Remotely-delivered cognitive remediation in multiple sclerosis (MS): protocol and results from a pilot study

Abstract

Background: Cognitive impairment represents a critical unmet treatment need in multiple sclerosis (MS). Cognitive remediation is promising but traditionally requires multiple clinic visits to access treatment. Computer-based programs provide remote access to intensive and individually-adapted training.

Objective: Our goal was to develop a protocol for remotely-supervised cognitive remediation that enables individuals with MS to participate from home while maintaining the standards for clinical study.

Methods: MS participants (n = 20) were randomized to either an active cognitive remediation program (n = 11) or a control condition of ordinary computer games (n = 9). Participants were provided study laptops to complete training for five days per week over 12 weeks, targeting a total of 30 hours. Treatment effects were measured with composite change via scores of a repeated neuropsychological battery.

Results: Compliance was high with an average of 25.0 hours of program use (80% of the target) and did not differ between conditions (25.7 vs. 24.2 mean hours, p = 0.80). The active vs. control participants significantly improved in both the cognitive measures (mean composite z-score change of 0.46 ± 0.59 improvement vs. -0.14 ± 0.48 decline, p = 0.02) and motor tasks (mean composite z-score change of 0.40 ± 0.71improvement vs. -0.64 ± 0.73 decline, p = 0.005).

Conclusions: Remotely-supervised cognitive remediation is feasible for clinical study with potential for meaningful benefit in MS.

Keywords: Multiple sclerosis; cognition; fingolimod; quality of life; rehabilitation; relapsing–remitting MS.

Figure 1.

Overview of study procedures.

Figure 2.

Reasons given for a noncompliant training week (across total weeks of trial participation).

Figure 3.

Participant and informant reported impression of cognitive change. Participant reported outcome active vs. control (0.73 ± 0.47 vs. 0.11 ± 0.33, p = 0.003). Informant reported outcome active vs. control (0.71 ± 0.49 vs. 0.33 ± 0.52, p = 0.20).