title: Multiple sclerosis: effects of cognitive rehabilitation on structural and functional MR imaging measures--an explorative study.
abstract: OBJECTIVE
  To evaluate brain changes after cognitive rehabilitation in patients with clinically stable relapsing-remitting (RR) multiple sclerosis (MS) by using neuropsychologic assessment and structural and functional magnetic resonance (MR) imaging techniques.
  
  
  METHODS
  The study was conducted with approval of the involved institutional review boards. Written informed consent was obtained from each participant. Twenty patients with RR MS and cognitive deficits at baseline were randomly assigned to undergo treatment (n = 10), which entailed computer-assisted cognitive rehabilitation of attention and information processing and executive functions, or to serve as a control subjects (n = 10) without cognitive rehabilitation. All patients underwent a standardized neuropsychologic assessment and MR imaging at baseline and after 12 weeks. Changes in gray matter (GM) volumes on three-dimensional T1-weighted images and changes in normal-appearing white matter (NAWM) architecture on diffusion-weighted images were assessed. Changes in functional activity at functional MR imaging during the Stroop task and at rest were also investigated by using linear models.
  
  
  RESULTS
  As compared with their performance at baseline, the patients in the treatment group improved at tests of attention and information processing and executive functions. Neither structural modifications to GM volume nor modifications to NAWM architecture were detected at follow-up in both groups. Functional MR imaging demonstrated modifications of the activity of the posterior cingulate cortex (PCC)/precuneus and dorsolateral prefrontal cortex (PFC) during the Stroop task, as well as modifications of the activity of the anterior cingulum, PCC and/or precuneus, left dorsolateral PFC, and right inferior parietal lobule at rest in the treatment group compared with the control group. In the treatment group, functional MR imaging changes were correlated with cognitive improvement (P < .0001 to .01).
  
  
  CONCLUSIONS
  Rehabilitation of attention and information processing and executive functions in RR MS may be effected through enhanced recruitment of brain networks subserving the trained functions.
authors.affiliation: Neuroimaging Research Unit, Institute of Experimental Neurology, Department of Neurology, Division of Neuroscience, and Scientific Institute and Vita-Salute University, Hospital San Raffaele, Via Olgettina 60, 20132 Milan, Italy. filippi.massimo@hsr.it
authors.forename: Massimo
authors.initials: M
authors.lastname: Filippi
authors.forename: Gianna
authors.initials: G
authors.lastname: Riccitelli
authors.forename: Flavia
authors.initials: F
authors.lastname: Mattioli
authors.forename: Ruggero
authors.initials: R
authors.lastname: Capra
authors.forename: Chiara
authors.initials: C
authors.lastname: Stampatori
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Pagani
authors.forename: Paola
authors.initials: P
authors.lastname: Valsasina
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Copetti
authors.forename: Andrea
authors.initials: A
authors.lastname: Falini
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Comi
authors.forename: Maria A
authors.initials: MA
authors.lastname: Rocca
mesh_terms: D000328:Adult; D001921:Brain / Q000473:pathology* / Q000503:physiopathology; D003072:Cognition Disorders / Q000473:pathology* / Q000503:physiopathology / Q000534:rehabilitation*; D017352:Echo-Planar Imaging; D005260:Female; D006801:Humans; D016014:Linear Models; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000473:pathology* / Q000503:physiopathology / Q000534:rehabilitation*; D009483:Neuropsychological Tests; D018709:Statistics, Nonparametric; D016896:Treatment Outcome