title: Cognitive rehabilitation of working memory in juvenile multiple sclerosis-effects on cognitive functioning, functional MRI and network related connectivity.
abstract: OBJECTIVE
  To assess possible effects of working memory (WM) training on cognitive functionality, functional MRI and brain connectivity in patients with juvenile MS.
  
  
  METHODS
  Cognitive status, fMRI and inter-network connectivity were assessed in 5 cases with juvenile MS aged between 12 and 18 years. Afterwards they received a computerized WM training for four weeks. Primary cognitive outcome measures were WM (visual and verbal) and alertness. Activation patterns related to WM were assessed during fMRI using an N-Back task with increasing difficulty. Inter-network connectivity analyses were focused on fronto-parietal (left and right), default-mode (dorsal and ventral) and the anterior salience network. Cognitive functioning, fMRI and inter-network connectivity were reassessed directly after the training and again nine months following training.
  
  
  RESULTS
  Response to treatment was seen in two patients. These patients showed increased performance in WM and alertness after the training. These behavioural changes were accompanied by increased WM network activation and systematic changes in inter-network connectivity. The remaining participants were non-responders to treatment. Effects on cognitive performance were maintained up to nine months after training, whereas effects observed by fMRI disappeared.
  
  
  CONCLUSIONS
  Responders revealed training effects on all applied outcome measures. Disease activity and general intelligence may be factors associated with response to treatment.
authors.affiliation: Department of Cognitive Psychology and Methodology, University of Basel, Basel, Switzerland.
authors.forename: Martina
authors.initials: M
authors.lastname: Hubacher
authors.affiliation: Kessler Foundation, West Orange, NJ, USA and Department of Physical Medicine & Rehabilitation and of Neurology & Neurosciences, Rutgers New Jersey Medical School, NJ, USA.
authors.forename: John
authors.initials: J
authors.lastname: DeLuca
authors.affiliation: Division of Pediatric Neurology and Developmental Medicine, University Children's Hospital Basel, Basel, Switzerland.
authors.forename: Peter
authors.initials: P
authors.lastname: Weber
authors.affiliation: Department of Neuropediatrics, University Children's Hospital Inselspital Bern, Switzerland.
authors.forename: Maja
authors.initials: M
authors.lastname: Steinlin
authors.affiliation: Department of Neurology, University Hospital Basel, Basel, Switzerland.
authors.forename: Ludwig
authors.initials: L
authors.lastname: Kappos
authors.affiliation: Department of Cognitive Psychology and Methodology, University of Basel, Basel, Switzerland.
authors.forename: Klaus
authors.initials: K
authors.lastname: Opwis
authors.affiliation: Department of Cognitive Psychology and Methodology, University of Basel, Basel, Switzerland.
authors.forename: Iris-Katharina
authors.initials: IK
authors.lastname: Penner
mesh_terms: D000293:Adolescent; D001921:Brain / Q000503:physiopathology*; D001931:Brain Mapping; D002648:Child; D003071:Cognition / Q000502:physiology*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003201:Computers; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007858:Learning; D008279:Magnetic Resonance Imaging; D008297:Male; D008570:Memory, Short-Term / Q000502:physiology*; D009103:Multiple Sclerosis / Q000503:physiopathology* / Q000534:rehabilitation*; D009434:Neural Pathways / Q000503:physiopathology; D009483:Neuropsychological Tests; D010865:Pilot Projects; D016896:Treatment Outcome
keywords: Connectivity; cognitive rehabilitation; juvenile multiple sclerosis; working memory