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.

scholarly journals Repetitive Transcranial Magnetic Stimulation, Cognition, and Multiple Sclerosis: An Overview

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Grigorios Nasios ◽  
Lambros Messinis ◽  
Efthimios Dardiotis ◽  
Panagiotis Papathanasopoulos
Keyword(s):  
Multiple Sclerosis ◽  
Transcranial Magnetic Stimulation ◽  
Functional Connectivity ◽  
Cognitive Rehabilitation ◽  
Magnetic Stimulation ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Cognitively Impaired ◽  
Functional Reorganization ◽  
Brain Volume Loss ◽  
Potential Therapeutic Role

Multiple sclerosis (MS) affects cognition in the majority of patients. A major aspect of the disease is brain volume loss (BVL), present in all phases and types (relapsing and progressive) of the disease and linked to both motor and cognitive disabilities. Due to the lack of effective pharmacological treatments for cognition, cognitive rehabilitation and other nonpharmacological interventions such as repetitive transcranial magnetic stimulation (rTMS) have recently emerged and their potential role in functional connectivity is studied. With recently developed advanced neuroimaging and neurophysiological techniques, changes related to alterations of the brain’s functional connectivity can be detected. In this overview, we focus on the brain’s functional reorganization in MS, theoretical and practical aspects of rTMS utilization in humans, and its potential therapeutic role in treating cognitively impaired MS patients.

scholarly journals Cognitive Rehabilitation in Multiple Sclerosis in the Period from 2013 and 2021: A Narrative Review

2021 ◽  
Vol 12 (1) ◽  
pp. 55
Author(s):  
Bruno Brochet
Keyword(s):  
Multiple Sclerosis ◽  
Neuropsychological Tests ◽  
Cognitive Rehabilitation ◽  
Cognitive Domains ◽  
Randomized Controlled ◽  
Computerized Training ◽  
Great Heterogeneity ◽  
Memory Rehabilitation ◽  
Group Rehabilitation ◽  
The Individual

Background: In recent years, several blinded randomized controlled trials (RCT) have been conducted on cognitive rehabilitation (CR) in adults with multiple sclerosis (MS). Objective: To review all blinded RCTs on CR in MS published since 2013. Methods: The National Library of Medicine database (Medline) and PSYCINFO were searched using the keywords MS and CR or cognitive training or NP rehabilitation or memory rehabilitation or attention rehabilitation. Results: After the exclusion of some papers not specifically focused on CR, a final list of 26 studies was established. The papers belong to three main categories: individual specific rehabilitation (8studies), group rehabilitation (4 studies), and computerized training (CT) (14 studies), while one study combined group rehabilitation and CT. Among the individual rehabilitation studies, 5 were devoted to memory, and most of the 19 other selected studies were about several cognitive domains. Most of the studies mainly concerned RRMS patients, except for 2 studies that were carried out exclusively in progressive forms. Despite the methodological limitations of some studies and the great heterogeneity of the protocols, the results are generally in favor of the efficacy of CR in neuropsychological tests. Conclusion: Recent blinded RCTs about CR in MS show promising results.

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.

Randomised multicentre trial on safety and efficacy of rivastigmine in cognitively impaired multiple sclerosis patients

2012 ◽  
Vol 19 (5) ◽  
pp. 631-638 ◽  
Author(s):  
M Mäurer ◽  
S Ortler ◽  
M Baier ◽  
M Meergans ◽  
P Scherer ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Cognitive Deficits ◽  
Memory Function ◽  
Recall Score ◽  
Analysis Of Covariance ◽  
Controlled Study ◽  
Cognitively Impaired ◽  
Total Recall ◽  
Double Blind ◽  
Multiple Sclerosis Patients

Background: Cognitive decline has been recognised as a frequent symptom in multiple sclerosis (MS). Cholinesterase inhibitors (ChEIs) are employed for the treatment of Alzheimer’s disease, but there is some evidence that ChEIs might also be effective in MS patients with cognitive deficits, particularly deficits of memory function. Objective: The aim of this study was to evaluate efficacy on memory function and safety of the ChEI rivastigmine in MS patients with cognitive deficits as measured by the change from baseline of the total recall score of the selective reminding test (SRT) after 16 weeks of treatment. Methods: Efficacy and safety of rivastigmine were analysed in a 16-week, multicentre, double-blind, randomised, placebo-controlled study, followed by an optional one-year open-label treatment phase. Effects of rivastigmine and placebo were compared by an analysis of covariance. Results: In total, 86 patients were enrolled. Patients who received rivastigmine ( n = 43) showed a non-significant increase in total recall score (sum of all words immediately recalled over all six trials) over placebo ( n = 38) after 16 weeks of treatment ( p = 0.2576). Other outcome measures provided no evidence supporting benefits of rivastigmine. Treatment with rivastigmine was well tolerated. Conclusions: With the results of this study, the need for an effective therapy in cognitively impaired MS patients is still required. Thus, intensive and continued clinical research is required to explore therapeutic options for cognitive deficits in MS patients.

scholarly journals Employing connectome-based models to predict working memory in multiple sclerosis

2021 ◽  
Author(s):  
Heena R. Manglani ◽  
Stephanie Fountain-Zaragoza ◽  
Anita Shankar ◽  
Jacqueline A. Nicholas ◽  
Ruchika Shaurya Prakash
Keyword(s):  
Multiple Sclerosis ◽  
Working Memory ◽  
Functional Connectivity ◽  
Predictive Modeling ◽  
Cognitive Rehabilitation ◽  
Clinical Samples ◽  
Validation Sample ◽  
Whole Brain ◽  
Internal Validation ◽  
Individual Level

AbstractBackgroundIndividuals with multiple sclerosis (MS) are vulnerable to deficits in working memory, and the search for neural correlates of working memory in circumscribed areas has yielded inconclusive findings. Given the widespread neural alterations observed in MS, predictive modeling approaches that capitalize on whole-brain connectivity may better capture individual-level working memory in this population.MethodsHere, we applied connectome-based predictive modeling to functional MRI data from working memory tasks in two independent samples with relapsing-remitting MS. In the internal validation sample (ninternal = 36), functional connectivity data were used to train a model through cross-validation to predict accuracy on the Paced Visual Serial Addition Test, a gold-standard measure of working memory in MS. We then tested its ability to predict performance on the N-back working memory task in the external validation sample (nexternal = 36).ResultsThe resulting model successfully predicted working memory in the internal validation sample but did not extend to the external sample. We also tested the generalizability of an existing model of working memory derived in healthy young adults to people with MS. It showed successful prediction in both MS samples, demonstrating its translational potential. We qualitatively explored differences between the healthy and MS models in intra- and inter-network connectivity amongst canonical networks.DiscussionThese findings suggest that connectome-based predictive models derived in people with MS may have limited generalizability. Instead, models identified in healthy individuals may offer superior generalizability to clinical samples, such as MS, and may serve as more useful targets for intervention.Impact StatementWorking memory deficits in people with multiple sclerosis have important consequence for employment, leisure, and daily living activities. Identifying a functional connectivity-based marker that accurately captures individual differences in working memory may offer a useful target for cognitive rehabilitation. Manglani et al. demonstrate machine learning can be applied to whole-brain functional connectivity data to identify networks that predict individual-level working memory in people with multiple sclerosis. However, existing network-based models of working memory derived in healthy adults outperform those identified in multiple sclerosis, suggesting translational potential of brain networks derived in large, healthy samples for predicting cognition in multiple sclerosis.

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

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.)

Multiple Sclerosis

2019 ◽  
pp. 481-503
Author(s):  
Brian M. Sandroff ◽  
John DeLuca
Keyword(s):  
Multiple Sclerosis ◽  
Cognitive Impairment ◽  
Cognitive Rehabilitation ◽  
Daily Life ◽  
Cognitive Impairments ◽  
Brain Pathology ◽  
Future Directions ◽  
Immune Mediated ◽  
The Central Nervous System ◽  
The Impact

Multiple sclerosis (MS) is a nontraumatic, immune-mediated and neurodegenerative disease of the central nervous system. This chapter describes cognitive dysfunction in persons with MS. The chapter begins with a description of the disease and its prevalence and economic impact. This is followed by its diagnosis and current understanding of the mechanisms of the disease and its symptoms. The bulk of the chapter describes the cognitive impairments commonly observed in persons with MS. This includes the assessment of cognitive impairment, neuroimaging studies of how cognition is affected by brain pathology, the impact of cognitive impairment on daily life, and cognitive rehabilitation in MS. The chapter concludes with a brief discussion on future directions.

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