Memory improvement in multiple sclerosis after an extensive cognitive rehabilitation program in groups with a multicenter double-blind randomized trial

Abstract

Objective: The aim of this study is to determine the effectiveness of an extended cognitive rehabilitation program in group’s sessions in multiple sclerosis. Design: Double-blind multicenter randomized trial. Participants: People with multiple sclerosis of 18 to 60 years, Expanded Disability Status Scale ⩽6.0, mild to moderate cognitive impairment. Interventions: They were randomized into cognitive rehabilitation program (ProCog-SEP) or in a placebo program. ProCog-SEP comprises 13 group’s sessions over 6 months and includes psychoeducational advices and cognitive exercises. Placebo program included non-cognitive exercises. No strategy and no cognitive advice were provided. Main measures: The primary endpoint was the percentage of verbal memory learning measured by the Selective Reminding Test. A comprehensive neuropsychological assessment is carried out before and after interventions by a neuropsychologist blinded to intervention. Effectiveness of the ProCog-SEP versus Placebo has been verified using linear regression models. Results: In total, 128 participants were randomized and 110 were included in the study after planning session in groups; 101 completed this trial (77.2% females); mean age: 46.1 years (±9.6); disease duration: 11.8 years (±7.5). ProCog-SEP was more effective in increasing in learning index (9.21 (95% confidence interval (CI): 1.43, 16.99); p = 0.02) and in working memory on manipulation (0.63 (95% CI: 0.17, 1.09); p = 0.01), and updating capacities (–1.1 (95% CI: –2.13, –0.06); p = 0.04). No difference was observed for other neuropsychological outcomes. Regarding quality of life outcomes, no change was observed between the two groups. Conclusion: These findings suggest that ProCog-SEP could improve verbal learning abilities and working memory in people with multiple sclerosis. These improvements were observed with 13 group sessions over 6 months.

Cognitive Rehabilitation in Multiple Sclerosis in the Period from 2013 and 2021: A Narrative Review

“…There were no significant differences in NP tests between the two groups. The three other studies showed some positive results [ 28 , 29 , 32 ]. The first study showed improvements in EM and EF tests, but this study did not identify a primary endpoint [ 28 ].…”

“…This category includes five studies on memory rehabilitation [ 7 , 20 , 24 , 26 , 31 ] and three studies on several domains [ 16 , 20 , 34 ] ( Table 3 ). The rehabilitation was carried out by a research assistant or a trainer in four studies [ 14 , 31 , 32 , 38 ], a neuropsychologist in one study [ 9 ], speech therapists in one study [ 34 ], an occupational therapist in one study [ 27 ], and the therapist was not specified in one study [ 20 ]. The material used was generally written material, but it could include computer-assisted exercises (three studies) [ 20 , 31 , 34 ].…”

“…After running searches using the other pre-selected keywords (memory rehabilitation and MS), three additional papers were selected. Table 1 presents the list of the 26 studies included in the analysis [ 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 ]. Papers were classified into three main categories: individual specific rehabilitation (eight studies), group rehabilitation (four studies), and other computerized training (CT) (14 studies), while one study combined group rehabilitation and CT [ 30 ].…”

“…Most studies incorporated HRQoL measures in their outcomes, but ten did not [ 15 , 17 , 21 , 23 , 25 , 26 , 28 , 29 , 30 , 37 ]. Seventeen studies used some self-assessment of cognitive functioning as outcomes, but nine did not [ 15 , 19 , 20 , 21 , 25 , 29 , 32 , 36 , 37 ].…”

New epidemiological data of multiple sclerosis, the impact of psychopathological symptoms on the health-related quality of life of multiple sclerosis patients

“…The involvement of psychological and psychiatric specialists and teamwork for the proper management of MS patients is also called for. This is of exceptional importance, as many of the factors that we have shown to play a major role in determining the patients' HRQoL have been demonstrated to be ameliorated and managed by not only a psychopharmacological but by a psychotherapeutic approach as well[103,107,131].…”