustain an SRC during their athletic careers at our university were identified. MAIN OUTCOME MEASURE(S):Four symptom clusters (cognitive, physical, affective, and sleep) and headache were examined as self-reported outcomes. Four neurocognitive outcome measures were explored: mean composite of memory, mean composite of attention/processing speed, memory intraindividual variability (IIV), and attention/processing speed IIV. RESULTS:Insufficient sleepers at baseline were nearly twice as likely (15.69%) as sufficient sleepers (8.79%) to go on to sustain an SRC. Insufficient sleepers at baseline, whether or not they went on to sustain an SRC, reported a higher number of baseline symptoms than did sufficient sleepers. When compared with either insufficient sleepers at baseline who did not go on to incur an SRC or with sufficient sleepers who did go on to sustain an SRC, the insufficient sleep group that went on to incur an SRC performed worse at baseline on mean attention/processing speed. CONCLUSIONS:The combination of insufficient sleep and worse attention/processing speed performance at baseline may increase the risk of sustaining a future SRC.

Standard treatments do not address impaired facial emotion processing, which compromises social functioning, in many neuropsychiatric disorders, including schizophrenia. This impairment correlates with abnormal activity and connectivity in neural networks underlying social cognition. Neuroplasticity-based social cognition training has shown promise in improving facial emotion processing and aberrant neural activity, but its impact on connectivity remains unknown. This study evaluates how social cognition training impacts connectivity during facial emotion processing in healthy individuals to better understand its therapeutic potential.

BACKGROUND:Depression is three to four times more prevalent in patients with neurological and inflammatory disorders than in the general population. For example, in patients with multiple sclerosis, the 12-month prevalence of major depressive disorder is around 25% and it is associated with a lower quality of life, faster disease progression, and higher morbidity and mortality. Despite its clinical relevance, there are few treatment options for depression associated with multiple sclerosis and confirmatory trials are scarce. We aimed to evaluate the safety and efficacy of a multiple sclerosis-specific, internet-based cognitive behavioural therapy (iCBT) programme for the treatment of depressive symptoms associated with the disease. METHODS:This parallel-group, randomised, controlled, phase 3 trial of an iCBT programme to reduce depressive symptoms in patients with multiple sclerosis was carried out at five academic centres with large outpatient care units in Germany and the USA. Patients with a neurologist-confirmed diagnosis of multiple sclerosis and depressive symptoms were randomly assigned (1:1:1; automated assignment, concealed allocation, no stratification, no blocking) to receive treatment as usual plus one of two versions of the iCBT programme Amiria (stand-alone or therapist-guided) or to a control condition, in which participants received treatment as usual and were offered access to the iCBT programme after 6 months. Masking of participants to group assignment between active treatment and control was not possible, although raters were masked to group assignment. The predefined primary endpoint, which was analysed in the intention-to-treat population, was severity of depressive symptoms as measured by the Beck Depression Inventory-II (BDI-II) at week 12 after randomisation. This trial is registered at ClinicalTrials.gov, NCT02740361, and is complete. FINDINGS:Between May 3, 2017, and Nov 4, 2020, we screened 485 patients for eligibility. 279 participants were enrolled, of whom 101 were allocated to receive stand-alone iCBT, 85 to receive guided iCBT, and 93 to the control condition. The dropout rate at week 12 was 18% (50 participants). Both versions of the iCBT programme significantly reduced depressive symptoms compared with the control group (BDI-II between-group mean differences: control vs stand-alone iCBT 6·32 points [95% CI 3·37-9·27], p<0·0001, effect size d=0·97 [95% CI 0·64-1·30]; control vs guided iCBT 5·80 points [2·71-8·88], p<0·0001, effect size d=0·96 [0·62-1·30]). Clinically relevant worsening of depressive symptoms was observed in three participants in the control group, one in the stand-alone iCBT group, and none in the guided iCBT group. No occurrences of suicidality were observed during the trial and there were no deaths. INTERPRETATION:This trial provides evidence for the safety and efficacy of a multiple sclerosis-specific iCBT tool to reduce depressive symptoms in patients with the disease. This remote-access, scalable intervention increases the therapeutic options in this patient group and could help to overcome treatment barriers. FUNDING:National Multiple Sclerosis Society (USA).

OBJECTIVE:To examine the relationship between sleep disturbance and functional outcomes following a concussion. Also, to explore athlete and injury-related variables that may be related to risk factors for poor sleep following concussion. METHOD:124 collegiate athletes completed a neuropsychological evaluation within 14 days of sustaining a sport-related concussion (SRC). Athletes were categorized as sleep disturbed (n = 52) or not sleep disturbed (n = 72). Outcome variables included symptom reports, cognitive performance (mean performance and variability), and mood (depression). Injury characteristics and athlete characteristics explored were loss of consciousness (LOC) associated with the injury, whether the athlete was immediately removed from play, and history of prior concussions. RESULTS:Sleep disturbed athletes reported more symptoms, F(4, 119) = 7.82, p < 0.001, ƞ2 = 0.21, were more likely to be symptomatic at the time of testing, χ2(1, N = 124) = 19.79, p < 0.001, φ = 0.40, and were marginally more likely to experience clinically significant depression, χ2(1, N = 120) = 3.03, p = 0.08, φ = 0.16, than not sleep disturbed athletes. There were no cognitive differences between the groups, p > 0.05. A greater proportion of sleep disturbed athletes experienced LOC (30%) compared to not sleep disturbed athletes (13%), χ2(1, N = 118) = 4.99, p = 0.03, φ = -0.21. CONCLUSION:Sleep disturbances following SRC are associated with a broad range of self-reported symptoms. LOC may be associated with an increased risk of developing sleep disturbances; alternatively, sleep disturbances may increase the risk of LOC following concussion.

ABSTRACTObjectives:The current study explored how affective disturbances, particularly concomitant anxiety and depressive symptoms, impact baseline symptom self-reporting on the Post-Concussion Symptoms Scale (PCSS) in college athletes.Methods:Athletes were separated into four groups (Healthy Control (HC) (n = 581), Depression Only (n = 136), Anxiety Only (n = 54), Concomitant Depression/Anxiety (n = 62)) based on their anxiety and depression scores. Groups were compared on Total PCSS Score as well as 5 PCSS Symptom Cluster scores (Cognitive, Physical, Affective, Sleep, and Headache).Results:The three affective groups reported significantly greater symptomatology than HCs, with the Concomitant group showing the highest symptomatology scores across all clusters. The depressive symptoms only group also reported significantly elevated symptomatology, compared to HCs, on every symptom cluster except headache. The anxiety symptoms only group differed from HCs on only the cognitive symptoms cluster. Additionally, the Concomitant group reported significantly increased PCSS symptomatology, in terms of total scores and all 5 symptom clusters, compared to the depressive symptoms only and anxiety symptoms only groups.Conclusions:Our findings suggest that athletes experiencing concomitant depressive/anxiety symptoms report significantly greater levels of symptomatology across all 5 PCSS symptom clusters compared to HCs. Further, results suggest that athletes experiencing concomitant affective disturbance tend to report greater symptomatology than those with only one affective disturbance. These findings are important because, despite the absence of concussion, the concomitant group demonstrated significantly elevated symptomatology at baseline. Thus, future comparisons with post-concussion data should account for this increased symptomatology, as test results may be skewed by affective disturbances at baseline.

Facial emotion recognition is a key component of social cognition. Impaired facial emotion recognition is tied to poor psychological wellbeing and deficient social functioning. While previous research has demonstrated the potential for social cognition training to improve overall facial emotion recognition, questions remain regarding what aspects of emotion recognition improve. We report results from a randomized controlled trial that evaluates whether computerized social cognition training can improve recognition of distinct facial emotions in healthy participants. This investigation was designed to better understand the therapeutic potential of social cognition training for individuals with neuropsychiatric disorders. Fifty-five healthy adult participants were randomly assigned to an internet-based intervention during which they either completed social cognition training (SCT) or played control computer games (CON) for 10.5 h over 2-3 weeks. Facial emotion recognition was measured with the Penn ER-40, which was conducted before and after training. The following variables were collected and analyzed: facial emotion recognition accuracy for each emotion (i.e., anger, fear, happy, neutral (no emotional expression), and sad), reaction times for each emotion, and response error types (i.e., frequency of an emotion being chosen incorrectly, frequency of an emotion being missed, and frequency of an emotion being confused for another particular emotion). ANOVAs and t-tests were used to elucidate intervention effects both within and between groups. Results showed that the SCT group improved their accuracy for angry and neutral faces. They also improved their reaction times for neutral, fearful, and sad faces. Compared to the CON group, the SCT group had significantly faster reaction times to neutral faces after training. Lastly, the SCT group decreased their tendency to confuse angry faces for no emotional expression and to confuse no emotional expression for sad faces. In contrast, the CON group did not significantly improve their accuracy or reaction times on any emotional expression, and they did not improve their response error types. We conclude that social cognition training can improve recognition of distinct emotions in healthy participants and decrease response error patterns, suggesting it has the potential to improve impaired emotion recognition and social functioning in individuals with facial emotion recognition deficits.

Objectives: The oral Symbol Digit Modalities Test (SDMT) has become the standard for the brief screening of cognitive impairment in persons with multiple sclerosis (PwMS). It has been shown to be sensitive to sensory-motor factors involving rudimentary oral motor speed and visual acuity, as well as multiple sclerosis (MS) affective-fatigue factors including depression, fatigue, and anxiety. The present study was designed to provide a greater understanding of these noncognitive factors that might contribute to the oral SDMT by examining all these variables in the same sample. Methods: We examined 50 PwMS and 49 healthy controls (HCs). All participants were administered the oral SDMT, two sensory-motor tasks (visual acuity and oral motor speed), and three affective-fatigue measures (depression, fatigue, and anxiety). Results: Partially consistent with hypotheses, we found that sensory-motor skills, but not affective-fatigue factors, accounted for some of the group differences between the MS and HC groups on the oral SDMT, reducing the MS/HC group variance predicted from 10% to 4%. Also, PwMS with below average sensory-motor abilities had oral SDMT scores that were lower than PwMS with intact sensory-motor skills (p < .05). Finally, 71% of PwMS in the below-average sensory-motor group were impaired on the oral SDMT compared with 14% of the intact group (p = .006). Conclusions: When the oral SDMT is used as the sole screening tool for cognitive impairment in MS, clinicians should know that limitations in visual acuity and rudimentary oral motor speed should be considered as possibly being associated with performance on it in MS.

Abstract Objectives: The current study aims to examine the prevalence rates and the relationship of symptoms of depression, anxiety, and comorbid depression/anxiety with neurocognitive performance in college athletes at baseline. We hypothesized a priori that the mood disturbance groups would perform worse than healthy controls, with the comorbid group performing worst overall. Methods: Eight hundred and thirty-one (M = 620, F = 211) collegiate athletes completed a comprehensive neuropsychological test battery at baseline which included self-report measures of anxiety and depression. Athletes were separated into four groups [Healthy Control (HC) (n = 578), Depressive Symptoms Only (n = 137), Anxiety Symptoms Only (n = 54), and Comorbid Depressive/Anxiety Symptoms (n = 62)] based on their anxiety and depression scores. Athletes’ neurocognitive functioning was analyzed via Z score composites of Attention/Processing Speed and Memory. Results: One-way analysis of variance revealed that, compared to HC athletes, the comorbid group performed significantly worse on measures of Attention/Processing Speed but not Memory. However, those in the depressive symptoms only and anxiety symptoms only groups were not significantly different from one another or the HC group on neurocognitive outcomes. Chi-square analyses revealed that a significantly greater proportion of athletes in all three affective groups were neurocognitively impaired compared to the HC group. Conclusions: These results demonstrate that collegiate athletes with comorbid depressive/anxiety symptoms should be identified, as their poorer cognitive performance at baseline could complicate post-concussion interpretation. Thus, assessing for mood disturbance at baseline is essential to obtain an accurate measurement of baseline functioning. Further, given the negative health outcomes associated with affective symptomatology, especially comorbidities, it is important to provide care as appropriate.

Objective: People with Multiple Sclerosis (PwMS) and healthy controls (HCs) were evaluated on cognitive variability indices and we examined the relationship between fatigue and cognitive variability between these groups. Intraindividual variability (IIV) on a neuropsychological test battery was hypothesized to mediate the group differences expected in fatigue. Method: Fifty-nine PwMS and 51 HCs completed a psychosocial interview and battery of neuropsychological tests and questionnaires during a 1-day visit. Fatigue in this study was measured with the Fatigue Impact Scale (FIS), a self-report multidimensional measure of fatigue. IIV was operationalized using two different measures, a maximum discrepancy score (MDS) and intraindividual standard deviation (ISD), in two cognitive domains, memory and attention/processing speed. Two mediation analyses with group (PwMS or HCs) as the independent variable, variability composite (memory or attention/processing speed) measures as the mediators, total residual fatigue (after accounting for age) as the outcome, and depression as a covariate were conducted. The Baron and Kenny approach to testing mediation and the PROCESS macro for testing the strength of the indirect effect were used. Results: Results of a mediation analysis using 5000 bootstrap samples indicated that IIV in domains of both attention/processing speed and memory significantly mediated the effect of patient status on total residual fatigue. Conclusion: IIV is an objective performance measure that is related to differences in fatigue impact between PwMS and HCs. PwMS experience more variability across tests of attention/processing speed and memory and this experience of variable performance may increase the impact of fatigue.

Although several single-nucleotide polymorphisms have been associated with cognitive functioning in a variety of healthy and clinical samples, the influence of gene × gene interactions on cognition is poorly understood. The purpose of this study was to examine interactive relationships between apolipoprotein E (APOE) and brain-derived neurotrophic factor (BDNF) polymorphisms on cognitive functioning in a sample of healthy adolescent athletes. Participants of this cross-sectional study included 78 student-athletes (52.6% male; age: M = 13.31, SD = 1.23). Athletes completed the Immediate Post-Concussion and Cognitive Testing (ImPACT) computerized battery at baseline. APOE and BDNF genotypes were determined with buccal samples (APOE ε4+: n = 26; APOE ε4-: n = 52; BDNF Met+: n = 23; BDNF Met-: n = 55). Two-way analyses of variance (ANOVAs) were used to evaluate the associations among APOE (ε4+ vs. ε4-) and BDNF (Met+ vs. Met-) genotypes and the ImPACT cognitive composites and two-factor model. No main effects were observed for either APOE or BDNF genotypes across the cognitive outcomes. However, there was a significant APOE × BDNF genotype interaction for the verbal (p=.009, ηp2=.091) and visual (p = .012, ηp2=.082) memory composites and the memory factor (p = .001, ηp2=.133), such that ε4+/Met+ carriers demonstrated poorer performance relative to other allele combinations. No significant interactions were observed for the visual motor speed (p = .263, ηp2=.017) or reaction time (p = .825, ηp2=.001) composites or the speed factor (p = .205, ηp2=.022). Our findings suggest an important relationship between APOE and BDNF genotypes on verbal and visual memory performance in healthy adolescent athletes. Clinicians may use this information to offer individualized concussion management based on individual athlete characteristics related to genetics and cognition.

Abstract Objective Studies are lacking that examine whether cognitive reserve (CR) plays a role in differential outcomes for individuals in sports-related concussion (SRC), particularly within the acute phase. This study explored the relationship between CR (WTAR FSIQ), concussion severity (total PCSS score), and three separate outcome measures: cognitive functioning, return-to-play (RTP) time, and depression symptoms. Method The total sample included 175 (Males = 131, Females = 44) student-athletes at a Division I University, but only a subset of participants had RTP data available (N = 72; Males = 57, Females = 15). Regression analyses were conducted with CR, PCSS, and their interaction as the main predictor variables for the three separate dependent variables (neurocognitive composite, days to RTP, and BDI-FS total). Sex was found to be significantly related to the neurocognitive variable and the RTP variable and was included in those analyses as a covariate. Results For the first regression predicting neurocognitive performance, sex (t = 4.63, p < 0.001) was the only significant predictor. For the second regression predicting depression symptoms, PCSS (t = 4.52, p < 0.001) was the only significant predictor. For the third regression predicting RTP time, sex (t = 3.77, p < 0.001) was the only significant predictor. Conclusion Our results did not support a significant moderating effect of CR on the relationship between concussion symptom severity and our three outcome measures (cognitive performance, depression symptoms, RTP time). However, sex appeared to be an important predictor for neurocognitive performance, with females performing significantly higher on average than males, and for RTP times, with females having significantly longer RTP times than males.