Cognitive issues in multiple sclerosis (MS) are common and cognitive rehabilitation has previously been reported to provide neuropsychological improvements but whether the gains were sustained has not been rigorously studied.
There is a newly published, multi-centre, randomised clinical trial now addressing this issue. The efficacy of 15 weeks of domain specific cognitive training was evaluated at 2 years follow up in 41 patients. Patients were randomly assigned to Specific Treatment Group (SG) or to an Aspecific Treatment Group (AG), for 15 consecutive weeks with 2 weekly 60’ sessions. Randomization (according to a computer-generated list of random number) and statistical analysis of data were carried out by an independent center, from whom all the Centers received the patients’ number.
Specific treatment was administered according to the impaired neuropsychological function: Plan a Day software of the Rehacom software suite was used if a patient demonstrated impairment in executive functions (that is if his/her poor score was in the Stroop test or in the COWA P or COWA/C);
Memory training software via RehaCom was used if the patient was impaired in either the SRT or SPART verbal or spatial memory measures and the previously described 29 A/IP training, if he/she resulted impaired in attention information processing (pathological PASAT 2″, PASAT 3″, SDMT). If a patient was impaired in more than one domain, all the single domain trainings were balanced within the hourly session each time. Exercise complexity was adapted each time to the severity of each single patient’s impairment in the selected domain, with the aim that the exercise had to be challenging in each treatment session.
In the trial, patients were randomly assigned either to domain specific cognitive rehabilitation, or to aspecific psychological intervention. Patients who were still cognitively impaired at 1 year follow up were resubmitted for the same treatment, whereas those considered "recovered" were not. Neuropsychological tests and functional scales were administered at 2 years follow up to all the patients.
Results revealed that both at 1 and at 2 years follow up more patients in the aspecific group (18/19, 94% and 13/17, 76% respectively) than in the specific group (11/22, 50% and 5/15, 33% respectively) remained cognitively impaired.
Furthermore patients belonging to the specific group showed significantly less impairment compared with the aspecific group ones (p = 0.02) with a significant amelioration in the majority of the tests. Patients in the aspecific group did not change.
The specific group subjects also perceived a subjective improvement in their cognitive performance, while the aspecific group patients did not. These results showed that short time domain specific cognitive rehabilitation is a useful treatment for patients with MS, shows very long lasting effects, compared to aspecific psychological interventions. Also subjective cognitive amelioration was found in patients submitted to domain specific treatment after 2 years.
The main result of the present study is that domain specific cognitive rehabilitation can be effective and can sustain significant cognitive improvements up to 2 years in patients with RR MS
The authors state this is the first study evaluating the persistence of cognitive improvement induced by a domain specific cognitive rehabilitation in MS with a follow up of 2 years. Despite limitations, results interestingly show a significant effect of this treatment in a multi center setting and its persistence after 2 years
Mattioli, F et al
"Two Years Follow up of Domain Specific Cognitive Training in Relapsing Remitting Multiple Sclerosis: A Randomized Clinical Trial"
Front. Behav. Neurosci., 23 February 2016 | http://dx.doi.org/10.3389/fnbeh.2016.00028
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