Evaluating cognitive rehabilitation in multiple sclerosis: on the bumpy road to establishing evidence.

Roshan Das Nair

doi:10.2217/nmt.15.44

Abstract

There is marked enfeeblement of the memory; conceptions are formed slowly; the intellectual and emotional faculties are blunted in their totality,” Charcot (1877) reportedly noted about people with multiple sclerosis (MS) [1]. Despite these early observations of what we now refer to as ‘cognitive deficits’ and ‘mood disorders’, the magnitude and severity of these problems in MS were not considered seriously until over 100 years later. By the early 1990s, studies had begun to consistently demonstrate that people with MS reported cognitive problems.

Highlights

“There is marked enfeeblement of the memory; conceptions are formed slowly; the intellectual and emotional faculties are blunted in their totality,” Charcot (1877) reportedly noted about people with multiple sclerosis (MS) [1]
There are some aspects of cognition that appear to be more affected than others, with attention, memory and executive functions being most affected
Based on eight trials (n = 521), our 2012 Cochrane review [11] evaluating the effectiveness of memory rehabilitation on functional outcomes found no evidence to support the effectiveness of memory rehabilitation on memory function or functional abilities in people with MS

Summary

Effectiveness of cognitive rehabilitation in MS

These different approaches to cognitive rehabilitation content and delivery formats have been researched, and based on this literature, Amato et al [7] produced a position paper on the treatment of cognitive impairments in MS. When the data were meta-analyzed, the authors found that: When comparing cognitive training with any control, there were improvements in memory span and working memory; and when cognitive training and compensatory strategies were combined, compared with any control group, they found improvements in attention, immediate verbal memory and delayed memory For both these strategies, there was no effect on some of the other basic cognitive functions, or patients’ (or carers’) self-reported everyday cognitive performance, depression, anxiety, fatigue or quality of life. Based on eight trials (n = 521), our 2012 Cochrane review [11] evaluating the effectiveness of memory rehabilitation on functional outcomes found no evidence to support the effectiveness of memory rehabilitation on memory function or functional abilities in people with MS This conclusion was because of the limited number and quality of some of the primary studies reviewed. Discrepancy between qualitative & quantitative study findings The discrepancy in findings based on the methodology that studies use raises certain questions, highlight the challenges of conducting cognitive rehabilitation research in MS, and suggests possible avenues for future research

RCT methodology

Sample size