An RCT to treat learning impairment in multiple sclerosis: The MEMREHAB trial

Abstract

Objective: To examine the efficacy of the modified Story Memory Technique (mSMT), a 10-session behavioral intervention teaching context and imagery to facilitate learning, to improve learning and memory abilities in persons with multiple sclerosis (MS).

Methods: This double-blind, placebo-controlled, randomized clinical trial included 86 participants with clinically definite MS, 41 in the treatment group and 45 in the placebo control group. Participants completed a baseline neuropsychological assessment, including questionnaires assessing everyday memory, a repeat assessment immediately posttreatment, and a long-term follow-up assessment 6 months after treatment. After completion of the treatment phase, persons in the treatment group were assigned to a booster session or a non-booster session group to examine the efficacy of monthly booster sessions in facilitating the treatment effect over time.

Results: The treatment group showed a significantly improved learning slope relative to the placebo group posttreatment. Similar results were noted on objective measures of everyday memory, general contentment, and family report of apathy and executive dysfunction. Long-term follow-up data showed that posttreatment improvement in the treatment group continued to be noted on the list learning and self-report measures. The provision of booster sessions demonstrated little benefit.

Conclusion: The mSMT is effective for improving learning and memory in MS.

Classification of evidence: This study provides Class I evidence that the mSMT behavioral intervention improves both objective memory and everyday memory in patients with MS over 5 weeks, with treatment effects lasting over a 6-month period.

Figure 1. Participant flow diagram

mSMT = modified Story Memory Technique; OT-SRT = Open-Trial Selective Reminding Test; TBI = traumatic brain injury.

Figure 2. California Verbal Learning Test (CVLT) learning slope across the 5 learning trials of the CVLT immediately posttreatment, by treatment group (p < 0.05)

Figure 3. Baseline and immediate follow-up Functional Assessment of Multiple Sclerosis general contentment scores for the treatment and control groups (p < 0.05)