Tuesday, 28 February 2012

Cognitive rehabilitation in MS

Filippi et al. Multiple Sclerosis: Effects of Cognitive Rehabilitation on Structural and Functional MR Imaging Measures--An Explorative Study. Radiology. 2012 Mar;262(3):932-40. 

"This study shows that cognitive rehabilitation in MS'ers with cognitive dysfunction may work by recruiting new areas of the brain. This implies that you can train your brain to cope with damage and to compensate for the damage. In other words these results underpin the concept of brain training; we know this works for motor tasks (e.g. walking, skipping, skiing, etc.) why shouldn't it work for cognitive tasks? The problem is  that MS is a progressive disease so ongoing damage may undermine the adaptive responses  with time. More reason to do this in combination with a DMT that suppresses ongoing damage."

Purpose: To evaluate brain changes after cognitive rehabilitation in MS'ers with clinically stable relapsing-remitting MS (RRMS) by using neuropsychologic assessment and structural and functional MRI techniques. 

Structural MRI: delineates the anatomy of the brain, for example lesions and atrophy or shrinkage of the brain.

Functional MRI: delineates function of the brain; how much oxygen and blood a part of the brain requires when doing a particular task. 

Materials and Methods: 20 with RR MS and cognitive deficits at baseline were randomly assigned to undergo treatment (n = 10), which entailed computer-assisted cognitive rehabilitation of attention and information processing and executive functions, or to serve as a control subjects (n = 10) without cognitive rehabilitation. All patients underwent a standardized neuropsychologic assessment and MR imaging at baseline and after 12 weeks. Changes in gray matter (GM) volumes on 3D images and changes in normal-appearing white matter (NAWM) architecture on were assessed. Changes in functional activity at functional MR imaging during the Stroop task and at rest were also investigated. 

Stroop task: this is a cognitive test that require some thought

Results: As compared with their performance at baseline, the MS'ers in the treatment group improved at tests of attention and information processing and executive functions. Neither structural modifications to GM volume nor modifications to NAWM architecture were detected at follow-up in both groups. Functional MR imaging demonstrated modifications of the activity of several areas of the brain* at rest in the treatment group compared with the control group. In the treatment group, functional MR imaging changes were correlated with cognitive improvement (P < .0001 to .01). 

* For those of you who want to know these areas included the posterior cingulate cortex/precuneus and dorsolateral prefrontal cortex during the Stroop task, as well as modifications of the activity of the anterior cingulum,  posterior cingulate cortex  and/or precuneus, left dorsolateral   prefrontal cortex and right inferior parietal lobule. 


Conclusion: Rehabilitation of attention and information processing and executive functions in RR MS may be effected through enhanced recruitment of brain networks subserving the trained functions.

3 comments:

  1. Can I ask., is cognitive rehabilitation offered on the NHS or even available widely? What sort of therapists could offer this?

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  2. Re: "Can I ask., is cognitive rehabilitation offered on the NHS or even available widely? What sort of therapists could offer this?"

    It is offered under the NHS, but only in a limited number of specialist units. I suggest you ask your MS CNS if there is a local programme.

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  3. Thanks. I will try and ask someone but our MS CNS retired and there is a massive hoo hah going on (Ipswich) as the hospital don't want to replace him (they think the service can be carried out "in the community"). It's a bit of a test case really.

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