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MS research update - Does tailored treatment help to improve cognitive symptoms? - 2 February 2015

Summary

About half of all people with MS have problems at some time with aspects of thinking such as memory, concentration or problem solving. Cognition is the term that covers all aspects of thinking and so these symptoms are referred to as cognitive problems.

41 people with relapsing remitting MS in Italy took part in the study. Participants were assessed using the Italian version of Rao's Brief Repeatable Battery, which is a collection of tests that examine memory, recall, attention, processing speed and language. All participants had a problem with at least one of these cognitive areas.

Participants were randomly allocated to receive either a treatment which was specifically designed to help with the cognitive problem they were experiencing or a general psychological intervention. The study aimed to compare these two types of treatment to see which is the most effective for cognitive problems.

The study found that specific treatment and cognitive training significantly reduced the cognitive problems the participants experienced. One year after completing the treatment approximately 40% of the participants who had the specific treatment had completely recovered from their cognitive problems. In the group that received general treatment only 5% completely recovered and most of the participants in that group saw their cognitive problems get worse over time.

The study shows that an intensive course of treatment that is specifically tailored to help with the cognitive problem the person with MS is experiencing is more effective than a general treatment.

Background

About half of all people with MS have problems at some time with aspects of thinking such as memory, concentration or problem solving. Cognition is the term that covers all aspects of thinking and so these symptoms are referred to as cognitive problems.

Previous research has shown that specifically tailored treatment for cognitive problems can be effective when compared to no treatment at all. General treatment may also help to improve cognitive problems. This study aimed to compare these two types of treatment to see which is the most effective for cognitive problems.

How this study was carried out

150 people with relapsing remitting MS in Italy were assessed for the study, 41 met the criteria to be included and completed the study. To be included in the study all participants had to be taking interferon beta 1a (Rebif) 44mcg three times a week, have some kind of cognitive impairment, but not have had a relapse within the previous six months.

Participants were assessed using the Italian version of Rao's Brief Repeatable Battery, which is a collection of tests that examine memory, recall, attention, processing speed and language. All participants had a problem with at least one of these cognitive areas.

Participants were randomly allocated to receive either a treatment which was specifically designed to help with the cognitive problem they were experiencing or a general psychological intervention. Treatments lasted for one hour, twice a week for 15 consecutive weeks.

The specific treatments included a plan a day procedure which trains the participant to organise and develop a plan and memory was trained using stories, followed by questions which asked about aspects of the story, with ten levels of difficulty.

The general psychological intervention consisted of the participant talking with a psychologist about their MS, work, family and hobbies, but it aimed to not specifically exercise any particular cognitive ability.

What was found

The study found that specific treatment and cognitive training significantly reduced the cognitive problems the participants experienced. One year after completing the treatment approximately 40% of the participants who had the specific treatment had completely recovered from their cognitive problems. In the group that received general treatment only 5% completely recovered and most of the participants in that group saw their cognitive problems get worse over time.

The only difference between the groups was the type of treatment they received, as ages, gender split, number of years in education, number of years since MS diagnosis, number of relapses in the past year, EDSS scores were all very similar.

What does it mean?

The study shows that an intensive course of treatment that is specifically tailored to help with the cognitive problem the person with MS is experiencing is more effective than a general treatment. The authors do state that they believe that this is the first study to compare a specific and general cognitive treatment in people with MS who are all taking the same medication. They say further research would be needed to determine the best location for the treatment to be carried out and the optimal length of the treatment, as a shorter duration of treatment may work just as well.

Mattioli F, Stampatori C, Bellomi F, et al.
A RCT Comparing Specific Intensive Cognitive Training to Aspecific Psychological Intervention in RRMS: The SMICT Study.
JFront Neurol. 2015 Jan 13;5:278.
abstract
Read the full paper

More about cognitive symptoms

Cognitive difficulties is the term used to describe a range of problems with slowed thinking such as poor memory, attention span or concentration and difficulty following complicated instructions or problem solving. Cognitive symptoms are common in MS but may not be recognised. Management of these symptoms involves finding strategies that minimise the difficulty, for example, if you have trouble remembering where you've put your car keys, always putting them in the same place will help.

There is more information, tips and strategies for getting around cognitive symptoms on the StayingSmart website. StayingSmart was developed by the MS Trust in partnership with Prof Dawn Langdon, a neuropsychologist at Royal Holloway University of London. The Tips and Tricks section, which includes ideas shared by people living with cognitive symptoms, and Gadgets and Gizmos features readily available items of equipment that may be helpful.

You can also read more about cognition and MS in the A to Z of MS.

Research by topic areas...

Assessment tools

Scott T, Wang P, You X, et al.
Relationship between Sustained Disability Progression and Functional System Scores in Relapsing-Remitting Multiple Sclerosis: Analysis of Placebo Data from Four Randomized Clinical Trials.
Neuroepidemiology. 2015;44(1):16-23.
abstract

Chung H, Kim J, Askew RL, et al.
Assessing measurement invariance of three depression scales between neurologic samples and community samples.
Qual Life Res. 2015 Jan 29. [Epub ahead of print]
abstract

Tsang B, Stothers L, Macnab A, et al.
A systematic review and comparison of questionnaires in the management of spinal cord injury, multiple sclerosis and the neurogenic bladder.
Neurourol Urodyn. 2015 Jan 25. [Epub ahead of print]
abstract

Bone health

Olsson A, Oturai D, Sørensen P, et al.
Short-term, high-dose glucocorticoid treatment does not contribute to reduced bone mineral density in patients with multiple sclerosis.
Mult Scler. 2015 Jan 26. [Epub ahead of print]
abstract

Carers

Labiano-Fontcuberta A, Mitchell AJ, Moreno-García S, et al.
Anxiety and depressive symptoms in caregivers of multiple sclerosis patients: The role of information processing speed impairment.
J Neurol Sci. 2015 Jan 26. [Epub ahead of print]
abstract

Co-existing conditions

Marrie RA, Cohen J, Stuve O, et al.
A systematic review of the incidence and prevalence of comorbidity in multiple sclerosis: Overview.
Mult Scler. 2015 Jan 26. [Epub ahead of print]
abstract

Diagnosis

Weisfeld-Adams JD, Katz Sand IB, Honce JM, et al.
Differential diagnosis of Mendelian and mitochondrial disorders in patients with suspected multiple sclerosis.
Brain. 2015 Jan 29. [Epub ahead of print]
abstract

Disease modifying treatments

Kappos L, Mehling M, Arroyo R, et al.
Randomized trial of vaccination in fingolimod-treated patients with multiple sclerosis.
Neurology. 2015 Jan 30. [Epub ahead of print]
abstract

Economics

Stevenson V, Gras A, Bárdos J, et al.
The high cost of spasticity in multiple sclerosis to individuals and society.
Mult Scler. 2015 Jan 26. [Epub ahead of print]
abstract

Pathophysiology

Liu Y, Liang P, Duan Y, et al.
Altered thalamic functional connectivity in multiple sclerosis.
Eur J Radiol. 2015 Jan 19. [Epub ahead of print]
abstract

Steenwijk MD, Daams M, Pouwels PJ, et al.
Unraveling the relationship between regional gray matter atrophy and pathology in connected white matter tracts in long-standing multiple sclerosis.
Hum Brain Mapp. 2015 Jan 27. [Epub ahead of print]
abstract

Schoonheim MM, Hulst HE, Brandt RB, et al.
Thalamus structure and function determine severity of cognitive impairment in multiple sclerosis.
Neurology. 2015 Jan 23. [Epub ahead of print]
abstract

Physical activity

Cruickshank TM, Reyes AR, Ziman MR.
A systematic review and meta-analysis of strength training in individuals with multiple sclerosis or Parkinson disease.
Medicine (Baltimore). 2015 Jan;94(4):e411.
abstract
Read the full text of this paper

Kamm CP, Mattle HP, Müri RM, et al.
Home-based training to improve manual dexterity in patients with multiple sclerosis: A randomized controlled trial.
Mult Scler. 2015 Jan 26. [Epub ahead of print]
abstract

Westerdahl E, Wittrin A, Kånåhols M, et al.
Deep breathing exercises with positive expiratory pressure in patients with multiple sclerosis - a randomized controlled trial.
Clin Respir J. 2015 Jan 26. [Epub ahead of print]
abstract

Prognosis

Radue EW, Barkhof F, Kappos L, et al.
Correlation between brain volume loss and clinical and MRI outcomes in multiple sclerosis.
Neurology. 2015 Jan 28. [Epub ahead of print]
abstract
Read the full text of this paper

Psychological aspects

Dickstein LP, Viguera AC, Nowacki AS, et al.
Thoughts of death and self-harm in patients with epilepsy or multiple sclerosis in a tertiary care center.
Psychosomatics. 2015 Jan-Feb;56(1):44-51.
abstract

Adler G, Lembach Y.
Memory and selective attention in multiple sclerosis: cross-sectional computer-based assessment in a large outpatient sample.
Eur Arch Psychiatry Clin Neurosci. 2015 Jan 24. [Epub ahead of print]
abstract

Self-management

Hadgkiss EJ, Jelinek GA, Taylor KL, et al.
Engagement in a program promoting lifestyle modification is associated with better patient-reported outcomes for people with MS.
Neurol Sci. 2015 Feb 1. [Epub ahead of print]
abstract

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