Evaluation of cognitive assessment and cognitive intervention for people with multiple sclerosis.

OBJECTIVES: Cognitive problems in multiple sclerosis are common but any possible benefits of treatment remain uncertain. The aim of the study was to evaluate the benefits of providing a psychology service, including cognitive assessment and intervention, to patients with multiple sclerosis. METHOD: The study was a single blind randomised controlled trial. A total of 240 patients with clinically definite, laboratory supported, or clinically probable multiple sclerosis were recruited from an multiple sclerosis management clinic and assessed on a brief screening battery. They were randomised into three groups. The control group received no further intervention. The assessment group received a detailed cognitive assessment, the result of which was fed back to staff involved in the patients' care. The treatment group received the same detailed cognitive assessment and a treatment programme designed to help reduce the impact of their cognitive problems. Patients were followed up 4 and 8 months later on the general health questionnaire (GHQ-28), extended activities of daily living scale, SF-36, everyday memory questionnaire, dysexecutive syndrome questionnaire, and memory aids questionnaire. RESULTS: The three groups were compared on the outcome measures at 4 and 8 months after recruitment. There were few significant differences between the groups and those that occurred favoured the control group. Overall, the results showed no effect of the interventions on mood, quality of life, subjective cognitive impairment or independence. CONCLUSIONS: The study failed to detect any significant effects of cognitive assessment or cognitive intervention in this cohort of people with multiple sclerosis.

Cognitive rehabilitation for attention deficits following stroke.

BACKGROUND: Attention problems occur following stroke and are treated using computerised activities or paper and pencil tasks. OBJECTIVES: To determine the effects of cognitive rehabilitation for attention deficits following stroke. SEARCH STRATEGY: We searched the Cochrane Stroke Group Trials Register, Medline, EMBASE, CINHAL and CLIN PSYCH databases and reference lists from relevant articles. Date of most recent searches: December 1998 SELECTION CRITERIA: Controlled trials of attention training in stroke. Studies with mixed aetiology groups were excluded unless they included more than 75% of stroke patients or separate data were available for the stroke patients. DATA COLLECTION AND ANALYSIS: Two reviewers extracted trial data and assessed trial quality. Reviewers contacted investigators for further details of trials. MAIN RESULTS: Two trials were identified with 56 participants. The two trials showed a benefit of training on measures of alertness and sustained attention. Only one trial included a measure of functional independence and this showed no significant effect of training. REVIEWER'S CONCLUSIONS: There is some indication that training improves alertness and sustained attention but no evidence to support or refute the use of cognitive rehabilitation for attention deficits to improve functional independence following stroke.

Cognitive rehabilitation for memory deficits following stroke.

BACKGROUND: Memory problems occur following stroke. Cognitive rehabilitation programmes are provided to retrain memory function or to teach patients strategies to cope despite memory impairment. OBJECTIVES: To determine the effects of cognitive rehabilitation for memory problems following stroke. SEARCH STRATEGY: We searched the Cochrane Stroke Group Trials Register, Medline, EMBASE, CINHAL and CLIN PSYCH databases and reference lists from relevant articles. Date of most recent searches: December 1998. SELECTION CRITERIA: Controlled trials of memory retraining in stroke. Studies with mixed aetiology groups were excluded unless they had more than 75% of stroke patients or separate data were available for the stroke patients. DATA COLLECTION AND ANALYSIS: Two reviewers extracted trial data and assessed trial quality. Reviewers contacted investigators for further details of trials. MAIN RESULTS: One trial was identified with 12 participants. This showed memory strategy training had no significant effect on memory impairment or subjective memory complaints. REVIEWER'S CONCLUSIONS: There is insufficient evidence to support or refute the effectiveness of cognitive rehabilitation for memory problems after stroke.