The possession of at least one APOE-epsilon4 allele may be linked to poor outcome in patients with predominantly severe traumatic brain injury (TBI). In mild TBI, which accounts for approximately 85% of all cases, the role of the APOE-epsilon4 allele is less clear. Studies completed to date have relied on brief cognitive assessments or coarse measures of global functioning, thereby limiting their conclusions. Our study investigated the influence of the APOE-epsilon4 allele in a prospective sample of 90 adults with mild to moderate TBI in whom neuropsychiatric outcome 6 months after injury was assessed as follows: (i) a detailed neuropsychological battery; (ii) an index of emotional distress (General Health Questionnaire); (iii) a diagnosis of major depression (Structured Clinical Interview for DSM-IV); (iv) a measure of global functioning (Glasgow Outcome Scale); (v) an index of psychosocial outcome (Rivermead Head Injury Follow-up Questionnaire); and (vi) symptoms of persistent post-concussion disorder (Rivermead Post-Concussion Symptoms Questionnaire). No association was found between the presence of the APOE-epsilon4 allele and poor outcome across all measures. Given the homogeneous nature of our sample (mild to moderate injury severity), the uniform follow-up period (6 months) and the comprehensive markers of recovery used, our data suggest that the APOE-epsilon4 allele does not adversely impact outcome in this group of TBI patients.

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The effect of major depression on subjective and objective cognitive deficits 6 months following mild to moderate traumatic brain injury (TBI) was assessed in 63 subjects. Patients with subjective cognitive complaints (n=63) were more likely to be women, with higher Glasgow Coma Scale (GCS) scores and have a diagnosis of major depression. They also performed significantly more poorly on various measures of memory, attention and executive functioning. Group differences on most but not all cognitive measures disappeared in a multivariate analysis when controlling for depression. In mild to moderate TBI, subjective cognitive deficits are linked in large measure to comorbid major depression. However, other mechanisms may also account for these deficits.

410More than half of patients with multiple sclerosis (MS) exhibit cognitive deficits that mainly affect long-term memory, working memory, speed of information processing, attention and executive functions [1][2][3][4][5] . those deficits have a direct impact on MS patients' employment status and quality of life 6 . Screening for such cognitive deficits is necessary to follow patients effectively. therefore, there is an important need for reliable and costeffective screening tests in clinical practice.Among the measures currently available for this purpose, the Multiple Sclerosis Neuropsychological Questionnaire (MSNQ) appears reliable to detect cognitive impairment 7 . this is particularly true for the MSNQ that is completed by an informant (MSNQ-I) 7-10 , since a high score on the MSNQ completed by the patient (MSNQ-P) correlates more with the score on the beck Depression Inventory -Fast Screen (bDI-FS) 11 , a measure of depression, than with objective measure of cognitive functions 12 . Reliability to detect cognitive deficits seems compromised when the patient presents with depressive ABSTRACT: Objective: Since a large proportion of multiple sclerosis (MS) patients exhibit cognitive deficits, it is important to have reliable and cost-effective screening measures that can be used to follow patients effectively. the objective of this study was to evaluate the clinical value of the Montreal Cognitive Assessment (MoCA) test in detecting cognitive deficits in MS patients. Methods: Forty-one (70.1% women, mean age 44.51 ±7.43) mildly impaired (EDSS: 2.26 ±1.87) MS patients were recruited for this study. In addition to the MoCA, they were administered the MSNQ-P (patient version) and the MSNQ-I (informant version), the bDI-FS and a comprehensive neuropsychological test battery. Results: there were significant correlations between the MoCA test and the three factors derived from the neuropsychological evaluation (Executive/speed of processing, Learning, Delayed recall). the MoCA test was correlated with the MSNQ-I but only marginally with the MSNQ-P. In addition, there was no significant correlation between the MSNQ-P and the neuropsychological factors, whereas significant correlations were found between two of those factors (Learning and Delayed recall) and the MSNQ-I, suggesting that the informant version is more reliable than the patient version for the presence of cognitive deficits. Conclusion: the results obtained in the present study support the value of the MoCA test as a screening tool for the presence of cognitive dysfunction in MS patients, even in patients with mild functional disability (EDSS).RÉSUMÉ: Valeur du test MoCA comme instrument de dépistage dans la sclérose en plaques. Objectif : Étant donné qu'une grande proportion des patients atteints de sclérose en plaques (SP) présentent des déficits cognitifs, il est important d'utiliser des mesures de dépistage fiables et économiques pour suivre ces patients efficacement. Le but de cette étude était d'évaluer la valeur clinique du MoCA pour détecter un ...

Pseudobulbar affect (PBA) is defined as episodes of involuntary crying, laughing, or both in the absence of a matching subjective mood state. This neuropsychiatric syndrome can be found in a number of neurological disorders including multiple sclerosis (MS). The aim of this study was to identify neuroanatomical correlates of PBA in multiple sclerosis (MS) using a case-control 1.5T MRI study. MS patients with (n = 14) and without (n = 14) PBA were matched on demographic, disease course, and disability variables. Comorbid psychiatric disorders including depressive and anxiety disorders were absent. Hypo- and hyperintense lesion volumes plus measurements of atrophy were obtained and localized anatomically according to parcellated brain regions. Between-group statistical comparisons were undertaken with alpha set at 0.01 for the primary analysis. Discrete differences in lesion volume were noted in six regions: Brainstem hypointense lesions, bilateral inferior parietal and medial inferior frontal hyperintense lesions, and right medial superior frontal hyperintense lesions were all significantly higher in the PBA group. A logistic regression model identified four of these variables (brainstem hypointense, left inferior parietal hyperintense, and left and right medial inferior frontal hyperintense lesion volumes) that accounted for 70% of the variance when it came to explaining the presence of PBA. In conclusion, MS patients with PBA have a distinct distribution of brain lesions when compared to a matched MS sample without PBA. The lesion data support a widely-dispersed neural network involving frontal, parietal, and brainstem regions in the pathophysiology of PBA.