Abstract
BackgroundCognitive impairment is common in multiple sclerosis (MS), but the definition of the best cognitive rehabilitation tools and features is still an open issue among researchers. The aims of the present study were to evaluate the effectiveness of COGNI-TRAcK (a customized application software delivering personalized working memory-based exercises) on cognitively impaired people with MS and to investigate the effects of an adaptive vs. a non-adaptive cognitive training administered by means of COGNI-TRAcK.MethodsTwenty eight patients (20 women, age 47.5 ± 9.3 years, Expanded Disability Status Scale score 3.8 ± 1.9) were randomized in two homogeneous groups, both performing a 8-week home-based cognitive rehabilitation treatment by means of COGNI-TRAcK. The study group (ADAPT-gr) underwent an adaptive training given by the automatic adjustment of tasks difficulty to the subjects’ performance, whilst the control group (CONST-gr) was trained at constant difficulty levels. Before and after the treatment, patients’ cognitive status was assessed using a gold standard neuropsychological evaluation. Moreover, the mostly affected cognitive domains in MS (i.e., attention, concentration and information processing speed) were also assessed 6 months after the end of the treatment.ResultsThe analysis of variance showed a significant Group*Time interaction in six out of ten tests of the cognitive evaluation. Post-hoc analysis revealed a significant improvement between the performances before and after the intervention only in the ADAPT-gr in tests evaluating verbal memory acquisition (p <0.05) and delayed recall (p = 0.001), verbal fluency (p = 0.01), sustained attention, concentration and information processing speed (p < 0.01). This last effect was maintained also after 6 months (p < 0.05).ConclusionsWe concluded that COGNI-TRAcK represents a suitable tool to administer a personalized training to cognitively impaired subjects and that an adaptive working load is a crucial feature determining the effectiveness of cognitive treatment, allowing transfer effects to several cognitive domains and long-term maintenance of results.
Highlights
Cognitive impairment is common in multiple sclerosis (MS), but the definition of the best cognitive rehabilitation tools and features is still an open issue among researchers
We recently developed and validated on people with multiple sclerosis (PwMS) an application software (App) for portable devices, named Cognitive Training Kit (COGNI-TRAcK), administering a user-friendly and personalized treatment based on working memory (WM) exercises [27]
Out of 37 screened patients, 32 accepted to participate and 30 met the MS diagnostic criteria of McDonald et al [29] and were in a stable phase of the disease. These patients’ cognitive status was evaluated by means of the Rao’s Brief Repeatable Battery of Neuropsychological Tests (BRB-NT) [30], and we considered as inclusion criterion a score at least 1.5 standard deviation (SD) below the mean normative values at one or more components of the BRB-NT
Summary
Cognitive impairment is common in multiple sclerosis (MS), but the definition of the best cognitive rehabilitation tools and features is still an open issue among researchers. In the last two decades, different studies have been produced aiming at validating computer-based CR programs in order to supply effective, usable and accessible tools preventing from the constraints of face-to-face interventions (such as the cost of personnel or the patients/operators mobility). Results in this fields showed that computer-based cognitive training can improve cognitive functions in elderly [8] and in people with stroke [9] or Alzheimer’s disease [10]
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