Abstract: Acquired brain injury leads to numerous affective symptoms, and coping with these changes can be a burdensome process. Therefore, we aimed to validate a guided imagery intervention with basic mindfulness elements (GIME) for patients in early neurological rehabilitation (ENR). Patients ( N = 30) could choose among four different scenarios and were presented with the intervention up to six times. Statistical analyses revealed a highly significant improvement in mood, arousal, and pain with large effect sizes. The above-mentioned improvements were found continuously for repeated applications. We found our GIME to be a useful, feasible, and easy tool to implement in everyday clinical life within the ENR.

IntroductionMultiple sclerosis (MS) is a chronic autoimmune disease affecting the central nervous system, leading to motor and cognitive impairment. These impairments become especially evident during dual-tasks, such as walking while performing a cognitive activity. Previous research has highlighted changes in gait-specific parameters during dual-tasks, but the cognitive component remains underexamined in MS. This study aims to expand on prior findings by using wearable inertial sensors and the Paced Auditory Serial Addition Test (PASAT) to evaluate the effects of dual-tasks on gait and cognitive performance in persons with MS (PwMS) compared to healthy controls.MethodsEighty-six adults (54 PwMS and 32 healthy controls) participated. PwMS were further divided into groups with lower (MS_LCP) and higher (MS_HCP) cognitive performance based on performance on the Symbol-Digit-Modalities Test (SDMT). Gait parameters were assessed using wearable inertial sensors during single- and dual-task 3-min-walking. Statistical analyses compared gait and cognitive performance across conditions and groups.ResultsUnder dual-task conditions, PwMS showed significant changes in all gait parameters, including reduced walking speed, stride length, percentage of swing phase and toe clearance, and increased stride time and percentage of stance phase compared to single-task condition. However, under dual-task condition in PwMS only walking speed, stride length and stride time differed from healthy controls. MS_LCP exhibited greater changes in both gait and PASAT performance than MS_HCP and healthy controls. While MS_HCP showed gait parameters comparable to healthy controls during single-tasks, deficits became apparent during dual-tasks. Correlations revealed strong associations between SDMT and PASAT scores but weak links between cognitive and self-reported measures.DiscussionThe findings confirm that dual-task conditions exacerbate gait impairments in PwMS, particularly in those with lower cognitive performance. The use of PASAT as a dual-task cognitive challenge was feasible and had a considerable influence on gait. Results support the capacity sharing theory, suggesting that limited cognitive resources are redistributed between tasks under dual-task conditions.

IntroductionCognitive-motor functioning in persons with Multiple Sclerosis (PwMS) may be studied effectively by means of dual-task paradigms, under which potential impairments may become more salient. However, the influence of task sequencing, i.e., the order in which a cognitive or motor task is administered prior to the dual-task condition remains unclear. This study aimed to investigate potential task-sequencing effects, as reflected in fatigue or learning effects across single- and dual-task conditions.MethodsA total of 152 PwMS with an average EDSS of 2.3 were quasi-randomly assigned to six groups. The groups differed in the sequence in which a single-motor-task (3-min-25-foot-walk) and a single-cognitive-task (Paced Auditory Serial Addition Test, PASAT) as well as a dual-task combining both were administered. Gait parameters were measured using an IMU sensor. Statistical analyses compared single- and dual-task performance depending on task-sequencing.ResultsTask-sequencing did not affect cognitive or motor performance during the dual-task condition. However, a significant improvement in PASAT scores was observed between the first and second single-task trials, indicating a learning effect. No significant fatigue effects were found in gait parameters between repeated single-task trials.DiscussionThe findings suggest that the sequence of task administration does not significantly influence dual-task performance in the subgroup of PwMS focused on in the current work. Merely repeated single-task use of the PASAT leads to cognitive performance improvements, likely due to learning effects. These results indicate that, in clinical settings, test order may be of minor importance for dual-task conditions, if administered according to the procedure used in the current work.

Objective:This study analyzed clinical characteristics, attack recovery and long-term disability accumulation in late-onset (LO ≥ 50 years at onset) versus early-onset (EO < 50 years) NMOSD. Methods:This multicenter cohort study included demographic and clinical data from 446 NMOSD patients collected from 35 German Neuromyelitis Optica Study Group (NEMOS) centers. Time to disability milestones was estimated through Kaplan-Meier analysis and Cox proportional hazard regression models adjusted for sex, year of onset, immunotherapy exposure and antibody status. Generalized estimating equations (GEE) were used to compare attack outcomes. Results:Of the 446 NMOSD patients analyzed (83.4% female, 85.4% AQP4-IgG-positive, median age at disease onset = 43 years), 153 had a late-onset (34.3%). AQP4-IgG+ prevalence was higher in LO- than in EO-NMOSD (94.1% vs. 80.9%, p<0.001). Optic neuritis at onset was more frequent in EO-NMOSD (27.4% vs. 42.6%, p<0.002), whereas myelitis was more common in LO-NMOSD (58.4% vs. 37.9%, p<0.001). Both groups had similar annualized attack rates (AAR, 0.51 vs. 0.54, p=0.352), but attack recovery was poorer (complete remission in 15.6% vs. 27.4%, p<0.001) and relapse-associated worsening (RAW) was higher in LO-NMOSD (RAW: 3 vs. 0.5, p<0.001). Long-term immunotherapy use was comparable. LO-NMOSD exhibited faster progression to disability endpoints (EDSS 4: HR = 2.64, 95% CI=1.81-3.84). Interpretation:LO-NMOSD patients presented more often with myelitis, experienced worse attack outcomes and faster disability accumulation, despite comparable AAR, acute attack treatment and long-term treatment regimens. Accordingly, therapeutic strategies for attack and prophylactic treatment in LO-NMOSD have to be improved.

Being hospitalized at an intensive-care unit (ICU) is stressful and often accompanied by feelings of helplessness, loss of control, fear and traumatic memories. There is substantial influence on cognition and emotion. Relaxation interventions have proven to be effective for regulating affect and cognition for various patient groups. N = 30 patients currently hospitalized at the ICU ward of an early neurological rehabilitation department were exposed once to an audio recording of a self-recorded customized guided imagery intervention with basic mindfulness elements (GIME) and a fictional diagnostic dialogue (control), in randomized order. We recorded respiratory rate, heart rate, systolic and diastolic blood pressure and perfusion. Functionally interactive patients were asked for self-report measures of mood, arousal and pain. We conducted repeated measures ANOVAs with the factors CONDITION and TIME and t-tests for all of the physiological parameters and self-report measures. Analyses showed significant interaction effects for systolic, as well as for diastolic blood pressure indicating a decrease during listening to the GIME. There also was a significant decrease in self-reported arousal after listening to the GIME. Our results suggest that an adapted GIME may induce a beneficial relaxation response and is suitable for administration to neurological patients within early neurological rehabilitation.

OBJECTIVES:Mindfulness-based interventions (MBIs) for persons with dementia (PwD) have yielded mixed results, possibly attributable to the fact that little is known about the validity and reliability of trait mindfulness self-report measures in PwD. This narrative review sought to identify studies involving self-reported trait mindfulness and other clinical measures that may hold information on the convergent validity and reliability of these measures in PwD. METHODS:Scientific databases were searched for studies involving PwD and mindfulness assessments. RESULTS:N = 426 studies from PubMed and N = 156 from PsychInfo databases were reviewed. Four cross-sectional studies were identified that allowed inferences about the validity of mindfulness measures. A qualitative review indicated that convergent validity with other measures varied with sample heterogeneity and cognitive impairment. Merely one MBI included self-reported trait mindfulness, however without reporting sample-specific validity or reliability. CONCLUSIONS:Despite efforts to implement MBIs in PwD, information on basic methodological psychometric issues is minimal. Future studies ought to address the validity and reliability of self-reported mindfulness in detail across different stages of dementia. CLINICAL IMPLICATIONS:Results of MBIs need to be considered cautiously. Basic information about psychometric properties of mindfulness self-report measures is required and these measures need to be included systematically in MBIs.

BackgroundGait variability in people with multiple sclerosis (PwMS) reflects disease progression or may be used to evaluate treatment response. To date, marker-based camera systems are considered as gold standard to analyze gait impairment in PwMS. These systems might provide reliable data but are limited to a restricted laboratory setting and require knowledge, time, and cost to correctly interpret gait parameters. Inertial mobile sensors might be a user-friendly, environment- and examiner-independent alternative. The purpose of this study was to evaluate the validity of an inertial sensor-based gait analysis system in PwMS compared to a marker-based camera system.MethodsA sample N = 39 PwMS and N = 19 healthy participants were requested to repeatedly walk a defined distance at three different self-selected walking speeds (normal, fast, slow). To measure spatio-temporal gait parameters (i.e., walking speed, stride time, stride length, the duration of the stance and swing phase as well as max toe clearance), an inertial sensor system as well as a marker-based camera system were used simultaneously.ResultsAll gait parameters highly correlated between both systems (r > 0.84) with low errors. No bias was detected for stride time. Stance time was marginally overestimated (bias = −0.02 ± 0.03 s) and gait speed (bias = 0.03 ± 0.05 m/s), swing time (bias = 0.02 ± 0.02 s), stride length (0.04 ± 0.06 m), and max toe clearance (bias = 1.88 ± 2.35 cm) were slightly underestimated by the inertial sensors.DiscussionThe inertial sensor-based system captured appropriately all examined gait parameters in comparison to a gold standard marker-based camera system. Stride time presented an excellent agreement. Furthermore, stride length and velocity presented also low errors. Whereas for stance and swing time, marginally worse results were observed.

Abstract Background Currently, there are several studies showing that wearable inertial sensors are highly sensitive in the detection of gait disturbances in people with multiple sclerosis (PwMS), showing excellent reliability within one or 7–14 days. However, it is not known how stable these gait parameters remain over a longer period of time. This is surprising, because many treatments last longer than two weeks. Thus, the purpose of the current study was to examine gait parameters obtained by means of wearable inertial sensors during a 6-min walk and to reassess these parameters after a period of one year. Methods Fifty PwMS (without a relapse or a recent change in the Expanded Disability Status Scale (EDSS) or treatment) and 20 healthy participants were examined at two assessment points (interval between assessments: 14.4 ± 6.6 months). At each assessment point, all participants had to complete a 6-min walking test, an observer-rater test (Berg Balance Scale, BBS) and a Timed-up and Go Test (TUG). To measure mean gait parameters (i.e. walking speed, stride length, stride time, the duration of the stance and swing phase and minimum toe-to-floor distance), as well as the intraindividual standard deviation of each mean gait parameter, wearable inertial sensors were utilized. Results We found that even after one year all mean gait parameters showed excellent Intraclass Correlation Coefficients (ICC between 0.75 and 0.95) in PwMS. Looking at MS subgroups, the ICCs were slightly higher in MS subgroup 2 (EDSS 2.0–5.0) than those in MS subgroup 1 (EDSS 0.0–1.5) and healthy controls. Compared to the mean gait parameters, parameters of gait variability showed only good-to-fair ICC values in PwMS. Concerning BBS and TUG, the ICC values after one year were close to the ICC values of the measured mean gait parameters. Conclusions Due to the excellent stability of mean gait parameters after one year, these sensor-based gait parameters can be identified as clinically relevant markers to evaluate treatment effects over a longer (several months) period of time in MS.

ABSTRACT Introduction Interferon beta (IFN beta) preparations are an established group of drugs used for immunomodulation in patients with multiple sclerosis (MS). Subcutaneously (sc) applied interferon beta-1a (IFN beta-1a sc) has been in continuous clinical use for 25 years as a disease-modifying treatment. Areas covered Based on data published since 2018, we discuss recent insights from analyses of the pivotal trial PRISMS and its long-term extension as well as from newer randomized studies with IFN beta-1a sc as the reference treatment, the use of IFN beta-1a sc across the patient life span and as a bridging therapy, recent data regarding the mechanisms of action, and potential benefits of IFN beta-1a sc regarding vaccine responses. Expert opinion IFN beta-1a sc paved the way to effective immunomodulatory treatment of MS, enabled meaningful insights into the disease process, and remains a valid therapeutic option in selected vulnerable MS patient groups.

Objectives Mindfulness-based interventions (MBIs) have been successfully applied to persons with dementia (PwD) and their caregivers and may yield beneficial effects on depression and quality of life. However, due to inconsistent results, it may be beneficial to re-examine mindfulness in PwD cross-sectionally to identify further potential therapeutic target variables. Rumination, the maladaptive disposition to excessively think about causes and consequences of symptoms and negative mood, may represent such a target. The current study sought to confirm the validity of trait rumination and the antagonistic relationship between mindfulness, rumination, and depression in PwD and their caregivers, as this may qualify rumination as a potential process and outcome variable in future MBIs. Method Forty patients with mild dementia completed a neuropsychological examination and provided self-report data on trait mindfulness, depression, and rumination. Self-report measures were also obtained from 30 caregivers. Regression analyses were used to examine the relation between mindfulness, depression, and rumination. We used clinical cutoffs for depression and rumination to estimate the practical implications of the opposing relationships between these variables. Results For PwD, mindfulness was significantly negatively correlated with depression and rumination, explaining 37% and 25% of variance, respectively. In PwD with low mindfulness scores, clinical depression and rumination syndromes occurred more frequently than in those with high mindfulness. Caregiver results were compatible. Conclusion Mindfulness shows an antagonistic relationship with clinically relevant rumination in PwD. Rumination may represent a relevant clinical outcome variable for future MBIs that can be reliably measured in PwD through validated self-report measures. Preregistration This study is not preregistered.

Background Diagnostics of Alzheimer’s Disease (AD) require a multimodal approach. Neuropsychologists examine the degree and etiology of dementia syndromes and results are combined with those of cerebrospinal fluid markers and imaging data. In the diagnostic process, neuropsychologists often rely on anamnestic and clinical information, as well as cognitive tests, prior to the availability of exhaustive etiological information. The congruency of this phenomenological approach with results from FDG-PET/CT examinations remains to be explored. The latter yield highly accurate diagnostic information. Method A mixed sample of N = 127 hospitalized neurological patients suspected of displaying a dementia syndrome underwent extensive neuropsychological and FDG-PET/CT examinations. Neuropsychological examinations included an anamnestic and clinical interview, and the CERAD cognitive test battery. Two decisional approaches were considered: First, routine diagnostic results were obtained, i.e. the final clinical decision of the examining neuropsychologist (AD Clinical vs. non-AD Clinical ). Secondly, a logistic regression model was implemented, relying on CERAD profiles alone. CERAD subscales that best predicted AD based on FDG-PET/CT were identified and a nominal categorization obtained (AD Test vs. non-AD Test ). Congruency of results from both approaches with those of the FDG-PET/CT (AD PET vs. non-AD PET ) were estimated with Cohen’s Kappa (κ) and Yule’s Y coefficient of colligation. Descriptive estimates of accuracy, sensitivity and specificity of CERAD relative to FDG-PET/CT diagnostics were derived. Results AD PET patients constituted N = 33/127 (26%) of the sample. The clinical decision approach (AD Clinical vs. non-AD Clinical ) showed substantial agreement with the FDG-PET/CT classification (κ = .69, Y = .72) involving good accuracy (84.2%), moderate sensitivity (75.8%) and excellent specificity (92.6%). In contrast, the decisional approach that relied on CERAD data alone (AD Test vs. non-AD Test ) involved only moderate agreement with the FDG-PET/CT (κ = .54, Y = .62) with lower accuracy (74.8%), attributable to decreased sensitivity (56.3%) and comparable specificity (93.3%). Conclusions It is feasible to identify AD through a comprehensive neuropsychological examination in a mixed sample of neurological patients. However, within the boundaries of methods applied here, decisions based on cognitive test results alone appear limited. One may conclude that the clinical impression based on anamnestic and clinical information obtained by the neuropsychological examiner plays a crucial role in the identification of AD patients in routine clinical practice.

Abstract: Cognitive deficits are common in multiple sclerosis (MS), necessitating diagnosis and constant monitoring. However, frequent neuropsychological assessments are costly and not always feasible. A computerized assessment of basic cognitive functions could contribute to better patient care in this regard. The primary cognitive inventory of the Memory and Attention Test (MAT-COBI) constitutes such a tool. In this feasibility study, we tested N = 44 patients with MS with a standardized neuropsychological assessment consisting of established screening procedures (Brief International Cognitive Assessment in MS [BICAMS] and Brief Repeatable Battery [BRB] and three subtests of the Test Battery of Attentional Performance (TAP). The results of these procedures were considered a gold standard for assessing which patients were cognitively impaired or cognitively unaffected. We also administered the MAT-COBI and compared the results to the gold standard. While the results of an exploratory correlation analysis pointed toward the interpretation that the the MAT-COBI adequately operationalized the basic cognitive domains of attention, memory, and executive, sensitivity was insufficient (32.3 %), while specificity reached 92.3 %. A closer look at the single cognitive domains showed marginal differences across domains (sensitivity ranged from 0–24 %, specificity: 89.5 %-100 %). Based on these results, the MAT-COBI does not appear to be a suitable tool for differentiating between cognitively preserved and cognitively impaired patients with MS. We discuss possible explanations and implications for automated cognitive diagnostics.

Cognitive deficits are common in multiple sclerosis (MS), necessitating diagnosis and constant monitoring. However, frequent neuropsychological assessments are costly and not always feasible. A computerized assessment of basic cognitive functions could contribute to better patient care in this regard.The primary cognitive inventory of the Memory and Attention Test (MAT-COBI) constitutes such a tool. In this feasibility study, we tested N = 44 patients with MS with a standardized neuropsychological assessment consisting of established screening procedures (Brief International Cognitive Assessment in MS [BICAMS] and Brief Repeatable Battery [BRB] and three subtests of the Test Battery of Attentional Performance (TAP). The results of these procedures were considered a gold standard for assessing which patients were cognitively impaired or cognitively unaffected. We also administered the MAT-COBI and compared the results to the gold standard. While the results of an exploratory correlation analysis pointed toward the interpretation that the the MAT-COBI adequately operationalized the basic cognitive domains of attention, memory, and executive, sensitivity was insufficient (32.3 %), while specificity reached 92.3 %.A closer look at the single cognitive domains showed marginal differences across domains (sensitivity ranged from 0-24%, specificity: 89.5 %-100 %). Based on these results, the MAT-COBI does not appear to be a suitable tool for differentiating between cognitively preserved and cognitively impaired patients with MS. We discuss possible explanations and implications for automated cognitive diagnostics.

Purpose: The purpose of this study was to assess the prevalence of injection site reactions (ISR) and flu-like symptoms (FLS) during treatment with subcutaneous (SC) interferon (IFN) beta therapies and to document measures to mitigate and prevent ISR and FLS. Patients and Methods: The cross-sectional post-authorization safety study PERFECT was conducted from 11/2017 to 7/2019 in neurology practices in Germany. Adult patients with relapsing-remitting multiple sclerosis (MS) receiving SC IFN beta for =3 months were eligible. The primary endpoints were patient-reported prevalence of ISR and FLS. Additional endpoints reported by patients, MS nurses, and neurologists included type, frequency, duration, time of occurrence, and management of ISR and FLS. Results: In total, 603 patients (median age 45 years [range 36-53], 74% female) were included in the analysis. Time since MS diagnosis was >5 years in most patients. The majority had received none (64%) or 1 (22%) prior therapy. Current MS therapy in 36%, 32%, and 30% of patients was IFN beta-1b, IFN beta-1a, and peginterferon beta-1a, respectively. ISR and FLS under current therapy were reported by 84% and 68% of patients, respectively. ISR developed within 5 days after injection (84%) and lasted for 2-14 days (53%) in most patients. The most frequent patient-reported symptom was erythema (39%). ISR resolved or abated with systemic treatments or topical ointments. Most frequent preventive measures included alternating injection sites (58%). Occurrence of ISR rarely resulted in treatment interruption (5%). FLS occurred predominantly up to 6 h after injection (40%) and lasted <12 h (26%). The most frequent patient-reported symptoms were fatigue (15%) and aching limbs (15%). Assessments by physicians and MS nurses differed from patientreported results. Conclusion: Although ISR were experienced by the majority of patients, they rarely resulted in treatment interruption. In this real-world setting, ISR and FLS management was in line with published expert recommendations.

Background The aim of the current study was to examine multiple gait parameters obtained by wearable inertial sensors and their sensitivity to clinical status in early multiple sclerosis (MS). Further, a potential correlation between gait parameters and subjective fatigue was explored. Methods Automated gait analyses were carried out on 88 MS patients and 31 healthy participants. To measure gait parameters (i.e. walking speed, stride length, stride duration, duration of stance and swing phase, minimal toe-to-floor distance), wearable inertial sensors were utilized throughout a 6-min 25-ft walk. Additionally, self-reported subjective fatigue was assessed. Results Mean gait parameters consistently revealed significant differences between healthy participants and MS patients from as early as an Expanded Disability Status Scale (EDSS) value of 1.5 onwards. Further, MS patients showed a significant linear trend in all parameters, reflecting continuously deteriorating gait performance throughout the test. This linear deterioration trend showed significant correlations with fatigue. Conclusions Wearable inertial sensors are highly sensitive in the detection of gait disturbances, even in early MS, where global scales such as the EDSS do not provide any clinical information about deviations in gait behavior. Moreover, these measures provide a linear trend parameter of gait deterioration that may serve as a surrogate marker of fatigue. In sum, these results suggest that classic timed walking tests in routine clinical practice should be replaced by readily and automatically applicable gait assessments, as provided by inertial sensors.

OBJECTIVES:Persons with MS (PwMS) are frequently affected by fatigue and depression. Mindfulness-based interventions may reduce these symptoms in PwMS and consequently their application has been extended to various settings. Only few efforts have been made to explore effects of short-term mindfulness training during brief periods of hospitalization. In the current study, the feasibility and potential effects of short-term mindfulness training on depression, fatigue, rumination and cognition were explored in PwMS in an acute-care hospital setting. Based on previous work, it was further examined whether the relation between trait mindfulness and fatigue prior to and following the intervention was mediated by depression and whether a mediation effect was also observable throughout the intervention.METHODS:A short-term mindfulness training protocol was developed, tailored to the requirements of the acute-care setting. Subsequently, 30 PwMS were recruited sequentially and received mindfulness training during the routine clinical process (median duration in hospital: eight days, number of sessions: four). Participants completed relevant self-report measures (depression, fatigue, rumination) and a neuropsychological assessment before and after training.RESULTS:Participants reported significantly increased trait mindfulness and decreased depression and fatigue following the intervention. Respective change scores were highly correlated so that increased trait mindfulness was associated with decreased symptoms. In the rumination domain, patients reported a tendency for an increased adaptive ability to engage in distractive behavior during arising negative mood. Other measures of trait rumination and cognition remained relatively stable. Results of the mediation analyses indicated that depression mediated the negative relationship between trait mindfulness and fatigue symptoms at pre and post assessments. With regards to the change scores, an association between mindfulness and cognitive fatigue ceased to be significant when depression was controlled, albeit in this case, the mediation effect did not reach significance.CONCLUSION:Results of the current study indicate that short-term mindfulness training during brief periods of hospitalization may be beneficial for PwMS. They further complement previous work by identifying depression as a potential mediator of the antagonistic relationship between mindfulness and fatigue. Based on the current exploratory study, future trials are warranted to address this mechanism of mindfulness training in more detail.

The evaluation of local divergence exponent (LDE) has been proposed as a common gait stability measure in people with multiple sclerosis (PwMS). However, differences in methods of determining LDE may lead to different results. Therefore, the purpose of the current study was to determine the effect of different sensor locations and LDE measures on the sensitivity to discriminate PwMS. To accomplish this, 86 PwMS and 30 healthy participants were instructed to complete a six-minute walk wearing inertial sensors attached to the foot, trunk and lumbar spine. Due to possible fatigue effects, the LDE short (~50% of stride) and very short (~5% of stride) were calculated for the remaining first, middle and last 30 strides. The effect of group (PwMS vs. healthy participants) and time (begin, mid, end) and the effect of Expanded Disability Status Scale (EDSS) and time were assessed with linear random intercepts models. We found that perturbations seem to be better compensated in healthy participants on a longer time scale based on trunk movements and on a shorter time scale (almost instantaneously) according to the foot kinematics. Therefore, we suggest to consider both sensor location and time scale of LDE when calculating local gait stability in PwMS.

Objectives Persons with MS (PwMS) often display symptoms of depression and fatigue. Mindfulness-based interventions are known to counteract these symptoms. However, to-date the exact relations between trait mindfulness, depression and fatigue remain to be examined. Fatigue is generally regarded as a symptom immanent to the disease and as a direct neurobiological consequence of increased cytokine levels and cortical atrophy. In depression on the other hand, psychosocial factors in the context of adaptation difficulties are probably of higher relevance. Hence, one may argue that mindfulness, as a trait that promotes successful adaption, may show a strong negative association with depression and a relatively minor negative association with fatigue in PwMS. Methods In the current study, the association between self-reported trait mindfulness, fatigue and depression was examined in a sample of 69 PwMS. Results Trait mindfulness showed highly significant negative correlations with both, depression and fatigue. Mediation analyses however, revealed that depression mediated the relation between mindfulness and fatigue. Conclusion It may be concluded that in PwMS, trait mindfulness shows a genuine negative association with depression, but that it is only secondarily associated with fatigue. Implications for mindfulness-based interventions in MS are discussed. Based on the results of the current study, it may be feasible to promote the acceptance of default fatigue symptoms, instead of an actual reduction of fatigue symptoms.

Background: With a large array of disease modifying therapies (DMTs) for relapsing-remitting MS (RRMS), identifying the optimal treatment option for the individual patient is challenging and switching of immunotherapies is often required. The objective of this study was to systematically investigate reasons for DMT switching in patients on immunotherapies for mild/moderate MS, and provide real-life insights into currently applied therapeutic strategies. Methods: This noninterventional, cross-sectional study (ML29913) at 50 sites in Germany included RRMS patients on therapies for mild/moderate MS who switched immunotherapy in the years 2014–2017. The key outcome variable was the reason to switch, as documented in the medical charts, based on failure of current therapy, cognitive decline, adverse events (AEs), patient wish, or a woman’s wish to become pregnant. Expectations of the new DMT and patients’ assessment of the decision maker were also recorded. Results: The core analysis population included 595 patients, with a mean age of 41.6 years, of which 69.7% were female. More than 60% of patients had at least one relapse within 12 months prior to the switch. The main reasons to switch DMT were failure of current therapy (53.9%), patient wish (22.4%), and AEs (19.0%). Most patients (54.3%) were switched within DMTs for mild/moderate MS; only 43.5% received a subsequent DMT for active/highly active MS. While clinical and outcome-oriented aspects were the most frequently mentioned expectations of the new DMT for physicians, aspects relating to quality of life played a major role for patients. Conclusions: Our data indicate suboptimal usage of DMTs, including monoclonal antibodies, for active/highly active MS in German patients. This illustrates the medical need for DMTs combining high efficacy, low safety risk, and low therapy burden.