Computer-aided cognitive rehabilitation improves cognitive performances and induces brain functional connectivity changes in relapsing remitting multiple sclerosis patients: an exploratory study

Abstract

To better understand the effects of short-term computer-based cognitive rehabilitation (cCR) on cognitive performances and default mode network (DMN) intrinsic functional connectivity (FC) in cognitively impaired relapsing remitting (RR) multiple sclerosis (MS) patients. Eighteen cognitively impaired RRMS patients underwent neuropsychological evaluation by the Rao's brief repeatable battery and resting-state functional magnetic resonance imaging to evaluate FC of the DMN before and after a short-term (8 weeks, twice a week) cCR. A control group of 14 cognitively impaired RRMS patients was assigned to an aspecific cognitive training (aCT), and underwent the same study protocol. Correlations between DMN and cognitive performances were also tested. After cCR, there was a significant improvement of the following tests: SDMT (p < 0.01), PASAT 3" (p < 0.00), PASAT 2" (p < 0.03), SRT-D (p < 0.02), and 10/36 SPART-D (p < 0.04); as well as a significant increase of the FC of the DMN in the posterior cingulate cortex (PCC) and bilateral inferior parietal cortex (IPC). After cCR, a significant negative correlation between Stroop Color-Word Interference Test and FC in the PCC emerged. After aCT, the control group did not show any significant effect either on FC or neuropsychological tests. No significant differences were found in brain volumes and lesion load in both groups when comparing data acquired at baseline and after cCR or aCT. In cognitively impaired RRMS patients, cCR improves cognitive performances (i.e., processing speed and visual and verbal sustained memory), and increases FC in the PCC and IPC of the DMN. This exploratory study suggests that cCR may induce adaptive cortical reorganization favoring better cognitive performances, thus strengthening the value of cognitive exercise in the general perspective of building either cognitive or brain reserve.

Brain activity pattern changes after adaptive working memory training in multiple sclerosis

“…In line with these findings, a crucial role of the inferior parietal lobule in working memory and sustained attention tasks, such as the PVSAT, was observed in a recent meta-analysis conducted on both healthy controls and PwMS (Kollndorfer et al 2013). The inferior parietal lobule has been demonstrated to be more active during the 2-back task in PwMS with preserved cognition compared to those with cognitive deficits (Rocca et al 2010) and to present increased functional connectivity with the default mode network after cognitive rehabilitation (Bonavita et al 2015). Moreover, a resting-state investigation involving PwMS showed increased functional connectivity of the right inferior parietal lobule after cognitive treatment (Parisi et al 2014).…”

A Pilot Study Examining Speed of Processing Training (SPT) to Improve Processing Speed in Persons With Multiple Sclerosis

“…CR protocols designed to train multiple cognitive skills, including PS, have also been developed and tested (21–24), with improved cognitive performance noted following treatment. For example, improvement has been shown in PS and other targeted cognitive domains following RehaCom, which persist over time [e.g., (25)].…”

Classic Block Design “Pseudo”‐Resting‐State fMRI Changes After a Neurorehabilitation Program in Patients with Multiple Sclerosis

“…Hence, RS is particularly suited for patients with impairment in targeted functions, and could be a useful technique to assess changes after neurorehabilitation and symptomatic therapy. Recent studies have reported RS changes in patients with MS following a cognitive rehabilitation program (CRP) . In addition, it has been shown that the rest periods in classical block‐design fMRI studies can be reanalyzed to assess functional connectivity …”