Abstract
Cognitive impairment affects more than half of all individuals living with multiple sclerosis (MS). We hypothesized that training at home with an adaptive online cognitive training program would have greater cognitive benefit than ordinary computer games in cognitively-impaired adults with MS. This was a double-blind, randomized, active-placebo-controlled trial. Participants with MS were recruited through Stony Brook Medicine and randomly assigned to either the adaptive cognitive remediation (ACR) program or active control of ordinary computer games for 60 hours over 12 weeks. Training was remotely-supervised and delivered through a study-provided laptop computer. A computer generated, blocked stratification table prepared by statistician provided the randomization schedule and condition was assigned by a study technician. The primary outcome, administered by study psychometrician, was measured by change in a neuropsychological composite measure from baseline to study end. An intent-to-treat analysis was employed and missing primary outcome values were imputed via Markov Chain Monte Carlo method. Participants in the ACR (n = 74) vs. active control (n = 61) training program had significantly greater improvement in the primary outcome of cognitive functioning (mean change in composite z score±SD: 0·25±0·45 vs. 0·09±0·37, p = 0·03, estimated difference = 0·16 with 95% CI: 0·02–0·30), despite greater training time in the active control condition (mean±SD:56·9 ± 34·6 vs. 37·7 ±23 ·8 hours played, p = 0·006). This study provides Class I evidence that adaptive, computer-based cognitive remediation accessed from home can improve cognitive functioning in MS. This telerehabilitation approach allowed for rapid recruitment and high compliance, and can be readily applied to other neurological conditions associated with cognitive dysfunction.Trial Registration: Clinicaltrials.gov NCT02141386
Highlights
Cognitive impairment occurs in up to 70% of all patients with multiple sclerosis (MS) affecting information processing, attention and learning [1, 2]
A total of n = 135 participants were enrolled between September 10, 2013 and June 5th, 2015 and all study visits were completed as of September, 9th, 2015
We found that 12 weeks of training with an adaptive cognitive remediation (ACR) training program was superior to an active control of playing ordinary computer games for improving cognitive functioning in participants with MS
Summary
Cognitive impairment occurs in up to 70% of all patients with multiple sclerosis (MS) affecting information processing, attention and learning [1, 2]. Despite longstanding recognition, it remains a troubling symptom without adequate treatment. There has been limited study of cognitive rehabilitation in MS. Traditional approaches (e.g., compensatory strategies and drill-and-practice training) are costly and difficult to uniformly implement, but with some trials indicating benefit [3,4,5,6]. Any cognitive training program requires multiple sessions administered across weeks or months. Due to the burdens of time and travel, the requirement for traveling to clinic for training often prevents access to treatment for many patients
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