Remotely-delivered cognitive remediation in multiple sclerosis (MS): protocol and results from a pilot study

Abstract

BackgroundCognitive impairment represents a critical unmet treatment need in multiple sclerosis (MS). Cognitive remediation is promising but traditionally requires multiple clinic visits to access treatment. Computer-based programs provide remote access to intensive and individually-adapted training.ObjectiveOur goal was to develop a protocol for remotely-supervised cognitive remediation that enables individuals with MS to participate from home while maintaining the standards for clinical study.MethodsMS participants (n = 20) were randomized to either an active cognitive remediation program (n = 11) or a control condition of ordinary computer games (n = 9). Participants were provided study laptops to complete training for five days per week over 12 weeks, targeting a total of 30 hours. Treatment effects were measured with composite change via scores of a repeated neuropsychological battery.ResultsCompliance was high with an average of 25.0 hours of program use (80% of the target) and did not differ between conditions (25.7 vs. 24.2 mean hours, p = 0.80). The active vs. control participants significantly improved in both the cognitive measures (mean composite z-score change of 0.46 ± 0.59 improvement vs. −0.14 ± 0.48 decline, p = 0.02) and motor tasks (mean composite z-score change of 0.40 ± 0.71improvement vs. −0.64 ± 0.73 decline, p = 0.005).ConclusionsRemotely-supervised cognitive remediation is feasible for clinical study with potential for meaningful benefit in MS.

Cognitive function in multiple sclerosis improves with telerehabilitation: Results from a randomized controlled trial

“…Our findings are consistent with our prior pilot study (using a different adaptive training program for the same time period) [11] as well as a previous trial of a version of the study program in a smaller sample [14]. Additionally, our findings also concur with those reported in a recent meta-analysis that found modest cognitive benefit for healthy aging adults who underwent cognitive remediation, typically seeing the greatest benefit for cognitive domains that were trained most often [7].…”

“…Additionally, our findings also concur with those reported in a recent meta-analysis that found modest cognitive benefit for healthy aging adults who underwent cognitive remediation, typically seeing the greatest benefit for cognitive domains that were trained most often [7]. The findings in this study are encouraging in that this is the largest clinical trial of cognitive remediation in an MS sample published as of yet and the results support the hypothesis that cognitive impairment in MS may be remediated [6, 11, 14]. Further, as baseline cognitive functioning as measured by the SDMT was not predictive of change in cognitive functioning overall or in response to the intervention, taken together the findings suggests that this intervention may be appropriate for MS participants with a wide range of cognitive problems.…”

Feasibility study for remote assessment of cognitive function in multiple sclerosis

“…Pilot work 39 suggests that a telemedicine approach to the symbol digit modalities test is feasible, although the optimal format and test form is yet to be determined. Other pilot work suggests that remotely-delivered cognitive remediation is feasible for individuals with MS 40 . Further, our study participants did not refuse testing for depression which must be measured at the time of any cognitive assessment in MS.…”

Remotely Supervised Transcranial Direct Current Stimulation Increases the Benefit of At-Home Cognitive Training in Multiple Sclerosis

“…We have carefully designed our remotely supervised protocols to maintain the standards of clinic‐based treatment which enhanced our recruitment rate and treatment compliance for both CT and tDCS .…”