Many MS patients undergo some cognitive impairment. Such impairments are common for many neurological diseases whether from a disease (Parkinson), a stroke or a trauma. Cognitive Rehabilitation Techniques (CRT) have been applied to cases , and it is comforting to the Multiple Sclerosis community to know that a recent study by the Kessler Foundation [1] showed  some success in applying CRTs to MS patients.

How did they measure cognitive improvements? Through the use a technique called fMRI or Functional Magnetic Resonance Imaging (fMRI). That technique consists in imaging the change in blood flow (hemodynamic response) related to energy use by neurons (Wikipedia). We have blogged about the use of  fMRIs before [2]

fMRI showing brain activity

 

Quoting the press release from the Kessler Foundation : ” After treatment, greater activation was evident on fMRI in the treatment group during performance of a memory task; no change was seen in the placebo group”. This greater activation was associated with memory improvement.

CRT is mostly associated with TBI (Traumatic Brain Injury) and the study in [3] describes the areas of intervention as “  attention, visual perception and constructional abilities, language and communication, memory, problem solving and executive functioning, multi-modal interventions, and comprehensive-holistic cognitive rehabilitation.

But what do CRTs consist of? A good description can be found in the the Learnet tutorial on Cognitive Intervention [4]. Quoting:

  • Traditional Cognitive Retraining: ..The goal of restoring cognitive functions: Retraining relies largely on focused cognitive exercises designed to restore impaired cognitive processes or skills…” In other words,  use the diminished cognition skills to bypass the hurdles
  •  Context-Sensitive Cognitive Intervention: “..Intervention and support includes flexible combination of cognitive exercises, task-specific training of relevant everyday skills, and intervention for strategic thinking and compensatory behavior in functional contexts…” In other words, environmental adaptations and supports to make everyday life possible.

The areas of intervention in Multiple sclerosis cases are based on the modified Story Memory Technique. Although details on what the Technique entails are scant, the main news as far as we are concerned is that this does not involve drugs. That is because drugs , in addition to their usual contingent of side effects seem to have very limited efficacy. Take Donepezil [5], or others [6] as study found them no better than a placebo.

So Cognitive Therapy looks promising.

Hope this helps,

Talk to your Doctor

Sources:

[1]  ScienceBlog ; “Greater brain activation after cognitive rehabilitation for MS” ; 2012

[2] MediNewsDigest; “Coma Consciousness: Not an Oxymoron Anymore”  ; December 30, 2011

[3] Archive Of Physical Medical Rehabilitation ; ” Evidence-based cognitive rehabilitation: recommendations for clinical practice.” ;

[4] Learnet Tutorial; “Tutorial: Cognitive Intervention / Rehabilitation” ;2006

[5] Neurologist ; “Is Donepezil Effective for Multiple Sclerosis-related Cognitive Dysfunction?: A Critically Appraised Topic.” ; 2012

[6] Cochrane Data Base of systematic reviews ; “Pharmacologic treatment for memory disorder in multiple sclerosis.” ; 2011

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