A Randomised Controlled Trial of Efficacy of Cognitive Rehabilitation in Multiple Sclerosis: A Cognitive, Behavioural, and MRI Study

Abstract

Aim. To explore the efficacy of home-based, computerised, cognitive rehabilitation in patients with multiple sclerosis using neuropsychological assessment and advanced structural and functional magnetic resonance imaging (fMRI). Methods. 38 patients with MS and cognitive impairment on the Brief International Cognitive Assessment for MS (BICAMS) were enrolled. Patients were randomised to undergo 45 minutes of computerised cognitive rehabilitation using RehaCom software (n = 19) three times weekly for six weeks or to a control condition (n = 19). Neuropsychological and MRI data were obtained at baseline (time 1), following the 6-week intervention (time 2), and after a further twelve weeks (time 3). Cortical activations were explored using fMRI and microstructural changes were explored using quantitative magnetisation transfer (QMT) imaging. Results. The treatment group showed a greater improvement in SDMT gain scores between baseline and time 2 compared to the control group (p = 0.005). The treatment group exhibited increased activation in the bilateral prefrontal cortex and right temporoparietal regions relative to control group at time 3 (p < 0.05FWE corrected). No significant changes were observed on QMT. Conclusion. This study supports the hypothesis that home-based, computerised, cognitive rehabilitation may be effective in improving cognitive performance in patients with MS. Clinical trials registration is ISRCTN54901925.

A Videogame-Based Digital Therapeutic to Improve Processing Speed in People with Multiple Sclerosis: A Feasibility Study

“…We observed 86% retention after 4 weeks, and in these 18 participants, 78% adhered to the treatment. These adherence rates for self-managed computerized cognitive rehabilitation at home are consistent with previous reports [ 28 ]. Interestingly, while we did not enroll patients with specific levels of CI, both cognitive deficits and anxiety at baseline were associated with greater use of the treatment over the course of the study, indicating feasibility of such an intervention in a group with mild to moderate impairments.…”

From micro‐ to macro‐structures in multiple sclerosis: what is the added value of diffusion imaging

“…Examination of the brain as an integrated network can provide new insights into large‐scale neuronal communication, and provides a platform to understand how brain connectivity relates to human behaviour, and how it may be altered in disease. This approach to the investigation of the brain is at the opposite end of the microscopic localized scale, far from closing the gap between imaging metrics and microscopy, but is essential to an understanding of functional impairment and functional reserve …”

“…This approach to the investigation of the brain is at the opposite end of the microscopic localized scale, far from closing the gap between imaging metrics and microscopy, but is essential to an understanding of functional impairment and functional reserve. 72,73 A whole-brain network can be defined similarly to the system networks introduced above at the mesoscopic scale. It can be seen as an ensemble of neuronal elements, the 'nodes', between which some pairwise relationships ('links' or 'edges') can be defined.…”

A Comparison of the Effectiveness of Computer-Based, Manual-Based, and Combined Cognitive Rehabilitation on Cognitive Functions in Relapsing-Remitting Multiple Sclerosis

“…Attention distraction, failure in careful concentration on special stimulus, and discovering complicated stimuli with affective methods are other difficulties mostly observed among MS patients (Llufriu et al, 2016). Many MS patients with deficits in executive functions have major difficulties in complex functions, like selective attention (Nejati, Shahidi, & Helmi, 2016;Campbell, Langdon, Cercignani, & Rashid, 2016).…”