BACKGROUND:Falls and gait variability are prevalent in older adults with and without multiple sclerosis. Gait variability has been associated with an increased likelihood of reporting falls in older adults, yet its prediction of falls in older adults with multiple sclerosis (OAMS) remains unclear. METHODS:We examined whether gait variability measured under single- and dual-task walking conditions predicted falls during longitudinal follow-up in OAMS and healthy older adults (HOA). HOA (n = 106, mean age = 69 years) and OAMS (n = 95, mean age = 65 years) completed a single and dual-task walking paradigm and reported falls during a longitudinal follow-up. Gait variability was measured using an instrumented walkway. RESULTS:Cox-regression models indicated that larger coefficients of variation (CVs) of dual-task-walk stride length (HR = 1.04, p = .017), dual-task-walk swing time (HR = 1.03, p = .044), and single-task-walk swing time (HR = 1.05, p < .001) were significantly associated with increased hazards of incident falls, even after adjustment. Cohort-stratified cox-regression models with adjustment showed that larger single-task-walk swing time CV was associated with a higher hazard of incident falls in HOA (HR = 1.10, p = .028), while larger CVs in dual-task-walk stride velocity (HR = 1.04, p = .017), stride length (HR = 1.06, p = .016), and swing time (HR = 1.05, p = .018) were significantly associated with a higher hazard of incident falls in OAMS. CONCLUSIONS:Findings suggest that greater gait variability predicts increased fall risk in OAMS and HOA participants, with a 1% increase in CV associated with a 4-10% fall hazard increase. However, walking condition influenced this association with single-task-walk variability being predictive in HOA, whereas dual-task-walk variability is more predictive in OAMS.

BACKGROUND:The concept of affective reserve has been proposed, but not operationalized, as a buffer designed to regulate mood and behavior in response to adverse events. This study derived a residual-based metric of affective reserve and evaluated whether it mediated associations between having multiple sclerosis and subjective well-being in older adults. METHODS:Sociodemographics and brain pathology metrics were regressed against a composite mood, extraversion, and consciousness variable to derive affective reserve in a sample of older adults with multiple sclerosis (n = 107) and without (n = 104). Linear regressions were run to examine the associations between affective reserve and well-being, measured with the Short Form-12 Mental Composite Summary and Physical Composite Summary. Hayes' PROCESS was used to evaluate affective reserve as a mediator between group status and well-being. RESULTS:Affective reserve was positively associated with both Mental Composite Summary and Physical Composite Summary. After covariate adjustments, affective reserve fully mediated the relationship between having multiple sclerosis and Mental Composite Summary (b = 1.350, 95% confidence interval: 0.142-2.591) and partially mediated the association between multiple sclerosis and Physical Composite Summary (b = 0.915, 95% confidence interval: 0.073-1.906). CONCLUSION:This residual-based metric offers a novel approach for measuring affective reserve. Not only is it associated with both physical and mental well-being, but it explained the relationship between the latter and the presence of multiple sclerosis.

Older adults with multiple sclerosis (MS) face unique issues related to the combined effects of MS and age-related changes, which often present with overlapping symptoms that complicate assessment and treatment decisions. In this review, based on the Consortium of MS Centers’ Aging and MS Consensus Statement committee meeting in 2024, we address the contributions of aging in MS by focusing on direct, biological aging effects on MS pathology and comorbid age-related changes in physical and cognitive function. Features of biological aging include cellular senescence and immune dysregulation, which may drive disease progression in MS through a variety of proinflammatory mediators that may maintain low levels of chronic inflammation in the immune and central nervous system compartments and offset regulatory processes, ultimately impairing remyelination and increasing neurodegeneration. Measuring biological aging in MS may help identify individuals at risk of worse MS outcomes and support gerotherapeutic treatments that target aging mechanisms. Compounding any direct effects of aging on MS pathology, aging-related impairments in neuromuscular function and cognition can worsen functional outcomes in people with MS. Characteristics of cognitive impairments in MS affecting attention and processing speed occur early in the disease course and are distinct from other age-associated neurodegenerative disorders, such as Alzheimer disease, that commonly affect language and executive function domains. As MS clinicians care for growing numbers of older adults with MS, a more comprehensive understanding of the interplay between aging and MS-related changes can improve the timing and modality of treatments to optimize MS neurogeriatric care.

Worldwide, the average age of people with multiple sclerosis (MS) has increased significantly over the past several decades. Findings from natural history studies reveal that the risk of new relapse and MRI activity diminishes with age. Available since 1993, the use of disease-modifying therapies (DMTs) for MS has expanded dramatically, with many patients using the drugs indefinitely. The participants of most phase 3 clinical trials that have resulted in regulatory approval of MS DMTs have been 55 years or younger at the onset of participation, so there remains a dearth of data as to the benefits and risks of DMT use in older people with MS. Risks associated with DMT use may increase as people age, especially vascular and malignancy comorbidities. Although some people with MS older than 55 years have discontinued DMT, some are reluctant to even consider a trial off DMT. Findings from many observational DMT discontinuation studies and 2 discontinuation randomized controlled trials have confirmed that the greatest risk of recurrent MS disease activity is in younger patients who discontinue DMT. For clinically stable people older than 60 years, the greatest enhanced risk faced by those who discontinue DMT is that of 1 to 2 brain MRI-detected lesions of unclear long-term clinical significance. Thus, although it may be reasonable to consider a personal DMT discontinuation or de-escalation trial, patients, their families, and MS clinicians would benefit from a substantial increase in clinical studies relevant to the risks and benefits of DMT use and nonuse in those older than 55 years.

As age increases, the prevalence of comorbidities increases in the general population. In turn, this often leads to an increase in the number of medications administered. This phenomenon creates additional challenges in the management of neurodegenerative disorders such as multiple sclerosis (MS). Higher comorbidity burden is associated with longer diagnostic delays and greater disability at diagnosis. A higher burden of comorbidities in people with MS is associated with higher disability levels and accelerated disability progression. Responses to rehabilitation therapy may also be altered in terms of timing and sustainability of response. Conversely, a diagnosis of MS negatively affects the management and outcomes of some comorbidities, and treatment of certain comorbidities can worsen MS symptoms. Thus, comorbid conditions in people with MS have important implications with respect to MS-specific care and general health care throughout the life course of the disease. Comorbidities must be considered when developing plans of care. Similarly, polypharmacy is common in non-MS populations, even more so in MS populations, and can adversely affect quality of life and worsen underlying disability. In 2023, the Consortium of Multiple Sclerosis Centers needs assessment identified comorbidity and polypharmacy as a core topic relevant to the care of aging adults with MS, and an in-person meeting of experts in 2024 discussed the existing literature. This narrative review discusses how comorbid disease and polypharmacy affect people with MS, strategies to mitigate these negative risks, as well as areas where evidence is lacking and further study is needed to inform optimal treatment strategies for older adults with MS.

BACKGROUND:Greater gait variability is associated with falls in aging and multiple sclerosis. However, whether older adults with MS (OAMS), show higher gait variability relative to healthy older adults (HOA), under single and dual-task walking conditions, has not been reported. Furthermore, it is unclear whether practice may improve gait variability in both groups. RESEARCH QUESTION:Is gait variability higher in OAMS relative to HOA, particularly in DTW compared to STW? Furthermore, does practice result in decreased gait variability in both groups, notably under DTW compared to STW? METHODS:We examined the effect of within-session practice on gait variability during single (STW) and dual (DTW) task gait conditions. OAMS (n = 97, mean±SD age: 65 ± 5 years, 66 females) and HOA (n = 113, mean±SD age: 68 ± 7 years, 73 females) were recruited. Practice effects on gait variability were evaluated over three repeated counterbalanced STW and DTW trials. Gait variability measures included Coefficient of Variation (CV) in stride velocity, stride length, and swing time. RESULTS:OAMS demonstrated higher gait variability, on all measures, relative to HOA during both STW and DTW (P < 0.001). Gait variability on all measures was higher in DTW compared to STW, (P < 0.05). Practice resulted in decreased gait variability (P < 0.01) on all measures in both OAMS and HOA. Furthermore, practice resulted in decreased temporal gait variability, as measured by swing time CV, under DTW in particular (P < 0.05). SIGNIFICANCE:In conclusion, OAMS exhibited greater gait variability than HOA, yet both groups demonstrated decreases in temporal and spatial gait variability after within-session practice, notably under DTW, which in turn may reduce fall risk.

BACKGROUND:Routine cognitive screenings have been recommended by several multiple sclerosis (MS) groups. One option are mobile-based programs, which can be administered using a smartphone or tablet. This scoping review aimed to identify the available mobile-based cognitive screening tools for persons with MS and understand potential gaps that should be considered when developing future cognitive screening tools. METHODS:Systematic searches of the literature (PubMed, MEDLINE, CINHAL, and PsycINFO) and commercial application stores (Apple App Store and Google Play Store) were conducted in English through March 2024. A cognitive screening tool was defined as a program that assessed one or more cognitive domains objectively, with the assessment time taking 20 minutes or less. Only programs that could be administered using a mobile device and have been evaluated in at least one peer-review study with adults with MS (≥ 18 years old) were included. Information about the tool's availability, specificity for MS, number of tests and assessed domains, administration and scoring, stimuli and psychometric data, and inclusion of patient-reported outcomes (PROs) were extracted. RESULTS:Thirty-two cognitive screening tools met the eligibility criteria. Five of the 16 commercially available programs were designed specifically for persons with MS, compared to 12 of the 16 investigational programs. Most programs were available in multiple languages, did not require a technician, and offered automated scoring. Limited screening options beyond information processing speed and availability of psychometric data, involvement of patient stakeholders, and integration with the electronic health record (EHR) were identified as weaknesses that could be addressed in the next generation of programs. CONCLUSIONS:While more mobile-based options are becoming available, including tools that also offer depression screening and other PROs, there are still limitations that can affect their utility as routine cognitive screeners in a clinic setting. Considerations for addressing these weaknesses, including increasing the involvement of persons with MS in the development process, are discussed.

Background: Multiple sclerosis (MS) and diabetes can cause deficits in processing speed, executive functioning, and learning and memory, although there is limited research on their combined impact. This study aimed to evaluate whether having both conditions had a negative effect on cognitive functioning in older adults. Methods: Persons with MS (n = 108) and healthy controls (HC; n = 114) completed letter fluency, semantic fluency, Trail Making Test (TMT), Symbol Digit Modalities Test (SDMT), and Hopkins Verbal Learning Test-Revised (HVLT-R). Distribution-based z-scores were calculated for each measure, which were used to compute an overall cognition z-score. Using the composite z-score as the outcome and adjusting for demographics, mood, and vascular-related factors, linear regression models were conducted, first with 1) diabetes and 2) MS as the independent variables, and then with 1) diabetes only, 2) MS only, and 3) both diabetes and MS. The latter approach was used to examine the individual measures. Results: Sixteen persons with MS (14.8 %) and 13 HC (11.4 %) had diabetes. Both diabetes (b =-0.30, p = .022) and MS (b =-0.30, p = .002) were independently associated with overall cognition. Having both conditions had a significant negative effect on overall cognition (b =-0.67, p < .001). The combination of diabetes and MS was associated with reductions in semantic fluency and HVLT-R Total Learning and Delayed Recall. Conclusions: In older adults, having both diabetes and MS negatively affects cognitive functioning. Clinicians should consider how comorbidities may contribute to greater difficulties in certain cognitive domains in older persons with MS.

INTRODUCTION:Multiple sclerosis (MS) is increasingly prevalent among older adults, and this results in the cumulative effects of aging and MS on mobility disability. The Patient-Determined Disease Steps (PDDS) is a patient-reported outcome measure of mobility disability in adults with MS, but its validity has not been established in older adults. This study validated the PDDS in older adults with MS by examining correlations with conceptually-relevant objective and subjective measures, including neuroimaging markers. METHODS:The sample included older adults with MS (N = 87, mean age = 64.67 ± 4.24yrs, percent female = 65.5). Primary outcome measures for validation included the Timed 25-foot Walk (T25FW), Short Physical Performance Battery (SPPB), University of Alabama at Birmingham Life-Space-Assessment scale (UAB-LSA), Nine-Hole Peg Test (9HPT), oral Symbol-Digit Modalities Test (Oral SDMT), and Fatigue Severity Scale (FSS). Structural measures of brain integrity, evaluated via 3T MRI, included grey matter volumes (thalamus, caudate, putamen, globus pallidus, hippocampus), and total white matter lesion load (WMLL). Spearman correlations were used for analyses based on non-normality of the data. RESULTS:Higher PDDS scores were significantly correlated with slower walking speed (T25FW time: ρ= 0.664, p < .001), worse lower extremity functioning (SPPB: ρ= -0.540, p < .001), poor fine motor dexterity (9HPT time) bilaterally (dominant hand: ρ= 0.367, p < .001; non-dominant hand: ρ= 0.263, p= .014), worse fatigue (FSS: ρ= 0.383, p < .001), and lower community mobility (UAB-LSA: ρ= -0.586, p < .001). Higher PDDS scores were also associated with lower grey matter volume in the caudate (ρ= -0.218, p= .042), putamen (ρ= -0.226, p= .036), and hippocampus (ρ= -0.213, p= .047). There were no significant correlations with WMLL, Oral SDMT, or socio-demographic covariates. CONCLUSION:The PDDS is a valid self-report measure of MS-related disability in ambulatory older adults with MS.

Mobility impairment is common in multiple sclerosis, especially in older adults with multiple sclerosis (OAMS). Grey matter (GM) changes are well documented in MS, and GM atrophy is common in older adults. The relationship between GM changes and mobility disability in OAMS is unknown. We sought to identify GM patterns associated with gait speed in OAMS and healthy older controls, using structural covariance network analysis. OAMS (n = 102; 64.8 ± 4.4 years) and healthy controls (n = 106; 68.2 ± 7.3 years) underwent brain MRI and gait assessments; structural covariance networks were constructed to elucidate brain regions with significant associations between GM volume and 25-foot walk gait speed. We used voxel-wise linear regression analyses to elucidate per-network subregions with significant correlations with gait speed. Voxel-wise moderation analysis tested for group differences in these associations. Across the entire cohort, the following networks demonstrated significant gait speed associations: bilateral hippocampus, bilateral caudate/pallidum/putamen, bilateral thalamus/putamen, right middle temporal gyrus and multiple cerebellar regions. There were no significant group-by-network interaction effects. In summary, structural network analysis reveals unique brain patterns of gait speed in older adults, but these patterns are common amongst healthy older adults and OAMS and highlight the importance of cerebellar and subcortical networks in supporting gait speed.

To assess whether resting-state functional connectivity (RSFC) brain networks are associated with gait speed in a sample of older adults with and without multiple sclerosis (MS). Older adults with MS (OAMS: n = 82, mean age = 64.4 ± 4.1 years) and controls (n = 85, mean age = 68.6 ± 7.1 years) underwent brain MRI, cognitive assessment, and motor testing. RSFC brain networks were computed from resting-state functional scans based on a data-driven approach. The timed-25-foot-walk test (T25FW), an established measure of disability in aging and clinical populations, served as the outcome measure. Analyses adjusted for confounders revealed that faster gait speed was significantly associated with higher RSFC in left fronto-parietal (p = 0.002) network in the full cohort. Among OAMS, significant associations between faster gait speed and higher RSFC were found in left fronto-parietal (p = 0.002), cerebellar (p = 0.023), and language (p = 0.046) networks. In contrast, among control participants, there were no significant associations between RSFC and gait speed. In aging, greater functional brain support of walking speed, operationalized using RSFC in empirically derived networks, is required in MS compared to healthy control participants.

BACKGROUND:The role of resilience on functional outcomes in multiple sclerosis (MS) has been debated. One theorized pathway is that healthy lifestyle behaviors contribute to better functioning capabilities, which resilient individuals with MS tend to engage in more. This study aimed to explore whether resilience might influence functioning in individuals with MS indirectly through specific lifestyle behaviors. METHODS:Participants (N = 64) were individuals with MS who completed measures assessing resilience (Multiple Sclerosis Resiliency Scale; MSRS), lifestyle behaviors (Simple Lifestyle Indicator Questionnaire and Alcohol Use Disorders Identification Test), and functional capabilities (PROMIS Physical Function-Short Form 20a; PROMIS-PF). Mediation models were constructed with the MSRS as the independent variable and significant individual lifestyle behaviors as the mediators, and PROMIS-PF as the dependent variable, with demographics and disease-related factors as covariates. RESULTS:Physical activity was the only lifestyle behavior associated with functioning capabilities (ρ = 0.43, P < .001). Resilience had a significant indirect effect on functioning through physical activity (b = 0.16; 95% CI, 0.04-0.32). Its corresponding direct effect was not significant (b = -0.02, P = .860). CONCLUSIONS:These findings suggest that resilience indirectly influences functioning through engagement in physical activity. The results highlight the important role of resilience in promoting well-being among individuals with MS.

OBJECTIVE:Literature concerning the structural brain correlates of verbal memory in aging with multiple sclerosis (MS) is scarce. This study addressed this gap by examining the impact of white matter microstructure and macrostructure on verbal memory in older adults with and without MS. METHOD:Participants were 64 older adults with MS (OAMS; age M [SD] = 64.19 [3.82]) and 72 controls (age M [SD] = 69.78 [6.99]). Verbal memory was measured using the Hopkins Verbal Learning Test-Revised (HVLT-R), and white matter fractional anisotropy and lesion volume were extracted from diffusion tensor and fluid-attenuated inversion-recovery magnetic resonance imaging. Statistical models examined whether white matter measures moderated the association between the presence of MS and HVLT-R performance. RESULTS:Adjusted moderation models revealed that OAMS showed lower HVLT-R total immediate recall compared to controls in the presence of higher lesion volume in the bilateral fornices, left uncinate fasciculus, and right ventral cingulum, and lower HVLT-R delayed recall in the presence of lower fractional anisotropy in the right ventral cingulum and higher lesion volume in the left uncinate fasciculus and right ventral cingulum, with small effect sizes (interaction term ΔR²s = .03-.06, ps < .05). CONCLUSIONS:Recall was lower in OAMS when limbic tract white matter had lower integrity and higher lesion load. Findings suggest that the influence of MS on verbal memory in older adults is related, in part, to underlying white matter disruptions in tracts implicated in memory. While the sample was generally representative of the U.S. MS population (majority White women), generalizability is limited and warrants further research. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Lower white matter integrity of frontal-subcortical circuitry has been associated with late-life depression in normally aging older adults and with the presence of multiple sclerosis (MS). Frontal-striatal white matter tracts involved in executive, cognitive, emotion, and motor function may underlie depression in older adults with MS. The present study examined the association between depression score and frontal-striatal white matter integrity in older adults with MS and controls. Older adults with MS (OAMS) (n = 67, mean age = 64.55 ± 3.89) and controls (n = 74, mean age = 69.04 ± 6.32) underwent brain MRI, cognitive assessment, psychological, and motoric testing. Depression was assessed through the 30-item Geriatric Depression Scale. Fractional anisotropy (FA) was extracted from two bilateral tracts: dorsolateral prefrontal cortex to putamen nucleus (DLPFC-pn) and dorsolateral prefrontal cortex to caudate nucleus (DLPFC-cn). OAMS reported significantly worse (i.e., higher) depression symptoms (β = .357, p < .001) compared to healthy controls. Adjusted moderation analyses revealed, via group by FA interactions, significantly stronger associations between FA of the left DLPFC-pn tract and total depression (B = − 61.70, p = .011) among OAMS compared to controls. Conditional effects revealed that lower FA of the left DLPFC-pn was significantly associated with worse (i.e., higher) depression symptoms (b = − 38.0, p = .028) only among OAMS. The other three tracts were not significant in moderation models. We provided first evidence that lower white matter integrity of the left DLPFC-pn tract was related to worse depression in older adults with MS.

Background/objective: Falls research in older adults with MS (OAMS) is scarce, and no studies have reported on the association between life-space mobility and falls in this group. Herein, we hypothesized that higher baseline life-space scores would be associated with reduced odds of reporting falls during follow-up, and explored whether the association differed by MS subtype (progressive vs. relapsing-remitting). Methods: OAMS (n = 91, mean age = 64.7 +/- 4.3ys, %female = 66.9,%progressive MS = 30.7) completed the University of Alabama at Birmingham Life-Space-Assessment (UAB-LSA) scale and reported falls during a structured monthly telephone interview during follow-up (mean = 16.39 +/- 11.44 months). General Estimated Equations (GEE) models were utilized to determine whether UAB-LSA scores predicted falls during follow-up. Results: GEE models revealed that higher UAB-LSA scores were associated with a significant reduction in the odds of falling during follow-up (OR = 0.69, p = 0.012, 95 %CI = 0.51 to 0.92). Stratified analyses revealed that this association was significant in progressive (OR = 0.57, p = 0.004, 95 %CI = 0.39 to 0.84), but not relapsingremitting (OR = 0.93, p = 0.779, 95 %CI = 0.57 to 1.53) MS. Conclusion: Higher life-space mobility was associated with lower odds of falling among OAMS with progressive subtype. The UAB-LSA may complement existing mobility measures for predicting fall risk.

Objective: We examined whether brain hemodynamic responses, gait, and cognitive performances under single- and dual-task conditions predict falls during longitudinal follow-up in older adults with multiple sclerosis (OAMS) with relapsing-remitting and progressive subtypes.Methods: Participants with relapsing-remitting (n = 53, mean age = 65.02 +/- 4.17 years, %female = 75.5) and progressive (n = 28, mean age = 64.64 +/- 4.31 years, %female = 50) multiple sclerosis (MS) subtypes completed a dual-task-walking paradigm and reported falls during longitudinal follow-up using a monthly structured telephone interview. We used functional near-infrared spectroscopy (fNIRS) to assess oxygenated hemoglobin (HbO) in the prefrontal cortex during active walking and while performing a cognitive test under single- and dual-task conditions.Results: Adjusted general estimating equations models indicated that higher HbO under dual-task walking was significantly associated with a reduction in the odds of reporting falls among participants with relapsing-remitting (odds ratio (OR) = 0.472, p = 0.004, 95% confidence interval (CI) = 0.284-0.785), but not progressive (OR = 1.056, p = 0.792, 95% CI = 0.703-1.588) MS. In contrast, faster stride velocity under dual-task walking was significantly associated with a reduction in the odds of reporting falls among progressive (OR = 0.658, p = 0.004, 95% CI = 0.495-0.874), but not relapsing-remitting (OR = 0.998, p = 0.995, 95% CI = 0.523-1.905) MS.Conclusion: Findings suggest that higher prefrontal cortex activation levels during dual-task walking, which may represent compensatory reallocation of brain resources, provide protection against falls for OAMS with relapsing-remitting subtype.

BACKGROUND:Multiple sclerosis (MS) disease factors, such as cognitive impairment, can cause disruptions in meaningful activities, also known as illness intrusiveness. Although the association between specific objective measures of cognition and illness intrusiveness has been documented in MS, the contributions of individuals' perceptions of their cognition or whether any psychological factors can buffer the relationship have yet to be explored. This study aimed to (1) simultaneously examine objective processing speed and subjective cognition as disease factors contributing to illness intrusiveness and (2) explore whether resilience moderates the relationship between cognition and illness intrusiveness. METHODS:Participants (N = 112) were individuals with MS who completed the Illness Intrusiveness Ratings Scale (IIRS), Symbol Digit Modalities Test (SDMT), Perceived Deficits Questionnaire (PDQ), and MS Resiliency Scale (MSRS) as part of a larger cross-sectional study. A hierarchical linear regression was done, followed by individual moderation analyses. RESULTS:Both the PDQ (b = .43, P = .001) and SDMT (b = -4.17, P = .003) were independent predictors of the IIRS. There was no evidence of moderation in either model, although the MSRS independently contributed to the IIRS. CONCLUSIONS:Among individuals with MS, objective processing speed and subjective cognition were independently associated with illness intrusiveness, highlighting the importance of considering both cognitive performance and perceptions as contributing factors to life disruptions.

An existing scale of personal growth in caregivers of people with multiple sclerosis (MS) was expanded for use with an acquired brain injury (ABI) population, and was modified following additional psychometric analyses. A cross-sectional online survey was administered to 315 caregiving partners of persons with MS and 310 family caregivers of persons with ABI. Principal component analysis (PCA) performed on the original 32-item instrument yielded a 4-component, 17-item solution with correlated subscales with solid psychometric properties. Subscales were labelled Appreciation, Positivity, Adjustment, and Spirituality. Secondary PCA conducted revealed three subscales (five items each) correlated moderately while the fourth, Spirituality, remained distinct. The sum of the three five-item subscales may serve as a total score. Reliability analysis yielded acceptable-to-high internal consistency. Comparisons of the PGS with existing instruments demonstrated its discriminant/convergent validity. Two kinds of latent class analyses were conducted on the 15-item PGS to identify three latent classes that spanned the neurologic groups, revealing that measurement invariance was held for the instrument in this sample. An instrument with sound psychometric properties was established, designed to assess personal growth in caregivers of individuals with ABI or MS. Future work should explore its value in other populations and as a metric of changes over time.

Abstract Objective Performance Validity Test (PVT) failure, originally designed to assess malingering in forensic settings, is remarkably common in the clinical setting. Though there are potentially numerous explanations for PVT failure, there is a paucity of research investigating its frequency, and contributing factors, in patients with neurological disorders. We aimed to identify factors associated with PVT failure among patients with multiple sclerosis (MS). Method A hierarchical logistic regression was performed on a dataset containing neuropsychological assessment results of 32 males (23.5%), and 104 females (76.5%) with MS (N = 106, Mean age = 47.9) to evaluate associations between depression (Patient Health Questionnaire-9, PHQ-9), anxiety (Hospital Anxiety and Depression Scale, HADS-Anxiety) (step 1), fatigue (Fatigue Scale of Motor and Cognitive Functions, FSMC) (step 2), age/years of education (step 3), and PVT failure (Test of Memory Malingering, TOMM score < 45). Results The final model was significant and explained 40.8% of the variance in TOMM failure (χ2(6) = 21, p = 0.002). The odds of PVT failure increased by 22.1% (p = 0.04) for every 1 unit increase in z-score on the PHQ-9. The odds of PVT failure increased by 66.3% for every 1 point increase in total Cognitive Fatigue (p = 0.01). Age, education, HADS-Anxiety, and Motor-Fatigue were not significantly associated with TOMM failure. Conclusion It is commonly assumed that neurology patients who fail PVTs are seeking secondary gain (e.g., disability). This study provides some support for the hypothesis that psychological factors, such as depression and cognitive fatigue, may significantly contribute to PVT failure in some clinical populations.