Peter A. Arnett, Ph.D. Penn State University Key

1
Cognitive Dysfunction Associated with Depression
in MS Patients

• Peter A. Arnett, Ph.D.
• Penn State University

2
Key Contributors

• Chris Higginson, Ph.D
• Bill Voss, Ph.D.
• Bruce Wright, M.D.
• William Bender, M.D.
• Jared Bruce, Ph.D.
• Dawn Polen, M.S.

• Jon Tippin, M.D.
• John Randolph, Ph.D.
• Pamela Freske, Ph.D.
• Megan Smith, M.S.
• Lauren Strober, M.S.
• Alicia Grandey, Ph.D.

3
Overview

• Depression Cognitive Dysfunction Importance of
  Mood Symptoms.
• Depression Cognitive Dysfunction Consideration
  of Evaluative Symptoms.
• Coping as a Possible Moderator Between Cognitive
  Dysfunction Depression.

4
Depression Cognitive Dysfunction The
Importance of Mood Symptoms.
5
Introduction

• The prevalence of depression in MS is high.
• Deficits on capacity-demanding cognitive tasks
  are common in MS.

6
Introduction

• Non-MS depressed commonly show impairments on
  capacity-demanding cognitive tasks (Hartlage et
  al., 1993).
• Surprisingly, most MS studies have not found a
  relationship between depression and
  capacity-demanding cognitive tasks.

7
Arnett et al. (1999a1999b2001)

• Depression significantly associated w/ deficits
  in speeded attention, working memory, planning.
  
• Tasks on which deficits were found PASAT,
  Symbol Digit, Visual Elevator, Reading Span,
  Tower of London.

8
Why are our data different from existing work?
9
Introduction

• Possible reason for difference We defined
  depression according to mood disturbance alone.
• Why important? Neurovegetative symptoms of
  depression may not reflect depression in MS.

10
Introduction

• Importantly, speeded attentional, working
  memory, and planning measures did not correlate
  w/ vegetative symptoms of depression in our
  studies.

11
Depression Cognitive Dysfunction
Consideration of Evaluative Symptoms
12
Evaluative Symptoms

• Negative self-evaluative depression symptoms may
  interfere with cognitive functioning because they
  use up available capacity.
• The CMDI Evaluative subscale provides a
  relatively pure measure of these symptoms.

13
Study Goals

• Examine relationship b/w evaluative depression
  symptoms speeded attentional function in MS.
• Examine stability of this relationship over time
  w/in the same sample.

14
Depression Measure

• Chicago Multiscale Depression Inventory (CMDI
  Nyenhuis et al., 1995). 3 Subscales of 14 items
  each
• Mood Sad, glum, low.
• Evaluative Inferior, worthless, a failure.
• Vegetative Fitful sleep, exhausted, uninterested
  in sex, poor appetite.

15
Speeded Attentional Tasks

• PASAT (3s version)
• Symbol Digit Modalities Test, Oral Form
• Visual Elevator subtest (from Test of Everyday
  Attention)

16
Participants

• 51 probable or definite MS patients tested at
  two time points 3 years apart.

17
Correlations Between CMDI Evaluative Scale
p lt .01 p lt .005 p lt .001
18

• All significant analyses remained so in
  follow-up regression analyses on each variable
  with age and education partialled out.

19
Summary

• Like mood symptoms, evaluative symptoms of
  depression are associated w/ performance on
  capacity-demanding cognitive tasks.
• Evaluative symptoms should also be considered in
  studies examining cognitive dysfunction
  depression in MS.

20
Interpretation

• Evaluative symptoms of depression may cause
  cognitive difficulties in MS patients by using up
  available cognitive capacity.
• If true, altering these negative self-beliefs
  could result in patients improving their
  cognitive functioning.

21
Interpretation

• Alternatively, cognitive difficulties in MS may
  lead to negative self-beliefs.
• If so, helping patients develop better coping
  strategies for cognitive difficulties may improve
  their self-perceptions reduce depression.

22
Arnett et al. (2002)

• Coping as a Possible Moderator Between
  Cognitive Dysfunction Depression

23
Study Considerations

• Objective Examine whether coping moderates
  relationship b/w cognitive dysfx depression.
• Prediction Cognitive dysfx will be associated
  w/ depression when high levels of maladaptive
  coping or low levels of adaptive coping are used.

24
Method

• Participants 55 definite or probable MS patients
  completed the COPE.
• Depression Measure CMDI Mood Evaluative
  scale.
• Cognitive Measure Index combining speeded
  attentional, working memory, planning indices.

25
Coping Measure

• COPE Indices (Carver et al., 1989)
• Avoidance Coping Identified as maladaptive.
• Active Coping Identified as adaptive.

26
Results
27
Avoidance Coping as Moderator
28
(No Transcript)
29
Active Coping as Moderator
30
(No Transcript)
31
Model Predicting Depression
Avoidance Coping High
Cognitive Dysfunction
Depression
Active Coping Low
32
Model Predicting Resistance to Depression
Avoidance Coping Low
Cognitive Dysfunction
Depression
Active Coping High
33
Summary Inferences

• Cognitive dysfx is associated w/ depression in MS
  pts who use low levels of active coping or high
  levels of avoidance coping.
• Cognitive dysfx may lead to depression in MS when
  patients use high levels of avoidance or low
  levels of active coping.

34
Summary Inferences

• Applied implications
• May be helpful to teach MS pts to use more active
  and fewer avoidance coping strategies.
• This may make pts more resistant to depression
  even when they do experience cognitive problems.
  
• Data may help to explain literature
  inconsistencies.