Cognitive rehabilitation in patients with advanced progressive multiple sclerosis: possible within limits?

Introduction: Progressive MS patients exhibit cognitive impairment with increased frequency and severity compared to RRMS patients. While cognitive rehabilitation seems to be a promising approach to treatment for patients with RRMS, patients with advanced progressive MS are underrepresented in most such studies. Therefore, the feasibility of cognitive rehabilitation in patients with progressive MS is unknown. Objectives: The feasibility of two cognitive interventions (functional training and compensatory strategies) was investigated in patients with progressive MS requiring assisted living. Methods: Eighteen patients with progressive MS requiring assisted living [median EDSS=7.5, mean age 58.1 (5.0) years, 13 SPMS, mean disease duration 20.6 (6.2) years] were randomized into 1) computer-based speed of processing training (SPT, n=9) for 5 weeks; or 2) compensatory memory strategies training (CST, n=9, care-as-usual) for 9 weeks. Patients underwent neuropsychological testing at baseline and follow-up. Feasibility was determined by evaluating practical aspects of the training (e.g. fatigue, motivation, concentration, difficulty, duration), as well as recruitment rate, dropout rate, completion rate, adherence rate and patient satisfaction (CSQ-8). Results: A number of patients contacted for participation deemed the proposed intervention too intensive time-wise, resulting in a 36% recruitment rate. For the SPT sessions, average self-reported energy level decreased minimally post-session (pre=6.9/10, post=6.4/10). Training difficulty (4.6) and duration (5.7) were almost ideal (5=ideal, < 5 too easy/short, >5 too difficult/long). Completion rates and adherence rates for both interventions were good (>70%). Increased fatigue and decreased adherence were observed on very warm (>30°C) days, for both interventions. CSQ-8 showed high satisfaction in both groups (SPT=28.1, CST=24). Conclusions: Our study shows that cognitive rehabilitation is within reach for patients with advanced progressive MS. For future studies we recommend screening a large number of potential participants, constant monitoring of fatigue and motivation, avoidance of warm temperatures, reduced session duration, and increased training frequency. Disclosure: S.E. Prouskas has nothing to disclose.