In our lab we focus on research issues relating to clinical neuropsychology. We have two primary lines of research that we have pursued here, with an additional line being developed.

Multiple Sclerosis: One pertains to neuropsychological aspects of multiple sclerosis (MS), with special emphasis on contributors to depression, cognitive functioning, fatigue, and general quality of life in this common neurological disorder.

o   Secondary Factors Impacting Cognitive Test Performance: We have found that secondary factors (e.g., , slow speech, poor visual acuity, depression, anxiety, fatigue, among others) are associated with neuropsychological test performance in MS.

o   Coping as an Important Moderator of Outcomes:  Several of our studies have shown that coping is a powerful moderator of outcomes in MS. Specifically, we have found that, compared to Persons with MS (PwMS) who favor avoidant coping in response to stress, those PwMS who rely more on active coping show less depression in the face of comparable pain and cognitive impairment. Also, those who use active coping are less likely to report affective difficulties compared with those who rely more on avoidant coping even when they have comparable levels of white matter tract integrity.  Finally, we have found that coping moderates the relationship between cognitive fatigue and cognitive variability in PwMS. We view these findings as significant because they show that a modifiable factor, coping, could potentially be changed via treatment to result in better outcomes for PwMS. 

o   Treatment of Depression in MS. We recently published a paper on our multi-site RCT with colleagues in Germany and the U.S., funded by the National MS Society (NMSS). We found that an online cognitive behavioral therapy (CBT) program designed for treating depression in PwMS resulted in a significant reduction in depression compared with a Wait List Control Group.

o   Current MS Work: At present, we are exploring whether personality factors in MS predict important outcomes in MS. Additionally, we are examining our RCT data in more detail to go beyond our mean data findings to explore who benefits and does not benefit from the CBT treatment, and what factors might predict these differences. We are also examining differences in how disability in MS has been characterized over the years to identify specific measures that best capture such disability.

Sports-Related Concussion:  A second line of research in our lab explores the consequences of sports-related concussion.

o   Predicting Risk for Concussion.  In recent work we have found that both sleep disturbance and co-morbid depression and anxiety at baseline predict increased risk for subsequent concussion.

o   Predictors of Outcomes:  We have found that depression alone, as well as co-morbid depression and anxiety predict worse cognitive functioning post-concussion.  Additionally, we have shown that, compared with individuals who do not have the E4 allele of the ApOE gene, those who do have the E4 allele are more likely to show increased problems with cognition, headache, and general symptom reports following sports concussion.

o   Refining Evaluation of Cognitive Recovery:  Although the baseline model for assessing cognitive change following concussion has been considered the gold standard, there are a number of problems with this model that make it less than ideal methodologically. Changes in motivation for testing from baseline to post-concussion testing, less than optimal test-retest reliability of measures used, and practice effects all interfere with the accuracy of assessments using this model.

o   As a result, we have tried to explore a model using base rates of impairment that does not rely on having any baseline testing, but just good estimates of base rates of impairment for the cognitive battery used. Specifically, we have developed an evidence-based algorithm using base rates of impairment from approximately 1000 Penn State athletes tested at baseline, that allows us to determine whether athletes are cognitively recovered following concussion even when we have not tested them at baseline. We have tested this model using outcome variables that were not explicitly used in developing the model in the first place, this showed the model had a high level of validity. We have also refined the model in recent years to take into consideration differences in levels of premorbid cognitive ability.

o   Current Sports Concussion Work: We are currently using machine learning and publicly available big data sets to predict factors impacting return to play speed in collegiate athletes. We are also exploring the extent to which depression post-concussion can interfere with accurate self-reports of memory problems. We have additionally been exploring ways to contextualize racial/ethnic group differences in neuropsychological test performance so that fairer and more accurate assessments post-concussion can be developed. We are also exploring in a Proof-of-Concept Study whether similar phenomena to what we have found in varsity college athletes can be observed in college students with a history of concussion.  

Women Who Have Experienced Intimate Partner Violence (IPV): In recent years we have begun to extend some of our work in sports concussion to the topic of IPV. Concussions and repetitive head injuries are common in IPV, and we have been exploring some of the cognitive and emotional consequences of such injuries. 

Work in our lab provides students with the opportunity to work with data from three very different clinical populations to explore research questions that have both theoretical and applied implications.

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