Multiple sclerosisWednesday, June 24, 2009, 08:30 - 10:00Cognitive training in multiple sclerosis: an fMRI studyF. Mattioli, C. Stampatori, M.A. Rocca, D. Zanotti, R. Capra, G. Riccitelli, M. Filippi (Brescia, Milano, Montichiari, IT)
Objectives: Studies on the efficacy of cognitive training in multiple sclerosis (MS) have provided conflicting results, due to patients’ clinical heterogeneity, the use of tasks not specific for the trained function, and poor neuropsychological outcome measures. We investigated the effectiveness of a PC administered intensive neuropsychological training of attention and executive functions in clinically stable relapsing-remitting MS patients with low disability and its correlation with brain activation changes during functional magnetic resonance imaging (fMRI).
Methods: Among 80 RRMS patients screened, 11 patients were included as they had z scores <1.5 SD in both Paced Auditory Serial Addition Test (PASAT) and Winsconsin Card Sorting Test (WCST). Other inclusion criteria were normal vision, normal right-hand motor function, and absence of psychiatric symptoms or therapies. Patients underwent an extensive neuropsychological evaluation (PASAT, WCST, verbal fluencies, Selective Reminding Test, Symbol Digit Modality Test, Divided attention reaction times, MSQoL and MADRS), and fMRI (Stroop interference test) at baseline and at the end of the cognitive training period. Six patients had attention and executive functions rehabilitation (3 hours weekly for 3 months by means of Rehacom ® Divided Attention and Plan a Day software).
Results: At baseline, the two groups had similar clinical and neuropsychological characteristics. At follow up, the rehabilitated group had a significant improvement at PASAT (p=0.02), WCST (p=0.04), phonemic fluency (p=0.03), divided attention (p=0.03), MSQOL (p=0.02). The not rehabilitated patients did not improve in any test. At follow up, fMRI showed between-group differences in Stroop congruent (rehabilitated group with greater activation in BA10, precuneus and S2) and incongruent (rehabilitated group with greater activation in cingulum and BA10) conditions. Between-group and time interaction showed a significantly greater activation in the rehabilitated group in left BA10, left M1, cingulate cortex, and right S2.
Conclusions: Specific cognitive training has a significant effect in mildly-disabled RRMS patients with poor attention and information processing abilities, whose neural correlate seems to be a greater cortical activation of brain structures, such as the cingulum and the prefrontal cortex.
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