Efficacy of a Computer-Assisted Cognitive Rehabilitation Intervention in Relapsing-Remitting Multiple Sclerosis Patients: A Multicenter Randomized Controlled Trial

Abstract

Cognitive impairment is frequently encountered in multiple sclerosis (MS) affecting between 40-65% of individuals, irrespective of disease duration and severity of physical disability. In the present multicenter randomized controlled trial, fifty-eight clinically stable RRMS patients with mild to moderate cognitive impairment and relatively low disability status were randomized to receive either computer-assisted (RehaCom) functional cognitive training with an emphasis on episodic memory, information processing speed/attention, and executive functions for 10 weeks (IG; n = 32) or standard clinical care (CG; n = 26). Outcome measures included a flexible comprehensive neuropsychological battery of tests sensitive to MS patient deficits and feedback regarding personal benefit gained from the intervention on four verbal questions. Only the IG group showed significant improvements in verbal and visuospatial episodic memory, processing speed/attention, and executive functioning from pre - to postassessment. Moreover, the improvement obtained on attention was retained over 6 months providing evidence on the long-term benefits of this intervention. Group by time interactions revealed significant improvements in composite cognitive domain scores in the IG relative to the demographically and clinically matched CG for verbal episodic memory, processing speed, verbal fluency, and attention. Treated patients rated the intervention positively and were more confident about their cognitive abilities following treatment.

Figure 1

Consort flow diagram.

Figure 2

Composite cognitive domain performance (z-scores) in the RehaCom group at baseline, posttreatment, and follow-up.

Figure 3

Composite cognitive domain performance (z-scores) in the RehaCom intervention and control group at baseline and posttreatment.

Figure 4

Example of a screen with a 3 by 3 matrix on level 18 of the attention and concentration RehaCom module.

Figure 5

Example of the divided attention task on level 14 of the RehaCom module.

Figure 6

Example training on level 9, of the topological memory task RehaCom module.

Figure 7

Example of training on level 3, of the verbal memory RehaCom module.

Figure 8

Example of training on level 8, on the logical reasoning RehaCom module.

Figure 9

Example of a shopping list on level 14, of the Shopping RehaCom module (from level 11 onward, an amount of money the patient has at his/her disposal is displayed in the upper left of the screen).