Thursday, 5 March 2015

ClinicSpeak: cognitive rehabilitation trial

Are you up for some brain exercise? #ClinicSpeak #MSResearch #MSBlog

"This is a very important pilot study and shows that the plasticity of the brain does not only apply to motor and visual function. You can now improve your cognitive function via well designed cognitive rehabilitation. Call it brain exercise. Various forms of brain exercise, be it education, playing bridge, or other cognitive gymnastics, has been shown to boost cognitive reserve in normal subjects and protect you or delay you from developing age-related cognitive impairment or Alzheimer's disease. I have not found any published evidence to show that MSers are protected from Alzheimer's disease or other age-related cognitive changes therefore anything that protects your brain and delays the onset of age-related cognitive impairment can only be helpful for MSers."

"Clearly this study's findings need to be confirmed in a larger group of MSers. However, the findings are compatible with what we know about the brain and has scientific validity. Should we adopt them? I see no reason why not. However, our NHS payers will not. In healthcare research it is simply not good enough to show that something works we also have to show that it is cost-effective and pragmatic to be adopted. Therefore to expand our services to include cognitive rehabilitation we need to show that cognitive rehabilitation is effective in real-life, has clinically meaningful benefits and is cost-effective. We need more data."

"At the moment we simply don't have enough resource to provide all MSers with access to cognitive rehabilitation. Shouldn't we do something about it? May be we can provide a self-managed cognitive rehabilitation programme. The problem with a self-management strategy is that will the MSers in most need, i.e with cognitive problems, have the motivation, drive and self-discipline to adhere to a programme? Clearly more research is needed.  If any of you are undergoing cognitive rehabilitation could you please share your experience with the community. Can you also recommend any good online cognitive rehabilitation programmes?"

"Please watch this space; cognitive rehabilitation is an essential component of any holistic programme to manage MS."

Epub: Gich et al. A randomized, controlled, single-blind, 6-month pilot study to evaluate the efficacy of MS-Line!: a cognitive rehabilitation programme for patients with multiple sclerosis. Mult Scler. 2015 Feb 25. pii: 1352458515572405.

BACKGROUND: MS-Line! was created to provide an effective treatment for cognitive impairment in MSers.

OBJECTIVE: To assess the efficacy of MS-Line!

METHODS: A randomized, controlled, single-blind, 6-month pilot study. MSers were randomly assigned to an experimental group (cognitive rehabilitation with the programme) or to a control group (no cognitive rehabilitation). Randomization was stratified by cognitive impairment level. Cognitive assessment included: selective reminding test, 10/36 spatial recall test (10/36 SPART), symbol digit modalities test, paced auditory serial addition test, word list generation (WLG), FAS test, subtests of WAIS-III, Boston naming test (BNT), and trail making test (TMT).

RESULTS: Forty-three MSers (22 in the experimental group, 21 in the control group) were analyzed. Covariance analysis showed significant differences in 10/36 SPART (P=0.0002), 10/36 SPART delayed recall (P=0.0021), WLG (P=0.0123), LNS (P=0.0413), BNT (P=0.0007) and TMT-A (P=0.010) scores between groups.

CONCLUSIONS: The study showed a significant improvement related to learning and visual memory, executive functions, attention and information processing speed, and naming ability in those patients who received cognitive rehabilitation. The results suggest that MS-Line! is effective in improving cognitive impairment in MSers.

1 comment:

  1. Hi Prof G,

    Can you give some relative information as to to what level the MSers improved after rehab?

    Where they close to the "normal" results or where they still very cognitively impaired?


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