title: A Randomised Controlled Trial of Efficacy of Cognitive Rehabilitation in Multiple Sclerosis: A Cognitive, Behavioural, and MRI Study.
abstract: Aim.To explore the efficacy of home-based, computerised, cognitive rehabilitation in patients with multiple sclerosis using neuropsychological assessment and advanced structural and functional magnetic resonance imaging (fMRI).Methods.38 patients with MS and cognitive impairment on the Brief International Cognitive Assessment for MS (BICAMS) were enrolled. Patients were randomised to undergo 45 minutes of computerised cognitive rehabilitation using RehaCom software (n= 19) three times weekly for six weeks or to a control condition (n= 19). Neuropsychological and MRI data were obtained at baseline (time 1), following the 6-week intervention (time 2), and after a further twelve weeks (time 3). Cortical activations were explored using fMRI and microstructural changes were explored using quantitative magnetisation transfer (QMT) imaging.Results.The treatment group showed a greater improvement in SDMT gain scores between baseline and time 2 compared to the control group (p= 0.005). The treatment group exhibited increased activation in the bilateral prefrontal cortex and right temporoparietal regions relative to control group at time 3 (p< 0.05FWE  corrected). No significant changes were observed on QMT.Conclusion.This study supports the hypothesis that home-based, computerised, cognitive rehabilitation may be effective in improving cognitive performance in patients with MS. Clinical trials registration is ISRCTN54901925.
authors.affiliation: Clinical Imaging Sciences Centre, Brighton and Sussex Medical School, Falmer, UK.
authors.forename: J
authors.identifier: 0000-0002-5384-5520
authors.initials: J
authors.lastname: Campbell
authors.affiliation: Department of Psychology, Royal Holloway, University of London, London, UK.
authors.forename: D
authors.initials: D
authors.lastname: Langdon
authors.affiliation: Clinical Imaging Sciences Centre, Brighton and Sussex Medical School, Falmer, UK.
authors.forename: M
authors.identifier: 0000-0002-4550-2456
authors.initials: M
authors.lastname: Cercignani
authors.affiliation: Department of Neurology, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK.
authors.forename: W
authors.initials: W
authors.lastname: Rashid
mesh_terms: D000328:Adult; D003072:Cognition Disorders / Q000000981:diagnostic imaging / Q000523:psychology / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D006699:Home Care Services; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000000981:diagnostic imaging / Q000523:psychology / Q000628:therapy*; D000066530:Neurological Rehabilitation / Q000379:methods / Q000523:psychology; D009483:Neuropsychological Tests; D010775:Photic Stimulation / Q000379:methods; D013813:Therapy, Computer-Assisted / Q000379:methods*; D016896:Treatment Outcome