Cognitive rehabilitation in multiple sclerosis.

Cognitive impairments are frequent in multiple sclerosis (MS). However, most studies about efficacy of cognitive rehabilitation interventions have been criticized in terms of methods and/or design. The aim of this study is to evaluate the efficacy of cognitive rehabilitation in MS patients with a cognitive intervention (ProCogSEP* program), compared to a control intervention (discussion program). Twenty MS patients have completed this simple blind study: 10 patients followed 13 sessions (2 hours) of the ProCog-SEP(1) program. Ten other patients followed 13 sessions (2 hours) of a discussion program (Control Group). All patients underwent neuropsychological assessment, before and after their program, in order to evaluate cognitive functions. Two neuropsychologists respectively assessed the patients and conducted the group sessions. Compared to its own baseline, ProCog-SEP Group show improvements in verbal memory [free recall (p = .02), learning (p = .002)], in visual memory [free (p = .05) and delayed recall (p = .007)], in working-memory (p = .03), in verbal fluency (p = .05) and in language (p = .01). Inter group analysis show a benefit of cognitive program mainly in verbal and visual memory, and in verbal fluencies. These results support the interest of a cognitive therapeutic management of MS patients.

Verbal episodic memory in 426 multiple sclerosis patients: impairment in encoding, retrieval or both?

Episodic memory is frequently impaired in multiple sclerosis (MS) patients but the exact nature of the disorder is controversial. It was initially thought to be due to a retrieval deficit but some studies have demonstrated an encoding deficit, which could be linked to a slowing of information processing speed or to a deficit in elaboration of strategies. The main objective of this study is to assess the prevalence and the nature of verbal episodic memory (VEM) impairment in MS patients. We retrieved memory performances of 426 patients [314 F-112 M; mean age: 46.1 years; median Expanded Disability Status Scale (EDSS) score: 3.1] from a neuropsychological data base. VEM was assessed using the 16 words RL-RI 16 test. 66% MS patients present at least one recall impaired in VEM (37.2% from 2 to 5 recall). 14.2% MS patients present an impairment in encoding phase. We observed that 5% of patients presented recognition difficulties. Correlations were observed between VEM performances and EDSS, and disease duration but no group effect (ANOVA) is observed between form of MS and VEM performances. These results confirm the high prevalence of VEM impairment in MS patients. Deficits affect mainly information retrieval in early stage MS patients and are then linked to encoding as disability increases. Storage disorders are infrequent, so cognitive rehabilitation with mental imaging could be effective in MS patients.

[Working memory in multiple sclerosis: a review]. / La mémoire de travail dans la sclérose en plaques: revue de la littérature.

INTRODUCTION: Impairment of working memory (WM) is frequently reported in multiple sclerosis (MS) patients. However, the various methodologies used, as well as the populations selected for study, hinder the interpretation of results. The aim of this study is to propose a review about WM in MS. METHOD: Twenty studies have presented results on WM with neuropsychological assessment. RESULTS: All studies conclude that WM is impaired in MS. Reduced processing speed would be central, with major impact on WM performance. According to Baddeley's model, difficulties may be located at the level of the central executive. MS patients would be sensitive to tasks with a high cognitive load. However, performances seem to become better when the processing speed is adapted. Explanatory models relating to this kind of impairment have been proposed from imaging studies. Compensation could mask deficits in WM at the early stage of the disease, but would become blurred with advancing illness and increasing load required for the task. CONCLUSIONS/PROSPECTS: In order to assess WM, adapted tools should be proposed to MS patients. Focus should be placed on processing speed. Further studies are needed, for instance to examine the dissociation of the processes operating within the central executive as described in Miyake's model. Imaging investigations have provided essential data helpful for understanding compensation mechanisms. These data should be useful for developing adapted remediation plans to compensate for the crippling impairment observed in everyday life.

[Cognitive rehabilitation in multiple sclerosis: a review of the literature]. / Remédiation cognitive dans la sclérose en plaques: revue de la litérature.

INTRODUCTION: Cognitive impairment is now well-known in multiple sclerosis (MS). However, few rehabilitation interventions are proposed or really efficient. OBJECTIVES: To present a review of cognitive rehabilitation intervention research conducted in people with multiple sclerosis (MS), regarding different findings about episodic memory, working memory, attention and executive function disorders in MS. DATA SOURCES: A search of Medline (yield 20 papers) and of PsychInfo (yield 1 article), using combinations of the following terms: cognitive rehabilitation, multiple sclerosis, cognitive therapy, neuropsychological rehabilitation, in the title or in the abstract, from 1960 to March 2010, excluding animal studies. RESULTS: Episodic memory rehabilitation studies appear to be promising. Programs on working memory, attention and executive functions are in the very early phases. CONCLUSIONS: Results are encouraging and allow specific recommendations for future research about: (1) inclusion criteria, often not defined, (2) a specific baseline adapted to the program of rehabilitation, (3) a control measure regarding program efficiency and (4) a role for the psychologist (presence and advice during the program).