Contributions
Abstract: 145
Type: Oral
Abstract Category: RIMS - Multi-disciplinary rehabilitation
Background: The effect of cognitive rehabilitation in multiple sclerosis (MS) is still controversial to date.
Objectives: to evaluate the effect of a home-based computerized program for retraining attention dysfunction in MS on behavioral performance and how baseline functional activity at functional MR imaging (fMRI) correlates with cognitive outcome after training.
Methods: Relapsing (RR) MS patients aged 18-55 years, who failed ≥ 2 tests of attention on an extensive neuropsychological evaluation (NP), and EDSS ≤6.0, were randomly allocated to specific (ST) or nonspecific (nST) computerized training, in one-hour sessions, twice a week for three months. All the patients enrolled underwent the NP before and after the completion of the cognitive training. fMRI while performing the N-Back (NB) Working Memory task was obtained before the cognitive training. The Cognitive Impairment Index (CII) as a measure of global cognitive function was calculated for each patient. A repeated measures ANOVA was used to evaluate changes in the CII and a multiple regression analysis was performed to evaluate the correlation between brain activity and cognitive improvement.
Results: fifty RRMS patients have been included in the analysis, 26 were randomized to the ST (17 female; mean±SD age 37.2±8.0 years) and 24 were randomized to the nST (16 female; 37.0±8.3 years). No significant differences were found between the 2 groups regarding sex, age, disease duration, EDSS score, annualized relapse rate, school education and the baseline CII. Patients exposed to the ST experienced a more pronounced reduction of the CII in comparison to patients trained with the nST (ST: 17.2±3.1 vs 11.4±4.8; nST: 16.6±2.7 vs 14.8±3.2; F= 12.342; p=0.001). Patients with lower functional activity in superior and middle frontal gyrus (Broadman Areas 6, 8, 9) while performing the N-Back had greater improvement after the cognitive training (p< 0.05FWE whole brain corrected).
Conclusions: our results confirmed that an attention ST ameliorates the global cognitive functions as measured by the CII, and suggest that this training may be more efficacious in patients who show a lower functional activity during working memory processing.
Disclosure: Iaffaldano P. has served on scientific advisory boards for Biogen Idec, and has received funding for travel and/or speaker honoraria from Sanofi-Aventis, Biogen Idec, Teva and Novartis. Tortorella C. has served on scientific advisory boards for Biogen, Merck Serono, Bayer-Schering and Novartis. She received also funding for travel, consulting and speaker honoraria from Biogen, Merck Serono, Bayer-Schering, Teva, Genzyme, Novartis and Almirall. Trojano M. has received honoraria for consultancy or speaking from Biogen, Sanofi-Aventis, Merck Serono and Bayer-Schering and research grants from Merck Serono, Biogen and Novartis. Viterbo RG, Fazio L, Taurisano P, Romano R, Portaccio E, Mancini M, Blasi G, Bertolino A, Amato MP: have nothing to disclose.
Abstract: 145
Type: Oral
Abstract Category: RIMS - Multi-disciplinary rehabilitation
Background: The effect of cognitive rehabilitation in multiple sclerosis (MS) is still controversial to date.
Objectives: to evaluate the effect of a home-based computerized program for retraining attention dysfunction in MS on behavioral performance and how baseline functional activity at functional MR imaging (fMRI) correlates with cognitive outcome after training.
Methods: Relapsing (RR) MS patients aged 18-55 years, who failed ≥ 2 tests of attention on an extensive neuropsychological evaluation (NP), and EDSS ≤6.0, were randomly allocated to specific (ST) or nonspecific (nST) computerized training, in one-hour sessions, twice a week for three months. All the patients enrolled underwent the NP before and after the completion of the cognitive training. fMRI while performing the N-Back (NB) Working Memory task was obtained before the cognitive training. The Cognitive Impairment Index (CII) as a measure of global cognitive function was calculated for each patient. A repeated measures ANOVA was used to evaluate changes in the CII and a multiple regression analysis was performed to evaluate the correlation between brain activity and cognitive improvement.
Results: fifty RRMS patients have been included in the analysis, 26 were randomized to the ST (17 female; mean±SD age 37.2±8.0 years) and 24 were randomized to the nST (16 female; 37.0±8.3 years). No significant differences were found between the 2 groups regarding sex, age, disease duration, EDSS score, annualized relapse rate, school education and the baseline CII. Patients exposed to the ST experienced a more pronounced reduction of the CII in comparison to patients trained with the nST (ST: 17.2±3.1 vs 11.4±4.8; nST: 16.6±2.7 vs 14.8±3.2; F= 12.342; p=0.001). Patients with lower functional activity in superior and middle frontal gyrus (Broadman Areas 6, 8, 9) while performing the N-Back had greater improvement after the cognitive training (p< 0.05FWE whole brain corrected).
Conclusions: our results confirmed that an attention ST ameliorates the global cognitive functions as measured by the CII, and suggest that this training may be more efficacious in patients who show a lower functional activity during working memory processing.
Disclosure: Iaffaldano P. has served on scientific advisory boards for Biogen Idec, and has received funding for travel and/or speaker honoraria from Sanofi-Aventis, Biogen Idec, Teva and Novartis. Tortorella C. has served on scientific advisory boards for Biogen, Merck Serono, Bayer-Schering and Novartis. She received also funding for travel, consulting and speaker honoraria from Biogen, Merck Serono, Bayer-Schering, Teva, Genzyme, Novartis and Almirall. Trojano M. has received honoraria for consultancy or speaking from Biogen, Sanofi-Aventis, Merck Serono and Bayer-Schering and research grants from Merck Serono, Biogen and Novartis. Viterbo RG, Fazio L, Taurisano P, Romano R, Portaccio E, Mancini M, Blasi G, Bertolino A, Amato MP: have nothing to disclose.