Rehabilitative approaches seem promising for managing cognitive problems in multiple sclerosis.
Brian M. Sandroff, PhD
Any cognitive processing fixes for multiple sclerosis (MS) patients will require a multifaceted approach of behavioral and pharmacological interventions. However, a new study shows that clinical trials can be the best approach to identify potential treatments for cognition in MS patients.
Investigators from the University of Alabama at Birmingham conducted a literature review of cognitive rehabilitation and exercise training trials that managed cognitive impairment in MS patients. Their goal was to shorten the timeline for research to influence clinical practice.
“Whereas a typical review paper might just summarize the overall evidence for cognitive rehabilitation and exercise training effects on cognition in MS and be able to provide recommendations for clinical practice, we reviewed the literatures based on trajectory,” study author Brian M. Sandroff, PhD, explained to MD Magazine®. “That is, we took a chronological look at how the fields have evolved over the past 25 (cognitive rehabilitation) and 15 (exercise training) years, respectively.”
Following that, the study authors provided a “roadmap” for subsequent research efforts in order to implement what they learned into clinical practice and standards of care.
“Based on the current states of the evidence, one important way to do this should involve the development of generalizability/transportability trials whereby cognitive rehabilitation and exercise training interventions that have demonstrated success (based on multiple laboratory-based trials) can actually be delivered in real-world settings,” Sandroff added.
The investigators learned that overall, the body of evidence surrounding cognitive rehabilitation effects on cognition in MS patients has improved in the last 25 years. Few studies opposed the idea of using cognitive rehabilitation to manage MS-related cognitive impairment, they said.
“It was very eye-opening as to the proliferation of cognitive rehabilitation research that has involved computerized cognitive training as a primary intervention over the past few years,” Sandroff said. “The beauty of this approach is that it is easily applicable in the clinic, and might not necessarily need to be delivered by board-certified personnel (i.e., clinical psychologists/neuropsychologists).”
Exercise training, based on the idea of cognitive-motor coupling in MS, offered another promising behavioral approach for managing cognitive dysfunction in MS patients, the investigators found. This idea is in its infancy, they said, and there is a lack of available research.
Sandroff said that only one of the 22 published papers on the effects of exercise training on cognition in MS had recruited cognitively-impaired individuals as an a priori inclusion criterion—and that was just a case study. This was particularly important to consider when weighing exercising training as a possible treatment for MS-related cognitive impairment.
“The study participants actually need to have the problem that is being studied,” said Sandroff.
In the roadmap that the study authors laid out, they discussed the facilitators and hindrances (typically funding) that could influence cognitive rehabilitation and exercise training in relation to cognitive improvement in MS. They believe researchers should continue to develop innovative control conditions that can account for as many variables as possible, which will eventually develop to a more representative sample of MS patients.
Other considerations include the heterogeneity of trial designs, which may contribute to the lack of replication in further trials. Or, it could result in the premature dismissal of an intervention that turns out to be beneficial, the study authors suggested.
“Ultimately, this is what’s most important—being able to provide therapies that actually work so that patients can experience real-life improvements in cognition that may also translate to improvements in quality of life and other functional outcomes,” Sandroff said.
The study, “Will behavioral treatments for cognitive impairment in multiple sclerosis become standards-of-care?,” was published online in the International Journal of Psychophysiology.