title: A functional magnetic resonance proof of concept pilot trial of cognitive rehabilitation in multiple sclerosis.
abstract: BACKGROUND
  Cognitive impairment is frequent in multiple sclerosis (MS) and lacks effective treatment. Cognitive rehabilitation is widely applied in neurorehabilitation settings. Functional magnetic resonance imaging (fMRI) may help in investigating changes in brain activity and provide a tool to assess the efficacy of rehabilitation.
  
  
  OBJECTIVE
  To investigate the effect on brain activity as measured by fMRI of a cognitive rehabilitation programme in patients with MS and cognitive impairment.
  
  
  METHODS
  Fifteen patients with MS and cognitive impairment and five healthy subjects were recruited. Neuropsychological assessments were performed in patients with MS at study entry and after rehabilitation to assess cognitive changes. fMRI scans were performed at week -5 (baseline), week 0 (immediately before rehabilitation) and week 5 (immediately after rehabilitation). The fMRI paradigm was the Paced Auditory Serial Addition Test (PASAT). The cognitive rehabilitation programme was composed of 15 computer-aided drill and practice sessions and five non-computer-aided cognitive stimulation group sessions (over 5 weeks). Strict guidelines ensured comparability of all rehabilitation interventions.
  
  
  RESULTS
  Patients had increased brain fMRI activity after rehabilitation in several cerebellar areas when compared with healthy subjects. After rehabilitation, patients had significantly improved their performance on the backward version of the Digit Span Test (p = 0.007) and on a composite score of neuropsychological outcomes (p = 0.009).
  
  
  CONCLUSIONS
  The results of the present study indicate that this cognitive rehabilitation programme increases brain activity in the cerebellum of cognitively impaired patients with MS. The role of fMRI in the assessment of neurorehabilitation schemes warrants further investigation.
authors.affiliation: Hospital de Dia de Barcelona, Multiple Sclerosis Centre of Catalonia, Barcelona, Spain. jsastre-garriga@cem-cat.org
authors.forename: J
authors.initials: J
authors.lastname: Sastre-Garriga
authors.forename: J
authors.initials: J
authors.lastname: Alonso
authors.forename: M
authors.initials: M
authors.lastname: Renom
authors.forename: M J
authors.initials: MJ
authors.lastname: Arévalo
authors.forename: I
authors.initials: I
authors.lastname: González
authors.forename: I
authors.initials: I
authors.lastname: Galán
authors.forename: X
authors.initials: X
authors.lastname: Montalban
authors.forename: A
authors.initials: A
authors.lastname: Rovira
mesh_terms: D001288:Attention / Q000502:physiology; D001921:Brain / Q000503:physiopathology*; D001931:Brain Mapping; D003071:Cognition / Q000502:physiology; D003072:Cognition Disorders / Q000503:physiopathology / Q000523:psychology / Q000534:rehabilitation*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008570:Memory, Short-Term / Q000502:physiology; D009103:Multiple Sclerosis / Q000503:physiopathology / Q000523:psychology / Q000534:rehabilitation*; D009483:Neuropsychological Tests; D010865:Pilot Projects; D016896:Treatment Outcome