Rebranding MS a dementia (5): neuropsychological rehabilitation did not improve cognitive performance

MS-related cognitive impairment does not respond to rehabilitation. #MSBlog #MSResearch

"In general neurologists would agree that a minority of dementing illnesses are reversible; in particular those that occur in the context of a progressive neurodegenerative disease such as MS. Therefore it is not surprising to see that cognitive rehabilitation did not improve cognitive performance. An interesting observation from this study is that MSers in the intervention group perceived a positive effect of cognitive rehabilitation on their cognition. Is this a the placebo effect? The downside of this observation is that if healthcare managers, or health economists, saw this kind of data they would not fund cognitive rehabilitation programmes for MS. Would you agree with this strategy? Unfortunately, this is the reality of practicing medicine in an age of austerity."
"The hidden message in this study is that if you let MSers develop cognitive impairment there is little we can do for them. This is why prevention is better than treatment and underpins the highly effective early DMT (HEEDMT) strategy."

Definition of dementia: Dementia is a loss of mental ability severe enough to interfere with normal activities of daily living, lasting more than six months, not present since birth, and not associated with a loss or alteration of consciousness.

Epub: Mäntynen et al. Neuropsychological rehabilitation does not improve cognitive performance but reduces perceived cognitive deficits in patients with multiple sclerosis: a randomised, controlled, multi-centre trial. Mult Scler. 2013 Jun 26.

BACKGROUND: There is preliminary evidence on the positive effects of neuropsychological rehabilitation on cognition in MS, but the generalisability of the findings is limited by methodological problems.

OBJECTIVE: The aim of the present study was to determine the effects of strategy-oriented neuropsychological rehabilitation on MS.

METHODS: A total of 102 RRMSers with subjective and objective attentional deficits were randomised into an intervention and a control group. Neuropsychological assessments were performed at baseline, at three months immediately after the intervention, and at six months. MSers in the intervention group received neuropsychological rehabilitation once a week in 60-minute sessions for 13 consecutive weeks. The control group received no intervention.

RESULTS: Neuropsychological rehabilitation including computer-based attention and working memory retraining, psychoeducation, strategy learning and psychological support did not improve cognitive performance but had a positive effect on perceived cognitive deficits. The intervention group perceived significantly fewer deficits than the control group both immediately after the intervention and at six months. The personal rehabilitation goals were also well achieved.

CONCLUSIONS: Strategy-oriented neuropsychological rehabilitation did not improve cognitive performance but reduced perceived cognitive deficits in MS.

"The following are the results of our recent dementia survey."

Other posts on rebranding MS a dementia

20 Jun 2013
"This issue clearly needs more explanation. Therefore, I will be hosting our first MS Research Webinar next month on this topic. In the webinar I will explain my thinking and motivation behind the proposed rebranding exercise.
14 Jun 2013
Rebranding MS as a Dementia: part 2. "What do you think of this of short animation? It tries to explain the impact of MS on the brain; in the other words the early phases of MS Dementia." ...
17 Jun 2013
Rebranding MS a dementia (3): Cognitive impairment in asymptomatic MS (or RIS). Cognitive impairment may begin before the first attack of MS. #MSBlog #MSResearch "This is an old post that needs more air time. It shows ...

12 Jun 2013
"For me the best thing about going to conferences is that it allows you thinking time, and time to interact with like minded colleagues. After my platform presentation on early aggressive treatment several European neurologists ...

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