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Nielsen J, Görtz S, Aschermann E, Saliger J, Hennecken E, Eschweiler M, Karbe H, Kalbe E, Folkerts AK. Exploring humor as a coping factor against depressive mood and fear of progression in people with multiple sclerosis with moderate disability: A cross-sectional analysis of a rehabilitation cohort. Mult Scler Relat Disord 2024; 91:105906. [PMID: 39369630 DOI: 10.1016/j.msard.2024.105906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 06/20/2024] [Accepted: 09/22/2024] [Indexed: 10/08/2024]
Abstract
BACKGROUND People with multiple sclerosis (pwMS) face disease-related stress throughout their lives, often resulting in depressive mood and fear of progression (FoP). People with a pronounced sense of humor demonstrate greater resilience to stress and tend to perceive threats as challenges. This research investigates whether humor can be identified as a relevant coping factor in pwMS regarding depressive mood and FoP. METHODS Participants were 77 German inpatients aged 25-64 years with predominantly relapsing-remitting MS. Blockwise regression analyses were conducted to examine the relationship between humor skills (Sense of Humor Scale, SHS), depressive mood (Centre for Epidemiologic Studies Depression Scale, CES-D), and fear of progression (Fear of Progression-Questionnaire, FoP-Q), adjusting for demographic, disease-specific, and self-management variables. Correlational and moderator analyses were conducted to evaluate the impact of humor styles (Comic Style Markers, CSM) and self-observation (as a self-distancing measure, Questionnaire to Assess Resources and Self-Management Skills) on these relationships. RESULTS The summed SHS score was found to be a significant unique determinant for less depressive mood (CES-D, RΔ = 0.05, p = .005), low FoP (FoP-Q sum score, RΔ = 0.06, p = .004), and greater anxiety coping (FoP-Q anxiety coping, RΔ = 0.06, p = .007). Only light humor style was associated with specific FoP-Q scales; the variable dark humor style was not correlated with any study variable. The subscale self-observation failed to moderate between SHS and emotional disorders. CONCLUSION Data indicate that humor skills in pwMS are associated with less depression and FoP, which argues for incorporating adaptive humor as a coping resource into psychosocial interventions for pwMS. However, further validation is needed through larger and longitudinal trials.
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Affiliation(s)
- Jörn Nielsen
- Department of Cognitive Rehabilitation, Johanniter Neurological Rehabilitation Center Godeshöhe GmbH, Waldstrasse 2-10; D-53117 Bonn, Germany; Department of Medical Psychology | Neuropsychology and Gender Studies, Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpenerstr. 62, D-50937 Cologne, Germany.
| | - Sarah Görtz
- Department of Cognitive Rehabilitation, Johanniter Neurological Rehabilitation Center Godeshöhe GmbH, Waldstrasse 2-10; D-53117 Bonn, Germany; Department of Psychology, Faculty of Human Sciences, University of Cologne, Gronewaldstr. 2, D-50931 Cologne, Germany.
| | - Ellen Aschermann
- Department of Psychology, Faculty of Human Sciences, University of Cologne, Gronewaldstr. 2, D-50931 Cologne, Germany.
| | - Jochen Saliger
- Department of Cognitive Rehabilitation, Johanniter Neurological Rehabilitation Center Godeshöhe GmbH, Waldstrasse 2-10; D-53117 Bonn, Germany.
| | - Eva Hennecken
- Department of Cognitive Rehabilitation, Johanniter Neurological Rehabilitation Center Godeshöhe GmbH, Waldstrasse 2-10; D-53117 Bonn, Germany.
| | - Mareike Eschweiler
- Department of Cognitive Rehabilitation, Johanniter Neurological Rehabilitation Center Godeshöhe GmbH, Waldstrasse 2-10; D-53117 Bonn, Germany.
| | - Hans Karbe
- Department of Cognitive Rehabilitation, Johanniter Neurological Rehabilitation Center Godeshöhe GmbH, Waldstrasse 2-10; D-53117 Bonn, Germany.
| | - Elke Kalbe
- Department of Medical Psychology | Neuropsychology and Gender Studies, Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpenerstr. 62, D-50937 Cologne, Germany.
| | - Ann-Kristin Folkerts
- Department of Medical Psychology | Neuropsychology and Gender Studies, Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpenerstr. 62, D-50937 Cologne, Germany.
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Gury P, Moulin M, Laroye R, Trachino M, Montazel M, Narme P, Ehrlé N. Happy facial emotional congruence in patients with relapsing-remitting multiple sclerosis. J Clin Exp Neuropsychol 2024; 46:644-654. [PMID: 39140395 DOI: 10.1080/13803395.2024.2391362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 08/07/2024] [Indexed: 08/15/2024]
Abstract
BACKGROUND Emotion categorization has often been studied in the relapsing-remitting form of multiple sclerosis (RR-MS), suggesting an impairment in the recognition of emotions. The production of facial emotional expressions in RR-MS has not been considered, despite their importance in non-verbal communication. METHOD Twenty-five RR-MS patients and twenty-five matched controls completed a task of emotional categorization during which their faces were filmed. The stimuli were dynamic (sound or visual), expressed by adults (women or men), and expressing happy (laughing or smiling) or negative emotion. Two independent blinded raters quantified the happy facial expressions produced. The categorization task was used as a proxy for emotional categorization, while the happy facial expressions produced assessed the production of emotions. RESULTS The main analysis indicated impaired categorization of RR-MS for happy stimuli selectively, whereas their happy facial expressions were not statistically different from those of the control group. More specifically, this group effect was found for smiles (and not laughter) and for happy stimuli produced by men. Analysis of individual patient profiles suggested that 77% of patients with impaired judgments produced normal facial expressions, suggesting a high prevalence of this dissociation. Only 8% of our samples showed reverse dissociation, with happy facial expressions significantly different from those of the control group and normal emotional judgments. CONCLUSION These results corroborated the high prevalence of emotional categorization impairment in RR-MS but not for negative stimuli, which can probably be explained by the methodological specificities of the present work. The unusual impairment found for happy stimuli (for both emotional categorization and facial congruence) may be linked to the intensity of the perceived happy expressions but not to the emotional valence. Our results also indicated a mainly preserved production of facial emotions, which may be used in the future sociocognitive care of RR-MS patients with impaired emotional judgments.
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Affiliation(s)
- Pauline Gury
- Neurology Department, Maison-Blanche Hospital, Reims, France
- Laboratoire Mémoire Cerveau et Cognition (UR 7536), Université Paris Cité, Boulogne-Billancourt, France
| | | | | | - Marine Trachino
- Neurology Department, Maison-Blanche Hospital, Reims, France
| | - Marine Montazel
- Neurology Department, Maison-Blanche Hospital, Reims, France
| | - Pauline Narme
- Laboratoire Mémoire Cerveau et Cognition (UR 7536), Université Paris Cité, Boulogne-Billancourt, France
| | - Nathalie Ehrlé
- Neurology Department, Maison-Blanche Hospital, Reims, France
- Laboratoire Mémoire Cerveau et Cognition (UR 7536), Université Paris Cité, Boulogne-Billancourt, France
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Gury P, Moulin M, Laroye R, Montazel M, Trachino M, Narme P, Ehrlé N. Explicit and implicit abilities in humor processing in patients with relapsing-remitting multiple sclerosis. Soc Neurosci 2024; 19:1-13. [PMID: 38424715 DOI: 10.1080/17470919.2024.2315817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 11/28/2023] [Indexed: 03/02/2024]
Abstract
Sociocognitive impairment is well known in the relapsing-remitting form of multiple sclerosis (RR-MS). The purpose of the present study was to assess explicit and implicit humor abilities in this population. Based on clinical observation and contrary to the current cognitive model, we hypothesized that implicit performances (happy facial expressions) would be better than explicit ones (humor judgment assessed by explicit humor comprehension, subjective feeling of amusement as a conscious appreciation of funniness, and verbal justifications of funniness). Twenty-five RR-MS patients and twenty-five healthy participants completed the tasks. Their face was filmed during humor ratings. Patients' results suggest that 32% of them showed an impairment in explicit humor comprehension, with normal facial expressions. Both groups found great difficulty in justifying the cause of their amusement. All these results may suggest the existence of a supplementary implicit pathway in humor processing. The preservation of this implicit pathway may be advantageous for future remediation. Contrary to the current model, we found that the subjective feeling of amusement was preserved when comprehension was impaired. Further studies will be needed to clarify this component, and adjust the theoretical modeling.
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Affiliation(s)
- Pauline Gury
- Neurology department, Maison-Blanche hospital, Reims, France
- Laboratoire Mémoire Cerveau et Cognition (UR 7536), University Paris Cité, Boulogne-Billancourt, France
| | | | | | - Marine Montazel
- Neurology department, Maison-Blanche hospital, Reims, France
| | - Marine Trachino
- Neurology department, Maison-Blanche hospital, Reims, France
| | - Pauline Narme
- Laboratoire Mémoire Cerveau et Cognition (UR 7536), University Paris Cité, Boulogne-Billancourt, France
| | - Nathalie Ehrlé
- Laboratoire Mémoire Cerveau et Cognition (UR 7536), University Paris Cité, Boulogne-Billancourt, France
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Rook J, Llufriu S, de Kok D, Rofes A. Language impairments in people with autoimmune neurological diseases: A scoping review. JOURNAL OF COMMUNICATION DISORDERS 2023; 106:106368. [PMID: 37717472 DOI: 10.1016/j.jcomdis.2023.106368] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 08/02/2023] [Accepted: 08/16/2023] [Indexed: 09/19/2023]
Abstract
INTRODUCTION Autoimmune neurological diseases (ANDs) are a specific type of autoimmune disease that affect cells within the central and peripheral nervous system. ANDs trigger various physical/neuropsychiatric symptoms. However, language impairments in people with ANDs are not well characterized. Here we aimed to determine the kinds of language impairment that most commonly emerge in 10 ANDs, the characteristics of the patients (demographic, neurological damage), and the assessment methods used. METHODS We followed the PRISMA Extension for Scoping Reviews (PRISMA-ScR). PubMed and Google Scholar were searched. We used a list of search terms containing 10 types of ANDs (e.g., multiple sclerosis, acute disseminated encephalomyelitis) in combination with the terms aphasia, dysphasia, fluency, language, listening, morphology, phonology, pragmatics, reading, semantics, speaking, syntax, writing. The reference lists and citations of the relevant papers were also investigated. The type of AND, patient characteristics, neurological damage and examination technique, language tests administered, and main findings were noted for each study meeting the inclusion criteria. RESULTS We found 171 studies meeting our inclusion criteria. These comprised group studies and case studies. Language impairments differed largely among types of ANDs. Neurological findings were mentioned in most of the papers, but specific language tests were rarely used. CONCLUSIONS Language symptoms in people with ANDs are commonly reported. These are often not full descriptions or only focus on specific time points in the course of the disease. Future research needs to assess specific language functions in people with ANDs and relate their language impairments to brain damage at different stages of disease evolution.
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Affiliation(s)
- Janine Rook
- Center for Language and Cognition, University of Groningen, Groningen, The Netherlands; Research School of Behavioural and Cognitive Neurosciences, University of Groningen, Groningen, The Netherlands
| | - Sara Llufriu
- Center of Neuroimmunology, Laboratory of Advanced Imaging in Neuroimmunological Diseases, Hospital Clinic Barcelona, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Dörte de Kok
- Center for Language and Cognition, University of Groningen, Groningen, The Netherlands
| | - Adrià Rofes
- Center for Language and Cognition, University of Groningen, Groningen, The Netherlands.
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Yap SM, Davenport L, Cogley C, Craddock F, Kennedy A, Gaughan M, Kearney H, Tubridy N, De Looze C, O'Keeffe F, Reilly RB, McGuigan C. Word finding, prosody and social cognition in multiple sclerosis. J Neuropsychol 2023; 17:32-62. [PMID: 35822290 DOI: 10.1111/jnp.12285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 03/29/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Impairments in speech and social cognition have been reported in people with multiple sclerosis (pwMS), although their relationships with neuropsychological outcomes and their clinical utility in MS are unclear. OBJECTIVES To evaluate word finding, prosody and social cognition in pwMS relative to healthy controls (HC). METHODS We recruited people with relapsing MS (RMS, n = 21), progressive MS (PMS, n = 24) and HC (n = 25) from an outpatient MS clinic. Participants completed a battery of word-finding, social cognitive, neuropsychological and clinical assessments and performed a speech task for prosodic analysis. RESULTS Of 45 pwMS, mean (SD) age was 49.4 (9.4) years, and median (range) Expanded Disability Severity Scale score was 3.5 (1.0-6.5). Compared with HC, pwMS were older and had slower information processing speed (measured with the Symbol Digit Modalities Test, SDMT) and higher depression scores. Most speech and social cognitive measures were associated with information processing speed but not with depression. Unlike speech, social cognition consistently correlated with intelligence and memory. Visual naming test mean response time (VNT-MRT) demonstrated worse outcomes in MS versus HC (p = .034, Nagelkerke's R2 = 65.0%), and in PMS versus RMS (p = .009, Nagelkerke's R2 = 50.2%). Rapid automatised object naming demonstrated worse outcomes in MS versus HC (p = .014, Nagelkerke's R2 = 49.1%). These word-finding measures showed larger effect sizes than that of the SDMT (MS vs. HC, p = .010, Nagelkerke's R2 = 40.6%; PMS vs. RMS, p = .023, Nagelkerke's R2 = 43.5%). Prosody and social cognition did not differ between MS and HC. CONCLUSIONS Word finding, prosody and social cognition in MS are associated with information processing speed and largely independent of mood. Impairment in visual object meaning perception is potentially a unique MS disease-related deficit that could be further explored and cautiously considered as an adjunct disability metric for MS.
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Affiliation(s)
- Siew Mei Yap
- Department of Neurology, St. Vincent's University Hospital, Dublin 4, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
| | - Laura Davenport
- Neuropsychology Service, Department of Psychology, St. Vincent's University Hospital, Dublin 4, Ireland
| | - Clodagh Cogley
- Neuropsychology Service, Department of Psychology, St. Vincent's University Hospital, Dublin 4, Ireland.,School of Psychology, University College Dublin, Dublin, Ireland
| | - Fiona Craddock
- Neuropsychology Service, Department of Psychology, St. Vincent's University Hospital, Dublin 4, Ireland
| | - Alex Kennedy
- Trinity Centre for Biomedical Engineering, Trinity College, The University of Dublin, Dublin 2, Ireland
| | - Maria Gaughan
- Department of Neurology, St. Vincent's University Hospital, Dublin 4, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
| | - Hugh Kearney
- Department of Neurology, St. Vincent's University Hospital, Dublin 4, Ireland
| | - Niall Tubridy
- Department of Neurology, St. Vincent's University Hospital, Dublin 4, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
| | - Céline De Looze
- Trinity Centre for Biomedical Engineering, Trinity College, The University of Dublin, Dublin 2, Ireland
| | - Fiadhnait O'Keeffe
- Neuropsychology Service, Department of Psychology, St. Vincent's University Hospital, Dublin 4, Ireland.,School of Psychology, University College Dublin, Dublin, Ireland
| | - Richard B Reilly
- Trinity Centre for Biomedical Engineering, Trinity College, The University of Dublin, Dublin 2, Ireland.,School of Medicine, Trinity College, The University of Dublin, Dublin 2, Ireland.,School of Engineering, Trinity College, The University of Dublin, Dublin 2, Ireland
| | - Christopher McGuigan
- Department of Neurology, St. Vincent's University Hospital, Dublin 4, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
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Bambini V, Bischetti L, Bonomi CG, Arcara G, Lecce S, Ceroni M. Beyond the motor account of amyotrophic lateral sclerosis: Verbal humour and its relationship with the cognitive and pragmatic profile. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2020; 55:751-764. [PMID: 32725835 DOI: 10.1111/1460-6984.12561] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 05/16/2020] [Accepted: 06/20/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Amyotrophic Lateral Sclerosis (ALS) was traditionally described as a disease restricted to the motor system. However, recent findings suggested that it also affects cognition, especially executive functions, social cognition, language and pragmatics. A relevant issue in current research is thus the description of the cognitive phenotype of ALS and the identification of the most vulnerable aspects. AIMS The focus was on a communicative phenomenon placed at the crossroads of pragmatic and other cognitive domains, namely humour, which till now has been poorly explored in ALS. The first aim was to investigate whether ALS is associated with impairments in understanding and appreciating jokes. The second aim was to explore the predictors of humour comprehension and appreciation in patients, to confirm the involvement of pragmatic skills and to explore the role of other cognitive and clinical aspects. METHODS & PROCEDURES A total of 30 non-demented patients with ALS and 27 controls were assessed with a task of verbal humour comprehension and appreciation, including two types of jokes: phonological and mental. We also administered a battery of pragmatic and other language tasks, and cognitive and socio-cognitive tasks. Mixed-effects models were used to test differences in the humour task between the two groups. Multiple regressions determined the best predictors of humour comprehension and appreciation in patients. OUTCOMES & RESULTS Patients obtained lower comprehension accuracy scores than controls in the humour task, independently of the type of joke. Conversely, patients and controls did not differ in joke appreciation and both rated mental jokes as funnier than the phonological ones. Patients' comprehension accuracy was predicted by pragmatic skills and ALS severity, whereas appreciation was predicted by several clinical variables and, to a smaller extent, by language skills. CONCLUSIONS & IMPLICATIONS The findings suggest that humour is a very vulnerable aspect in ALS, and that impairment in humour comprehension might be part of the larger cognitive impairment, being linked to pragmatic impairment. Clinical variables were also important, especially in relation to humour appreciation. More generally, these data speak in favour of pragmatics as a relevant aspect to sketch the cognitive phenotype of ALS. On the practical level, these findings point to the need of supporting communication at large, not only motor-related aspects such as dysarthria but also social-pragmatic aspects such as understanding jokes, to increase well-being in ALS. What this paper adds What is already known on this subject The literature of the last decades has shown that ALS comes with impairment in several cognitive domains, affecting especially executive functions as well as language. There is also initial evidence that the pragmatics of communication and humour comprehension are impaired, although non-serious talk has been documented in conversational interaction among people with ALS. What this paper adds to existing knowledge This study offers compelling evidence of an impairment in the comprehension of jokes in ALS, whereas the appreciation of joke funniness seems to be spared. The study also highlights the interplay of cognitive factors (especially pragmatics) and clinical factors (related to disease severity) in predicting the patients' performance in the humour task. What are the potential or actual clinical implications of this work? The study's findings call for the need of increased awareness among scholars as well as practitioners and caregivers of the profile of humour comprehension and appreciation in ALS. On a practical level, we highlight the need of assessing humour comprehension and adapting the communicative style accordingly. Second, we recommend that intervention programmes targeting communication in ALS go beyond speech-related difficulties and include pragmatic aspects such as humour. Considering the important communicative and social function of humour, as well as its use as a coping strategy, humour interventions are key to improve the quality of life of individuals with ALS.
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Affiliation(s)
- Valentina Bambini
- Center for Neurocognition, Epistemology and Theoretical Syntax, University School for Advanced Studies IUSS, Pavia, Italy
| | - Luca Bischetti
- Center for Neurocognition, Epistemology and Theoretical Syntax, University School for Advanced Studies IUSS, Pavia, Italy
| | | | | | - Serena Lecce
- Department of Brain and Behavioral Science, University of Pavia, Pavia, Italy
| | - Mauro Ceroni
- Department of Brain and Behavioral Science, University of Pavia, Pavia, Italy
- Neurological Institute Mondino Foundation, Pavia, Italy
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