Episodic Foresight in Multiple Sclerosis

Objective: Episodic foresight refers to the ability to imagine future scenarios and to then use this imaginative capacity to guide future-directed behavior. Multiple sclerosis (MS) is associated with deficits generating the phenomenological characteristics of future events (the imaginative component of episodic foresight), but no study to date has tested whether MS is also associated with deficits using episodic foresight to appropriately guide future-directed behavior. Method: Forty people with relapsing-remitting MS (RRMS) and 40 demographically matched healthy participants completed a validated measure that met strict criteria for assessing the functional application of episodic foresight, Virtual-Week Foresight (VW-Foresight). Results: Overall, people with RRMS did not differ significantly relative to comparison participants in how likely they were to spontaneously acquire items that would later allow a problem to be solved and were also just as likely to subsequently use these items to solve the problem. However, the latter group difference was large in magnitude and just failed to attain significance. Higher levels of depression were significantly related to performance on this same "use" component of foresight in the RRMS group, and depressed RRMS participants were significantly impaired in this aspect of foresight relative to both healthy participants and nondepressed RRMS participants. The depressed MS subgroup also differed from the nondepressed subgroup in their ability to perform instrumental activities of daily living. Conclusions: People with RRMS who present with heightened levels of depressive symptomatology also appear to be at greater risk of experiencing specific problems with episodic foresight. Key Points Question: The present study provided the first test of whether multiple sclerosis (MS) is associated with deficits using episodic foresight to appropriately guide future-directed behavior. Findings: People with relapsing-remitting MS (RRMS) were impaired on a validated measure that met strict criteria for assessing the functional application of episodic foresight, but only when depressive symptoms were a prominent clinical feature. The depressed MS subgroup also differed significantly from the nondepressed subgroup in their ability to perform instrumental activities of daily living. Importance: Episodic foresight plays a key role in many activities that are fundamental to independent living. Next Steps: Future work should examine the