Cognitive training in MS: effects and relation to brain atrophy

Objectives: Cognitive disorders are common in MS patients and no generally recommended treatment is available. Recent brain imaging studies show a considerable neuroplasticity for cognitive tasks in MS patients, but on the other hand brain atrophy already early in the disease progression. We explored the benefits of a home-based cognitive training program for memory and working memory functions in relapsing-remitting MS patients controlling for whole brain and central brain atrophy as covariates.

Methods: Using a single-blinded controlled study design 42 patients were randomised into a treatment group and a control group. Home based computer training focusing on memory and working memory was started at least 4 weeks after the discontinuation of the methylprednisolone treatment and lasted for 6 weeks. Two weeks later the patients were re-investigated for their clinical and cognitive performance. We assessed also quality of life, depression and fatigue using self-rating scales.

Results: Training had no effect on the neurological status and on quality of life and fatigue. But the treatment group showed better verbal learning, long-delay verbal memory performance, working memory performance and fine-motor hand control. The impact of the treatment on long-delay verbal memory performance was independent of the extent of brain atrophy, whereas for the other results brain atrophy played a significant role.

Conclusions: A intensive home-based cognitive training program is able to improve the performance of MS patients. The impact of brain atrophy on rehabilitation outcome may differ for cognitive functions.