title: Association Between Cognitive Complaints and Vulnerability to Environmental Distraction in Multiple Sclerosis.
abstract: OBJECTIVE
  Individuals with multiple sclerosis (MS) often report cognitive dysfunction, although neuropsychological evaluation findings may not correlate with subjective concerns. One factor that may explain this lack of correspondence is the controlled testing environment, which differs from busier settings where cognitive lapses are noted to occur. This study used a novel environmental manipulation to determine whether individuals with MS who report cognitive dysfunction are more vulnerable to the effects of auditory distraction during neuropsychological testing.
  
  
  METHODS
  Twenty-four individuals with clinically definite MS or clinically isolated syndrome were administered a cognitive battery during two counterbalanced auditory conditions: quiet/standard condition, and distraction condition with random office background noise. Participants were divided into high versus low cognitive complaint groups using a median split analysis of Perceived Deficits Questionnaire responses.
  
  
  RESULTS
  Participants with more cognitive complaints showed a decrement in performance on the oral Symbol Digit Modalities Test during the distraction condition while those with fewer cognitive complaints demonstrated stable performance across conditions. These findings remained significant after controlling for education, premorbid intellect, fatigue, and depressed mood.
  
  
  CONCLUSIONS
  These results suggest that individuals with MS with more cognitive complaints are vulnerable to environmental distraction, particularly regarding processing speed. Incorporating random environmental noise or other distraction conditions during selected measures may enhance the ecological validity of neuropsychological evaluation results in MS.
authors.affiliation: Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH 03756, USA john.randolph@randolphnp.com.
authors.forename: John J
authors.initials: JJ
authors.lastname: Randolph
authors.affiliation: Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH 03756, USA.
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Randolph
authors.affiliation: Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH 03756, USA.
authors.forename: Heather A
authors.initials: HA
authors.lastname: Wishart
mesh_terms: D000161:Acoustic Stimulation; D001288:Attention; D003072:Cognition Disorders / Q000150:complications / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications / Q000523:psychology*; D009483:Neuropsychological Tests
keywords: Assessment; Attention; Cognitive complaints; Distraction; Multiple sclerosis