title: The effects of rivastigmine on processing speed and brain activation in patients with multiple sclerosis and subjective cognitive fatigue.
abstract: BACKGROUND
  Cognitive decline and fatigue are typical in multiple sclerosis (MS). However, there is no official medication for either of these symptoms.
  
  
  OBJECTIVE
  The purpose of this study was to estimate the effects of a single dose of rivastigmine on processing speed and associated brain activity in patients with MS and subjective cognitive fatigue.
  
  
  METHODS
  Fifteen patients with MS and subjective cognitive fatigue and 13 healthy controls (HCs) matched for age, gender and education performed a neuropsychological assessment and functional (f)MRI. A modified version of the Paced Visual Serial Addition Test (mPVSAT) was used as the behavioural task during fMRIs. After the first scanning session, both groups were randomly divided into two subgroups receiving either rivastigmine or placebo. A single dose of rivastigmine or placebo was administrated double-blindly and 2.5 hours later the scanning was repeated.
  
  
  RESULTS
  At baseline, the patients with MS showed slower processing speed in mPVSAT compared with the HCs. They also demonstrated stronger bilateral frontal activation after sustained cognitive effort than the HCs. Performance improvement and a further activation increase in the left anterior frontal cortex and additional activation in the right cerebellum were observed in patients who received rivastigmine but not in patients on placebo, or in HCs with placebo or rivastigmine.
  
  
  CONCLUSIONS
  These preliminary findings suggest that rivastigmine may improve cognitive processing speed by enhancing compensatory brain activation in patients with MS.
authors.affiliation: Rehabilitation Clinic, Turku University Hospital, Turku, Finland. sini.huolman@utu.fi
authors.forename: S
authors.initials: S
authors.lastname: Huolman
authors.forename: P
authors.initials: P
authors.lastname: Hämäläinen
authors.forename: V
authors.initials: V
authors.lastname: Vorobyev
authors.forename: J
authors.initials: J
authors.lastname: Ruutiainen
authors.forename: R
authors.initials: R
authors.lastname: Parkkola
authors.forename: T
authors.initials: T
authors.lastname: Laine
authors.forename: H
authors.initials: H
authors.lastname: Hämäläinen
mesh_terms: D000328:Adult; D001288:Attention / Q000187:drug effects; D001921:Brain / Q000187:drug effects* / Q000503:physiopathology; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use*; D003071:Cognition / Q000187:drug effects*; D003072:Cognition Disorders / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology / Q000523:psychology; D004311:Double-Blind Method; D005260:Female; D005387:Finland; D006801:Humans; D008279:Magnetic Resonance Imaging; D008568:Memory / Q000187:drug effects; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology / Q000523:psychology; D009483:Neuropsychological Tests; D048448:Phenylcarbamates / Q000627:therapeutic use*; D010919:Placebos; D011930:Reaction Time / Q000187:drug effects; D000068836:Rivastigmine; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D002800:Cholinesterase Inhibitors; D048448:Phenylcarbamates; D010919:Placebos; D000068836:Rivastigmine