scholarly journals Cognition in multiple sclerosis

Neurology ◽  
2018 ◽  
Vol 90 (6) ◽  
pp. 278-288 ◽  
Author(s):  
James F. Sumowski ◽  
Ralph Benedict ◽  
Christian Enzinger ◽  
Massimo Filippi ◽  
Jeroen J. Geurts ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Cognitive Deficits ◽  
Cognitive Rehabilitation ◽  
Clinical Care ◽  
Theoretical Models ◽  
Scientific Basis ◽  
Evidence Based ◽  
Extensive Literature ◽  
Current State ◽  
Neural Bases

Cognitive decline is recognized as a prevalent and debilitating symptom of multiple sclerosis (MS), especially deficits in episodic memory and processing speed. The field aims to (1) incorporate cognitive assessment into standard clinical care and clinical trials, (2) utilize state-of-the-art neuroimaging to more thoroughly understand neural bases of cognitive deficits, and (3) develop effective, evidence-based, clinically feasible interventions to prevent or treat cognitive dysfunction, which are lacking. There are obstacles to these goals. Our group of MS researchers and clinicians with varied expertise took stock of the current state of the field, and we identify several important practical and theoretical challenges, including key knowledge gaps and methodologic limitations related to (1) understanding and measurement of cognitive deficits, (2) neuroimaging of neural bases and correlates of deficits, and (3) development of effective treatments. This is not a comprehensive review of the extensive literature, but instead a statement of guidelines and priorities for the field. For instance, we provide recommendations for improving the scientific basis and methodologic rigor for cognitive rehabilitation research. Toward this end, we call for multidisciplinary collaborations toward development of biologically based theoretical models of cognition capable of empirical validation and evidence-based refinement, providing the scientific context for effective treatment discovery.

Evidence-based guidelines for acute stabilization and management of neonates with persistent pulmonary hypertension of the newborn

2021 ◽  
Author(s):  
Molly K Ball ◽  
Ruth Seabrook ◽  
Elizabeth M Bonachea ◽  
Bernadette Chen ◽  
Omid Fathi ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Neonatal Intensive Care ◽  
Best Practice ◽  
Clinical Care ◽  
Persistent Pulmonary Hypertension ◽  
High Morbidity ◽  
Evidence Based ◽  
Extensive Literature ◽  
Disciplinary Expertise ◽  
Evidence Based Guidelines

Persistent pulmonary hypertension of the newborn, or PPHN, represents a challenging condition associated with high morbidity and mortality. Management is complicated by complex pathophysiology and limited neonatal specific evidence-based literature, leading to a lack of universal contemporary clinical guidelines for the care of these patients. To address this need and to provide consistent high-quality clinical care for this challenging population in our neonatal intensive care unit, we sought to develop a comprehensive clinical guideline for the acute stabilization and management of neonates with PPHN. Utilizing cross-disciplinary expertise and incorporating an extensive literature search to guide best practice, we present an approachable, pragmatic, and clinically relevant guide for the bedside management of acute PPHN.

scholarly journals A cognitive occupation-based programme for people with multiple sclerosis: A new occupational therapy cognitive rehabilitation intervention

2019 ◽  
Vol 32 (1) ◽  
pp. 41-52 ◽  
Author(s):  
Sinéad M Hynes ◽  
Susan Forwell
Keyword(s):  
Multiple Sclerosis ◽  
Cognitive Rehabilitation ◽  
Occupational Therapists ◽  
Cognitive Intervention ◽  
Evidence Based ◽  
Cognitive Difficulties ◽  
Stakeholder Groups ◽  
Everyday Problems ◽  
Purposive Sample

Introduction Cognitive difficulties have been reported to have the greatest effect on function and quality of life in people with multiple sclerosis, affecting 50–60% of people. To date, few interventions have been developed to treat cognitive issues in multiple sclerosis. Here we report on a Cognitive Occupation-Based programme (COB-MS) for people with Multiple Sclerosis an evidence-based intervention to address everyday problems encountered due to cognitive difficulties. The aim of this research was to explore the views of people with multiple sclerosis and occupational therapists on the programme and its potential implementation in practice. Methods Data were elicited from a purposive sample of 12 people from two stakeholder groups, people with multiple sclerosis (n = 5) and occupational therapists (n = 7), through focus groups and interviews. The programme and related materials were presented, and contributions recorded, transcribed and thematically analysed. Results Two main themes were identified from analysis of the data: response to the intervention and challenges to implementing the programme. Occupational therapists agreed that the COB-MS is client-centred. People with multiple sclerosis thought that it was a validating intervention. The overall format was viewed to be useful and feasible. Conclusion The COB-MS for people with Multiple Sclerosis is the first known cognitive intervention using an occupation frame of reference to address difficulties faced among persons with multiple sclerosis and was found to be timely and relevant to the needs of the population.

Strengthening Mental Abilities with Relational Training (SMART) in Multiple Sclerosis (MS): Study Protocol for a Feasibility Randomised Controlled Trial

2021 ◽  
Author(s):  
Nima Moghaddam ◽  
David L Dawson ◽  
Nikos Evangelou ◽  
James Turton ◽  
Annie Hawton ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Cognitive Functioning ◽  
Cognitive Deficits ◽  
Cognitive Rehabilitation ◽  
Retention Rates ◽  
Feasibility Trial ◽  
Trial Participant ◽  
Attention And Memory ◽  
Definitive Trial ◽  
Brain Functions

Abstract Background Multiple Sclerosis (MS) is a chronic condition of the central nervous system, affecting around 1 in every 600 people in the UK, with 130 new diagnoses every week. Cognitive difficulties are common amongst people with MS, with up to 70% experiencing deficits in higher-level brain functions – such as planning and problem-solving, attention, and memory. Cognitive deficits make it difficult for people with MS to complete everyday tasks and limit their abilities to work, socialise, and live independently. There is a clear need – and recognised research priority – for treatments that can improve cognitive functioning in people with MS. The absence of effective cognitive interventions exacerbates burdens on the services accessed by people with MS – requiring these services to manage sequelae of untreated cognitive deficits, including reduced quality of life, greater disability and dependence, and poorer adherence to disease-modifying treatments. Our planned research will fill the evidence gap through developing – and examining the feasibility of trialling – a novel online cognitive rehabilitation programme for people with MS (SMART). Methods The primary objective of this study aims to conduct a feasibility study to inform development of a definitive trial of SMART for improving cognitive functioning in people with MS. Secondary objectives include accessing the acceptability to participants of the intervention, delivery format, inclusion/exclusion criteria, baselines and outcome measures, randomisation protocol, and the study procedures. It will further assess the framework for a cost-effectiveness analysis alongside a definitive trial; participant recruitment and retention rates, sample-size needed for a fully powered trial, and signal of efficacy. Discussion As a feasibility trial, outcomes are unlikely to immediately effect changes to NHS practice. However, this is a necessary step towards developing a definitive trial – and will give us a signal of efficacy, a prerequisite for progression to a definitive trial. If found to be clinically- and cost-effective, the latter trial could create a step-change in MS cognitive rehabilitation – improving service-delivery and optimising support with limited additional resources. Trial Registration: Registration ID: ClnicalTrials.gov: NCT04975685 – registered on July 23rd, 2021 Protocol version: 2.0, 25 November 2021

Cognitive Rehabilitation: How it is and how it might be

1997 ◽  
Vol 3 (5) ◽  
pp. 487-496 ◽  
Author(s):  
BARBARA A. WILSON
Keyword(s):  
Cognitive Psychology ◽  
Cognitive Deficits ◽  
Cognitive Rehabilitation ◽  
Theoretical Models ◽  
Cognitive Difficulties ◽  
The Third ◽  
Rehabilitation Programs ◽  
Brain Injured ◽  
Rehabilitation Model ◽  
Basic Philosophy

This paper suggests there are, at present, four main kinds of cognitive rehabilitation programs for brain injured people. The first attempts to rehabilitate cognitive deficits through drills and exercises. The second uses theoretical models from cognitive psychology to identify deficits in order to remediate them. The third is primarily a patient-driven approach that uses a combination of learning theory, cognitive psychology, and neuropsychology to identify and remediate cognitive difficulties. The fourth is the holistic approach that has, as its basic philosophy, a belief that cognitive functions cannot be divorced from emotion, motivation, or other noncognitive functions, and consequently all aspects of functioning should be addressed in rehabilitation programs. Despite some overlap between these approaches, there are major differences. The two main arguments offered in this paper are (1) that the first two approaches do not lead to good clinical rehabilitation practice; and (2) that a synthesis of the second two approaches would result in the best cognitive rehabilitation model. (JINS, 1997, 3, 487–496.)

scholarly journals Reporting interventions in trials evaluating cognitive rehabilitation in people with multiple sclerosis: a systematic review

2017 ◽  
Vol 32 (2) ◽  
pp. 243-254 ◽  
Author(s):  
Jacqueline R Mhizha-Murira ◽  
Avril Drummond ◽  
Olga A Klein ◽  
Roshan dasNair
Keyword(s):  
Multiple Sclerosis ◽  
Cognitive Deficits ◽  
Cognitive Rehabilitation ◽  
Grey Literature ◽  
Executive Dysfunction ◽  
Control Group ◽  
Delivery Mode ◽  
Quality Of Reporting ◽  
Author Citations

Objective: To determine the quantity and quality of description of cognitive rehabilitation for cognitive deficits in people with multiple sclerosis, using a variety of published checklists, and suggest ways of improving the reporting of these interventions. Data sources: A total of 10 electronic databases were searched, including MEDLINE, EMBASE, CINAHL and PsycINFO, from inception to May 2017. Grey literature databases, trial registers, reference lists and author citations were also searched. Review methods: Papers were included if participants were people with multiple sclerosis aged 18 years and over and if the effectiveness of cognitive rehabilitation in improving functional ability for memory, attention or executive dysfunction, with or without a control group, was being evaluated. Results: A total of 54 studies were included in this review. The reporting of a number of key aspects of cognitive rehabilitation was poor. This was particularly in relation to content of interventions (reported completely in 26 of the 54 studies), intervention procedures (reported completely in 16 of the 54 studies), delivery mode (reported completely in 24 of the 54 studies) and intervention mechanism of action (reported completely in 21 of the 54 studies). Conclusion: The quality of reporting of cognitive rehabilitation for memory, attention and executive function for multiple sclerosis, across a range of study designs, is poor. Existing reporting checklists do not adequately cover aspects relevant to cognitive rehabilitation, such as the approaches used to address cognitive deficits. Future checklists could consider these aspects we have identified in this review.

Self-generated learning in people with multiple sclerosis

2006 ◽  
Vol 12 (5) ◽  
pp. 640-648 ◽  
Author(s):  
MICHAEL R. BASSO ◽  
NATASHA LOWERY ◽  
COURTNEY GHORMLEY ◽  
DENNIS COMBS ◽  
JAY JOHNSON
Keyword(s):  
Multiple Sclerosis ◽  
Activities Of Daily Living ◽  
Cognitive Deficits ◽  
Present Experiment ◽  
Daily Living ◽  
Cognitive Rehabilitation ◽  
Memory Impairment ◽  
Object Locations ◽  
Abstract Words

Memory impairment is among the most common cognitive deficits in people with multiple sclerosis (MS). To remediate this problem, recent research has evaluated the benefits of self-generated encoding. These nascent investigations reveal that people with MS who have mild memory impairment demonstrate a significant memory benefit from self-generated encoding compared with didactic learning. To extend prior research, the present experiment included MS patients with moderate–severe, rather than just mild, memory impairment. Additionally, the experiment evaluated whether self-generated encoding improves memory for activities of daily living instead of abstract words. Specifically, the experiment determined whether self-generated encoding enhanced memory for names, appointments, and object locations. In agreement with and extending prior research, MS patients remembered more information if it was self-generated rather than didactically presented, and this finding occurred despite moderate–severe memory impairment. Furthermore, compared with didactic encoding, self-generation enhanced recall of activities of daily living. Implications of these findings for cognitive rehabilitation and the nature of memory impairment in MS are discussed (JINS, 2006, 12, 640–648.)

Adaptational Approach to Cognitive Rehabilitation in Multiple Sclerosis: Description of Three Models of Care

1999 ◽  
Vol 1 (2) ◽  
pp. 12-22
Author(s):  
Päivi Hämäläinen ◽  
Arja Seinelä ◽  
Juhani Ruutiainen
Keyword(s):  
Multiple Sclerosis ◽  
Cognitive Deficits ◽  
Cognitive Rehabilitation ◽  
Cognitive Impairments ◽  
Models Of Care ◽  
Cognitively Impaired ◽  
Individual Counseling ◽  
Rehabilitation Centre ◽  
Individual Level ◽  
Group Rehabilitation

Abstract Cognitive deficits are among the most harmful symptoms in multiple sclerosis (MS). Neuropsychological assessment methods have been extensively developed in MS, but rehabilitation of cognition is still in its infancy. At the Masku Neurological Rehabilitation Centre, we have developed 3 models of neuropsychological group rehabilitation in MS.Information/family weekends for MS patients who are concerned about cognitive deficits1-week inpatient cognitive rehabilitation courses for MS patients and their spouses3-week inpatient cognitive rehabilitation courses for MS patientsWe used an adaptational approach to help participants live with cognitive impairments. Instead of retraining affected cognitive functions, we tried to help patients find better ways of coping with existing cognitive deficits in daily life. The course consisted of information at a general and at an individual level, neuropsychological evaluation and feedback, individual counseling, and group meetings. We evaluated the participants’ experiences in the course by means of questionnaires. The participants reported that they received information and support they thought could help them to live with cognitive impairments. The experiences of these participants suggest that these types of rehabilitation interventions may be useful in treating patients with cognitive deficits and their family members. In this article, we report 3 models of care for cognitively impaired MS patients and an evaluation of participants’ experiences on these rehabilitation courses.

Abstraction: An alternative neurocognitive account of recognition, prediction, and decision making

2020 ◽  
Vol 43 ◽  
Author(s):  
Valerie F. Reyna ◽  
David A. Broniatowski
Keyword(s):  
Decision Making ◽  
Software Engineering ◽  
Systems Engineering ◽  
Evidence Based ◽  
Extensive Literature ◽  
Trace Theory ◽  
Fuzzy Trace Theory ◽  
Abstract Representations ◽  
Technical Systems

Abstract Gilead et al. offer a thoughtful and much-needed treatment of abstraction. However, it fails to build on an extensive literature on abstraction, representational diversity, neurocognition, and psychopathology that provides important constraints and alternative evidence-based conceptions. We draw on conceptions in software engineering, socio-technical systems engineering, and a neurocognitive theory with abstract representations of gist at its core, fuzzy-trace theory.

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