Cognitive rehabilitation in patients with advanced progressive multiple sclerosis: possible within limits?
ECTRIMS Online Library. Prouskas S. 09/12/19; 279508; 228
Stefanos Enricos Prouskas
Stefanos Enricos Prouskas
Contributions
Abstract

Abstract: 228

Type: Scientific Session

Abstract Category: RIMS - Symptoms Management (including cognition, fatigue, imbalance)

S.E. Prouskas1,2, N.D. Chiaravalloti3,4, N. Kant2, K.K. Ball5, V. de Groot6, B.M.J. Uitdehaag7, J.J.G. Geurts1, E.A. Kooij2, H.E. Hulst1

1Department of Anatomy and Neurosciences, Amsterdam UMC, Location VU University Medical Center, Amsterdam, 2Nieuw Unicum, Zandvoort, The Netherlands, 3Neuropsychology and Neuroscience Laboratory, Kessler Foundation, West Orange, 4Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, 5Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, United States, 6Department of Rehabilitation Medicine, 7Department of Neurology, Amsterdam UMC, Location VU University Medical Center, Amsterdam, The Netherlands

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.
N.D. Chiaravalloti has nothing to disclose.
N. Kant has nothing to disclose.
K.K. Ball holds stock in the Visual Awareness Research Group (formerly Visual Awareness, Inc.), and Posit Science, Inc, the companies that market the Useful Field of View Test and speed of processing training software.
V. de Groot has nothing to disclose.
B.M.J. Uitdehaag received compensation for consulting from Biogen, Genzyme, Merck Serono, Novartis, Roche, and Teva Pharmaceuticals.
J.J.G. Geurts has served as a consultant for Merck-Serono, Biogen, Novartis, Genzyme and Teva Pharmaceuticals.
E.A. Kooij has nothing to disclose.
H.E. Hulst serves as a consultant for Sanofi Genzyme, Merck BV and Biogen Idec.

Abstract: 228

Type: Scientific Session

Abstract Category: RIMS - Symptoms Management (including cognition, fatigue, imbalance)

S.E. Prouskas1,2, N.D. Chiaravalloti3,4, N. Kant2, K.K. Ball5, V. de Groot6, B.M.J. Uitdehaag7, J.J.G. Geurts1, E.A. Kooij2, H.E. Hulst1

1Department of Anatomy and Neurosciences, Amsterdam UMC, Location VU University Medical Center, Amsterdam, 2Nieuw Unicum, Zandvoort, The Netherlands, 3Neuropsychology and Neuroscience Laboratory, Kessler Foundation, West Orange, 4Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, 5Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, United States, 6Department of Rehabilitation Medicine, 7Department of Neurology, Amsterdam UMC, Location VU University Medical Center, Amsterdam, The Netherlands

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.
N.D. Chiaravalloti has nothing to disclose.
N. Kant has nothing to disclose.
K.K. Ball holds stock in the Visual Awareness Research Group (formerly Visual Awareness, Inc.), and Posit Science, Inc, the companies that market the Useful Field of View Test and speed of processing training software.
V. de Groot has nothing to disclose.
B.M.J. Uitdehaag received compensation for consulting from Biogen, Genzyme, Merck Serono, Novartis, Roche, and Teva Pharmaceuticals.
J.J.G. Geurts has served as a consultant for Merck-Serono, Biogen, Novartis, Genzyme and Teva Pharmaceuticals.
E.A. Kooij has nothing to disclose.
H.E. Hulst serves as a consultant for Sanofi Genzyme, Merck BV and Biogen Idec.

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