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Can cognitive rehabilitation help in MS? New study says: unlikely

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  • Can cognitive rehabilitation help in MS? New study says: unlikely

    The best way to treat cognitive issues in MS? Prevent them from happening in the first place by taking a DMT and exercising. -D

    Cognitive Rehabilitation for Attention and Memory in people with Multiple Sclerosis: a randomised controlled trial (CRAMMS)

    Authors:
    Nadina Lincoln
    Lucy Bradshaw
    Chris Constantinescu
    Florence Day
    Avril Drummond
    Deborah Fitzsimmons
    Shaun Harris
    Alan Montgomery
    Roshan das Nair

    Abstract

    Objective
    The aim was to assess the clinical and cost-effectiveness of cognitive rehabilitation for attention and memory problems in people with multiple sclerosis.

    Design
    Multi-centre, pragmatic, randomised controlled trial.

    Setting
    Community.

    Participants
    People with multiple sclerosis aged 18 to 69 years, who reported cognitive problems in daily life and had evidence of cognitive problems on standardised assessment.

    Interventions
    A group cognitive rehabilitation programme delivered in 10 weekly sessions in comparison with usual care.

    Main measures
    The primary outcome was the Multiple Sclerosis Impact Scale Psychological subscale at 12 months after randomisation. Secondary outcomes included measures of everyday memory problems, mood, fatigue, cognitive abilities and employment at 6 and 12 months after randomisation.

    Results
    245 participants were allocated to cognitive rehabilitation and 204 to usual care. Mean Multiple Sclerosis Impact Scale Psychological subscale at 12 months was 22.2 [SD=6.1] for cognitive rehabilitation and 23.4 [SD=6.0] for usual care group; adjusted difference -0.6, 95% CI -1.5 to 0.3, p=0.20. No differences were observed in cognitive abilities, fatigue or employment. There were small differences in favour of cognitive rehabilitation for the Multiple Sclerosis Impact Scale Psychological subscale at 6 months and everyday memory and mood at 6 and 12 months. There was no evidence of an effect on costs (-£808 95% CI -£2248 to £632) or on quality adjusted life year gain (0.00 95% CI -0.01 to 0.02).

    Conclusions
    This cognitive rehabilitation programme had no long-term benefits on the impact of multiple sclerosis on quality of life, but there was some evidence of an effect on everyday memory problems and mood.
    Dave Bexfield
    ActiveMSers
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