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. 2021 Oct 18;10(10):CD008754.
doi: 10.1002/14651858.CD008754.pub4.

Memory rehabilitation for people with multiple sclerosis

Lauren A Taylor  1 , Jacqueline R Mhizha-Murira  2 , Laura Smith  3 , Kristy-Jane Potter  4 , Dana Wong  5 , Nikos Evangelou  6 , Nadina B Lincoln  7 , Roshan das Nair  4
Affiliations

Memory rehabilitation for people with multiple sclerosis

Lauren A Taylor et al. Cochrane Database Syst Rev. .

Abstract

Background: Problems with cognition, particularly memory, are common in people with multiple sclerosis (MS) and can affect their ability to complete daily activities and can negatively affect quality of life. Over the last few years, there has been considerable growth in the number of randomised controlled trials (RCTs) of memory rehabilitation in MS. To guide clinicians and researchers, this review provides an overview of the effectiveness of memory rehabilitation for people with MS.

Objectives: To determine whether people with MS who received memory rehabilitation compared to those who received no treatment, or an active control showed better immediate, intermediate, or longer-term outcomes in their: 1. memory functions, 2. other cognitive abilities, and 3. functional abilities, in terms of activities of daily living, mood, and quality of life.

Search methods: We searched CENTRAL which includes Clinicaltrials.gov, World Health Organization (The Whoqol) International Clinical Trials Registry Portal, Embase and PubMed (MEDLINE), and the following electronic databases (6 September 2020): CINAHL, LILACS, the NIHR Clinical Research Network Portfolio database, The Allied and Complementary Medicine Database, PsycINFO, and CAB Abstracts.

Selection criteria: We selected RCTs or quasi-RCTs of memory rehabilitation or cognitive rehabilitation for people with MS in which a memory rehabilitation treatment group was compared with a control group. Selection was conducted independently first and then confirmed through group discussion. We excluded studies that included participants whose memory deficits were the result of conditions other than MS, unless we could identify a subgroup of participants with MS with separate results.

Data collection and analysis: Eight review authors were involved in this update in terms of study selection, quality assessment, data extraction and manuscript review. We contacted investigators of primary studies for further information where required. We conducted data analysis and synthesis in accordance with Cochrane methods. We performed a 'best evidence' synthesis based on the methodological quality of the primary studies included. Outcomes were considered separately for 'immediate' (within the first month after completion of intervention), 'intermediate' (one to six months), and 'longer-term' (more than six months) time points.

Main results: We added 29 studies during this update, bringing the total to 44 studies, involving 2714 participants. The interventions involved various memory retraining techniques, such as computerised programmes and training on using internal and external memory aids. Control groups varied in format from assessment-only groups, discussion and games, non-specific cognitive retraining, and attention or visuospatial training. The risk of bias amongst the included studies was generally low, but we found eight studies to have high risk of bias related to certain aspects of their methodology. In this abstract, we are only reporting outcomes at the intermediate timepoint (i.e., between one and six months). We found a slight difference between groups for subjective memory (SMD 0.23, 95% CI 0.11 to 0.35; 11 studies; 1045 participants; high-quality evidence) and quality of life (SMD 0.30, 95% CI 0.02 to 0.58; 6 studies; 683 participants; high-quality evidence) favoring the memory rehabilitation group. There was a small difference between groups for verbal memory (SMD 0.25, 95% CI 0.11 to 0.40; 6 studies; 753 participants; low-quality evidence) and information processing (SMD 0.27, 95% CI 0.00 to 0.54; 8 studies; 933 participants; low-quality evidence), favoring the memory rehabilitation group. We found little to no difference between groups for visual memory (SMD 0.20, 95% CI -0.11 to 0.50; 6 studies; 751 participants; moderate-quality evidence), working memory (SMD 0.16, 95% CI -0.09 to 0.40; 8 studies; 821 participants; moderate-quality evidence), or activities of daily living (SMD 0.06, 95% CI -0.36 to 0.24; 4 studies; 400 participants; high-quality evidence). AUTHORS' CONCLUSIONS: There is evidence to support the effectiveness of memory rehabilitation on some outcomes assessed in this review at intermediate follow-up. The evidence suggests that memory rehabilitation results in between-group differences favoring the memory rehabilitation group at the intermediate time point for subjective memory, verbal memory, information processing, and quality of life outcomes, suggesting that memory rehabilitation is beneficial and meaningful to people with MS. There are differential effects of memory rehabilitation based on the quality of the trials, with studies of high risk of bias inflating (positive) outcomes. Further robust, large-scale, multi-centre RCTs, with better quality reporting, using ecologically valid outcome assessments (including health economic outcomes) assessed at longer-term time points are still needed to be certain about the effectiveness of memory rehabilitation in people with MS.

PubMed Disclaimer

Conflict of interest statement

RdN, JMM, KJP and NBL have conducted memory rehabilitation studies in MS that have been included in this review.

RdN and NE have been funded by NIHR for a programme grant on cognitive screening and rehabilitation.

NE has received lecture fees from Biogen and participated in paid advisory board for Biogen, Roche and Merck where cognition was discussed.

LT, DW, and LS have nothing to declare.

RdN is the Chair of the NIHR Research for Patient Benefit East Midlands Research Advisory Committee. He has received funding to prepare and deliver lectures (speakers bureau) on cognitive rehabilitation in multiple sclerosis from Novartis, Merck, and Biogen.

Figures

1
1
Flow diagram showing article screening process
2
2
Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.
3
3
Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
1.1
1.1. Analysis
Comparison 1: Subjective memory measures, Outcome 1: Immediate
1.2
1.2. Analysis
Comparison 1: Subjective memory measures, Outcome 2: Intermediate
1.3
1.3. Analysis
Comparison 1: Subjective memory measures, Outcome 3: Longer‐term
2.1
2.1. Analysis
Comparison 2: Objective verbal memory, Outcome 1: Immediate
2.2
2.2. Analysis
Comparison 2: Objective verbal memory, Outcome 2: Intermediate
2.3
2.3. Analysis
Comparison 2: Objective verbal memory, Outcome 3: Longer‐term
3.1
3.1. Analysis
Comparison 3: Objective visual memory, Outcome 1: Immediate
3.2
3.2. Analysis
Comparison 3: Objective visual memory, Outcome 2: Intermediate
3.3
3.3. Analysis
Comparison 3: Objective visual memory, Outcome 3: Longer‐term
4.1
4.1. Analysis
Comparison 4: Objective working memory, Outcome 1: Immediate
4.2
4.2. Analysis
Comparison 4: Objective working memory, Outcome 2: Intermediate
4.3
4.3. Analysis
Comparison 4: Objective working memory, Outcome 3: Longer‐term
5.1
5.1. Analysis
Comparison 5: Information processing, Outcome 1: Immediate
5.2
5.2. Analysis
Comparison 5: Information processing, Outcome 2: Intermediate
5.3
5.3. Analysis
Comparison 5: Information processing, Outcome 3: Longer‐term
6.1
6.1. Analysis
Comparison 6: Mood ‐ Depression Scale, Outcome 1: Immediate
6.2
6.2. Analysis
Comparison 6: Mood ‐ Depression Scale, Outcome 2: Intermediate
6.3
6.3. Analysis
Comparison 6: Mood ‐ Depression Scale, Outcome 3: Longer‐term
7.1
7.1. Analysis
Comparison 7: Mood ‐ Anxiety Scale, Outcome 1: Immediate
7.2
7.2. Analysis
Comparison 7: Mood ‐ Anxiety Scale, Outcome 2: Intermediate
7.3
7.3. Analysis
Comparison 7: Mood ‐ Anxiety Scale, Outcome 3: Longer‐term
8.1
8.1. Analysis
Comparison 8: Quality of life, Outcome 1: Immediate
8.2
8.2. Analysis
Comparison 8: Quality of life, Outcome 2: Intermediate
8.3
8.3. Analysis
Comparison 8: Quality of life, Outcome 3: Longer‐term
9.1
9.1. Analysis
Comparison 9: Activities of Daily Living, Outcome 1: Immediate
9.2
9.2. Analysis
Comparison 9: Activities of Daily Living, Outcome 2: Intermediate
9.3
9.3. Analysis
Comparison 9: Activities of Daily Living, Outcome 3: Longer‐term
See this image and copyright information in PMC

Update of

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Mattioli 2012 {published data only}
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Rosti‐Otajärvi 2013b {published data only}
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Veldkamp 2019 {published data only}
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References to ongoing studies

ISRCTN54901925 {published data only}
    1. ISRCTN54901925. A randomised study of cognitive rehabilitation in multiple sclerosis. http://isrctn.com/ISRCTN54901925 (accessed 31 July 2015).
NCT03471338 {published data only}
    1. Neuropsychological management of multiple sclerosis: benefits of a computerised semi-autonomous at-home cognitive rehabilitation programme. Ongoing study. March 2018. Contact author for more information.

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