Many people with MS experience cognitive difficulties, and these can impact on a range of activities. Perhaps most seriously, they can affect how well a person can function at work. They can also make disease management harder, including adherence to medication regimes, symptom management, and medical decision making. They can also affect safety when driving and increase the risk of falls. For several decades researchers have investigated what kinds of programmes might be beneficial for cognition in MS and there have been some encouraging hints that rehabilitation by therapists and computer training programmes have positive effects.
However, it is only recently that a study of an intervention to benefit memory in MS has been judged to reach the highest scientific standards, which means the results are convincing. The MEMREHAB trial from the Kessler Foundation has been accepted as Class 1 evidence by the prestigious journal Neurology. The design was a randomised controlled trial, which means that MS patients were allocated on a chance basis to either the MEMREHAB treatment or to a comparison group that met with a therapist, but did not get the key ingredients (imagery and context).
Both groups met twice a week for five weeks. Sessions lasted 45 to 60 minutes. The intervention was called Story Memory Technique. The treatment group was taught to use imagery to remember things, such as visualisation and pictorial cues. They were also taught to use context. The whole programme closely followed a manual. The last two sessions focussed on applying the techniques to everyday situations.
By the end of treatment, the treatment group was better at learning word lists, on measures of everyday memory and their families reported they were more engaged and organised (formally, apathy and executive function). The memory improvements were maintained at six-month follow up.
A small number of people from both the treatment and comparison group underwent MRI investigations of brain activity. Increased brain activation was demonstrated in the treatment group members immediately after treatment and at six month follow up. The areas of the brain that showed increased activation were the visual cortex, involved in visualisation, and the medial temporal lobe, involved in information acquisition.
It has been known for a while that physical rehabilitation in MS can improve physical function and now strong evidence exists that cognitive retraining can improve memory function in MS. Although MS is a progressive disease, treatments can help maintain function to support independence and effectiveness.
Dawn Langdon is a trustee of the MS Trust.