A double-blind, randomized, placebo-controlled trial by MS researchers at Kessler Foundation shows significant improvement in processing speed following a five-week, 10-session training intervention; treatment effect maintained at six-month follow-up    

Experts at Kessler Foundation reported the results of a randomized controlled trial to target deficits of processing speed in persons with multiple sclerosis (MS) and showed improvement through the application of speed-of-processing training.

Their article, “The efficacy of speed of processing training for improving processing speed in individuals with multiple sclerosis: A randomized clinical trial,” (doi: 10.1007/s00415-022-10980-9) was published online February 12, 2022, in Journal of Neurology. (https://tinyurl.com/5d9ykvtv). The authors are Nancy D. Chiaravalloti, PhD, Silvana L. Costa, PhD, Nancy B. Moore, MA, Kristen Costanza, and John DeLuca, PhD, of Kessler Foundation.

Cognitive dysfunction affects as many as 70% of people with MS. The most common deficit in cognitive function impacts processing speed, which adversely affects performance of tasks of daily living, including household chores, driving, and using public transportation, and contributes to the high employment among people with MS. Effective ways to improve processing speed in this population have the potential to enhance outcomes.

A total of 84 individuals with MS and impaired processing speed were randomized to treatment or placebo groups; final data analyses were based on 71 participants (Treatment, 37; Placebo, 34). All participants underwent neuropsychological evaluation and assessment of everyday cognitive function at baseline and at follow up immediately after the five-week, 10-session speed-of-processing training, and again six months later.

“We saw significant improvement in processing speed in the treatment group,” said Dr. Chiaravalloti, director of the Centers for Neuropsychology, Neuroscience, and Traumatic Brain Injury Research. “Moreover, we found that treatment dosage correlated with improvement. That is, participants who completed more levels within each training task showed greater benefits.”

“Another important finding was the sustained benefit at the six-month follow up,” noted Dr. Chiaravalloti, “regardless of whether the person received booster sessions. Future research is needed to evaluate long-term efficacy of speed-of-processing training in people with different subtypes of MS, including progressive MS.”

 

Dr. DeLuca, an expert in cognitive rehabilitation research, is senior vice president for Research and Training at Kessler Foundation. He is professor of Neurology and Physical Medicine and Rehabilitation at Rutgers New Jersey Medical School, and president-elect of the National Academy of Neuropsychology. Kessler Foundation

Experts in cognitive research evaluated the status of available treatments as well as promising strategies for treating cognitive deficits in multiple sclerosis. The article, “Treatment and management of cognitive dysfunction in patients with multiple sclerosis”, was published in Nature Reviews 2020 May 05. (doi: 10.1038/s41582-020-0355-1) The authors are John DeLuca, PhD, and Nancy Chiaravalloti, PhD, of Kessler Foundation, and Brian Sandroff, PhD, of the University of Alabama at Birmingham.

Cognitive dysfunction is a common, disabling symptom of multiple sclerosis, affecting two-thirds of patients. These individuals can have difficulties managing finances, performing household tasks, and functioning in the community and the workplace. Although the impact on daily life may be profound, the diagnosis and management of cognitive dysfunction in this population remains inadequate. The authors provided detailed analyses of different approaches to treatment, including cognitive rehabilitation, exercise training, and pharmacotherapy, and the important contributions of brain neuroimaging to advances in this field.

Over the past decade, research activity in cognitive rehabilitation has increased in the population with MS. There is greater emphasis on cognitive screening and assessment, and some standardized treatment protocols are available. “Evidence suggests that cognitive rehabilitation is effective in MS-related cognitive dysfunction, and may confer long-lasting effects,” said John DeLuca, PhD, senior VP of Research and Training at Kessler Foundation, and a co-author of the article. “Access to cognitive rehabilitation therapy is likely to increase as remote options for delivery become more widely accepted, such as programs for home computers and telerehabilitation services.”

Exercise training is an active area of MS research that shows promise for enhancing cognitive function and effecting positive change in the everyday lives of people living with MS. With improvements in methodology, this line of research will support consideration of exercise as the standard of care for individuals with MS. “It is critical that larger scale studies include participants with MS, including progressive MS, and target select cognitive outcomes,” Dr. DeLuca noted. To develop treatment protocols, the timing, dosage and duration of exercise need to be determined. “As studies continue to evolve, clinical applications of exercise recommendations are likely to be implemented within the next ten years,” he predicted.

The authors found that current pharmacotherapeutic approaches were of limited benefit for the cognitive symptoms of MS. To date, none of the available medications or disease-modifying therapies for MS are indicated for the treatment of cognitive deficits. Dr. DeLuca addressed the fundamental challenge to trials of pharmaceutical agents: “To determine the efficacy of a pharmacologic intervention for cognitive dysfunction, randomized controlled trials need to include cognition among their primary outcomes.”