Cognitive training in MS: effects and relation to brain atrophy.
OBJECTIVE
Cognitive disorders are common in MS patients without any generally recommended treatment. Recent brain imaging studies show considerable neuroplasticity for cognitive tasks in MS patients, but also brain atrophy already early in the disease progression. We explored the benefits of a home-based cognitive training program for memory and working memory functions in relapsing-remitting MS patients controlling for whole brain and central brain atrophy as covariates.


METHODS
Using a single-blinded controlled study design, 42 patients were randomised into a treatment group and a control group. Home based computer training focusing on memory and working memory was started at least 4 weeks after the discontinuation of methylprednisolone treatment and lasted for 6 weeks. Two weeks later the patients were re-investigated for their clinical and cognitive performance. We assessed also quality of life (QoL), depression and fatigue using self-rating scales.


RESULTS
Training had no effect on the neurological status and on QoL or fatigue. However, the treatment group showed better verbal learning, long-delay verbal memory performance, and working memory performance. The impact of treatment on long-delay verbal memory performance was independent from the extent of brain atrophy, whereas for the other findings brain atrophy played a significant role.


CONCLUSIONS
An intensive home-based cognitive training program is suitable to improve the cognitive performance of MS patients. The impact of brain atrophy on rehabilitation outcome may differ for cognitive functions.
Hildebrandt
Helmut
H
Klinikum Bremen-Ost, Department of Neurology, Züricher Str. 40, 28325 Bremen, Germany. helmut.hildebrandt@uni-oldenburg.de
Lanz
Michael
M
Hahn
Horst K
HK
Hoffmann
Ebba
E
Schwarze
Björn
B
Schwendemann
Günther
G
Kraus
Jürgen A
JA
D000328:Adult; D000704:Analysis of Variance; D001284:Atrophy / Q000534:rehabilitation; D001921:Brain / Q000473:pathology*; D003071:Cognition / Q000502:physiology; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000150:complications* / Q000523:psychology / Q000534:rehabilitation*; D009483:Neuropsychological Tests; D011788:Quality of Life; D012720:Severity of Illness Index; D016037:Single-Blind Method