Abstract
Aim. To explore 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). Methods. 38 patients with MS and cognitive impairment on the Brief International Cognitive Assessment for MS (BICAMS) were enrolled. 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. Results. 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. Conclusion. This study supports the hypothesis that home-based, computerised, cognitive rehabilitation may be effective in improving cognitive performance in patients with MS. Clinical trials registration is ISRCTN54901925.
Highlights
Cognitive impairment is present in 40–65% of individuals with MS [1]
Inclusion criteria were as follows: (a) age between 18 and 65, (b) clinically definite MS, according to the McDonald criteria [18], (c) Expanded Disability Status Scale (EDSS) ≤ 6.5, and (d) cognitive impairment defined as scores below the 5th percentile for normative data adjusted for age, sex, and years of formal education [19] on one or more of the Brief International Cognitive Assessment for MS (BICAMS) tests
There was an improvement in BICAMS performance across participants at follow-up
Summary
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 [2,3,4]. RehaCom is one particular type of software designed and utilised for treatment of cognitive impairment in a number of disease states such as stroke, brain injury, and psychiatric disorders [10, 11]. It has been used in a growing number of trials of cognitive rehabilitation in MS as a more standardised intervention [8, 9, 12, 13]. The difficulty level of the computerised tasks adapts to an individual’s performance, only increasing in difficulty in response to improving performance
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