Regular use of a home-based computerized program for retraining attention dysfunction significantly improved verbal memory tasks in patents with multiple sclerosis (MS)–related cognitive impairment, a new study shows.

"We found that both cognitive training specifically focused on attention and also nonspecific cognitive training were associated with a reduction in the cognitive impairment index, but the reduction was more pronounced and significant with the attention-specific training," lead author Pietro Iaffaldano, MD, University of Bari Aldo Moro, Italy, concluded.

The study was particularly notable in that the researchers tracked what was happening in the brain by monitoring the relationship between MRI functional activity during working memory at baseline and cognitive outcomes at the end of the study. They showed a significant response involving the fronto-parietal network during the working memory processing, which correlated to cognitive outcomes.

"Our results also suggest that this training may be more efficacious in patients who show a lower functional activity during working memory processing," Dr Iaffaldano said.

The results were presented at the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) 2016.

Commenting on the study for Medscape Medical News was co-chair of the ECTRIMS session at which it was presented, Paivi Hamalanen, PhD, Masku Rehabilitation Center, Finland, who recently authored a Cochrane review on neuropsychological rehabilitation studies in MS.

"I liked this study very much," Dr Hamalanen said. "They selected patients with cognitive impairment so they were truly rehabilitating. And the fact that they measured changes in the brain gives confidence in the results."

She explained that rehabilitation for patients with MS, including cognitive rehabilitation, is more common in Europe than in the United States. "There has been a view that cognitive rehabilitation is not worth doing in MS as cognitive impairment is progressive, but the thinking is changing and many people now believe cognitive rehabilitation is important in MS. This study reinforces that view."

For the study, 50 patients with relapsing-remitting MS aged 18 to 55 years, who failed two or more tests of attention on an extensive neuropsychological evaluation, were randomly allocated to attention-specific or nonspecific computerized cognitive training, in 1-hour sessions twice a week for 3 months.

All the patients enrolled underwent functional MRI while performing the Variable Attentional Control and the N-Back tasks, before and after the completion of the cognitive training. The Cognitive Impairment Index as a measure of global cognitive function was calculated for each patient.

Results showed that patients exposed to the attention-specific training experienced a more pronounced reduction of the Cognitive Impairment Index compared with patients who received the nonspecific training. Scores decreased from 17.2 to 11.4 in the attention-specific training group and from 16.6 to 14.8 in the nonspecific training group (P = .001).

Furthermore, patients exposed to the attention-specific training showed a change in left prefrontal cortex activity on functional MRI with the attention-specific training but not with the nonspecific training.

Patients with lower functional activity in superior and middle frontal gyrus while performing the N-Back had greater improvement after the cognitive training.

European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) 2016. Abstract 145. Presented September 15, 2016.

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