Two Years Follow up of Domain Specific Cognitive Training in Relapsing Remitting Multiple Sclerosis: A Randomized Clinical Trial.

Flavia Mattioli,Ruggero Capra,Chiara Calanca,Annalisa Lattuada,Debora Trafficante,Leandro Provinciali,Paolo Gallo,Chiara Stampatori,Matteo Pardini,Maria Rosaria Tola,Beatrice Allegri,Giuseppe Santuccio,Daria Baldini,Marianna Pattini,Cristina Montomoli,Angelo Ghezzi,Alice Riccardi,Marco Roscio,Giuditta Fregonese,Antonio Uccelli,Barbara Corso,Fabio Bellomi,Laura Compagnucci,Raffaella Clerici

doi:10.3389/fnbeh.2016.00028

Abstract

Cognitive rehabilitation in multiple sclerosis (MS) has been reported to induce neuropsychological improvements, but the persistence of these effects has been scarcely investigated over long follow ups. Here, the results of a multicenter randomized clinical trial are reported, in which the efficacy of 15 week domain specific cognitive training was evaluated at 2 years follow up in 41 patients. Included patients were randomly assigned either to domain specific cognitive rehabilitation, or to aspecific psychological intervention. Patients who still resulted to be cognitively impaired at 1 year follow up were resubmitted to the same treatment, whereas the recovered ones were not. Neuropsychological tests and functional scales were administered at 2 years follow up to all the patients. Results revealed that both at 1 and at 2 years follow up more patients in the aspecific group (18/19, 94% and 13/17, 76% respectively) than in the specific group (11/22, 50% and 5/15, 33% respectively) resulted to be cognitively impaired. Furthermore patients belonging to the specific group showed significantly less impaired tests compared with the aspecific group ones (p = 0.02) and a significant amelioration in the majority of the tests. On the contrary patients in the aspecific group did not change. The specific group subjects also perceived a subjective improvement in their cognitive performance, while the aspecific group patients did not. These results showed that short time domain specific cognitive rehabilitation is a useful treatment for patients with MS, shows very long lasting effects, compared to aspecific psychological interventions. Also subjective cognitive amelioration was found in patients submitted to domain specific treatment after 2 years.

Highlights

Patients affected with multiple sclerosis (MS) often have a certain degree of cognitive impairment
Eighteen of them resulted to be still impaired at T12, two of which refused to repeat the neuropsychological evaluation at T24, so 16 patients in the Aspecific Treatment Group (AG) repeated the aspecific treatment
The main result of the present study is that domain specific cognitive rehabilitation can be effective and can sustain significant cognitive improvements up to 2 years in patients with relapsing remitting (RR) MS

Summary

Introduction

Patients affected with multiple sclerosis (MS) often have a certain degree of cognitive impairment. 40–70% of patients present a certain degree of cognitive deficit, independently from disease duration, disease severity and physical disability (Chiaravalloti and DeLuca, 2008). This frequently contributes to the loss of employment, reduced social and working abilities and worsened quality of life (Pompeii et al, 2005; Putzki et al, 2009). In the long-term, the likelihood increases that patients with initial cognitive preservation may deteriorate (Amato et al, 2006b)

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