A recently published study supports the hypothesis that home-based, computerised, cognitive rehabilitation using RehaCom may be effective in improving cognitive performance in patients with MS.
There is mounting evidence for neuroplasticity as a mechanism to compensate for accumulating pathology in MS and some tentative evidence that cognitive rehabilitation may be effective in preserving or improving cognitive function in patients with MS. An important issue is how to provide such rehabilitation. A home-based approach to cognitive rehabilitation is significantly less resource intensive to treatment alternatives and may pave the way to greater access for a greater number of patients to such interventions in the future.
Cognitive impairment is present in 40–65% of individuals with MS and studies have shown cognitive deficits (in particular deficits in information processing speed, concentration, and working memory) to be present in the early stages of MS. Cognitive impairment has a negative impact on quality of life (QOL) independent of physical symptoms.
The authors, Campbell, Langdon, Cercignani and Rashid have explored 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).
Some 38 patients with MS and cognitive impairment on the Brief International Cognitive Assessment forMS (BICAMS) were enrolled in the study. 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.
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.
J. Campbell, D. Langdon, M. Cercignani, and W. Rashid
Clinical Study - A Randomised Controlled Trial of Efficacy of Cognitive Rehabilitation in Multiple Sclerosis: A Cognitive, Behavioural, and MRI Study
Neural Plasticity, Volume 2016, Article ID 4292585, 9 pages