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MSVirtual2020: Does effortful reading improve cognitive performance in MS?

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  • MSVirtual2020: Does effortful reading improve cognitive performance in MS?

    P0810 - Great Expectations in Multiple Sclerosis (GEMS): Does effortful reading improve cognitive performance in multiple sclerosis? (ID 354)

    K. French
    K. French E. Duffy

    Presentation Number
    Presentation Topic
    Neuropsychology and Cognition


    Early cognitive impairment in MS has been shown to predict more disability and worse prognosis (Giovannoni, 2016). The concept of brain reserve is a hypothetical notion that illustrates the individual’s specific innate and finite capacity to withstand injury to the brain and maintain normal function (Krieger, 2018). Based off recent work in the cognitive and brain reserve literature, there is evidence that reading early in life is associated with preserved memory and larger hippocampal volumes in multiple sclerosis (Sumowski J. R., 2016). Many cognitively enriching activities exist including reading, writing, playing a musical instrument, and certain hobbies, but only reading and writing are consistently shown to have an impact on cognitive reserve (Sumowski J. R., 2016).

    The primary endpoint was to determine whether cognitively effortful reading activities impact cognitive processing and learning over 1 year in patients with multiple sclerosis.

    A one-year prospective, randomized, blinded study. A total of 22 patients completed the study with 14 patients randomized to the intervention group and 8 patients to the control group. Participants were 18 year of age and older with an established diagnosis of multiple sclerosis. Two established neuro-cognitive testing measures, the symbol digit modalities test (SDMT) and the California verbal learning test version II (CVLT-2) were used as primary endpoints for cognitive status. Neuro-cognitive testing was performed at the initial enrollment for baseline status and then at completion of 1 year.

    SDMT scores for the intervention group were significant (7/14 versus 0/8 patients in the control group; p=0.04885). 14% of patients (2/14) in the intervention group had worse SDMT scores versus 25% in the control group. Short-delayed free recall (SDFR) demonstrated clinically significant improvement versus the control group (p=0.0034). Retroactive interference was clinically significant with 3/14 (21.4%) patients in the intervention group versus 1/8 (12.5%) in the control group (p=0.0169).

    The SDMT and portions of the CVLT-II can be practically and feasibly implemented into the clinical setting. Effortful reading programs can be employed easily into the treatment models of multiple sclerosis management. The prescription of reading challenging classic literature has the potential to stabilize and, in some cases, improve certain domains of cognition.
    Dave Bexfield

  • #2
    I’m curious to know if “effortful” listening to audio recordings would Also help short delayed free recall In MSers. I’ve found it difficult to read print some days and have been trying out audio books. I noticed that I sometimes relisten to a passage and not realize it. Instead of being critical of my lack of recall, I have been taking the approach that it a chance to better absorb (encode?) the material. And I think I am better absorbing material with audio, where with print, I had been more reluctant to reread passages I knew that I had recently read. I think I psychologically felt, I can’t keep rereading the same page. This frustration takes the enjoyment away from reading. If It’s helpful to any of you, I found putting short notes in back of book about main points or characters in a passage, helped me with recall and focus on story. I have recently been looking for a hybrid, where it’s audio but you can read it too. I think I need different resources based on different MS days. Not sure if nook will do that. Anyone have suggestions that worked for you ? Also, I thought it was interesting that Author says to prescribe “challenging classical literature”. One would think the MSer would have their own preference for topics worthy of their own “effortful” reading. Just saying’.


    • #3
      Very interesting. I had the exact same question Suebee. I've been "reading" a lot of audio books, but this article makes me wonder if the mechanics of reading and writing text are what matters to improving cognition. Thinking about what it takes to write something coherently and read and comprehend I can see how my listening to a book doesn't do quite the same things. I admit, reading a book is a lot harder for me than listening to one.

      Maybe challenging classical literature is more engaging mentally? I wonder if poetry is just as beneficial?


      My Two Numb Feet - An MS Diary


      • #4
        Liv well, yes I agree with you, poetry must be able to get the neurons moving too!!! Poetry requires contemplation/ reflection on word meaning and abstract thought. And it can be beautiful, soul lifting. I felt this poem Kindness by Nye spoke to me about how to reflect on my bad MS days...couldn't resist quoting a poem excerpt, forgive me

        " ...Before you know kindness as the deepest thing inside,
        you must know sorrow as the other deepest thing.
        You must wake up with sorrow.
        You must speak to it till your voice
        catches the thread of all sorrows
        and you see the size of the cloth.

        Then it is only kindness that makes sense anymore,
        only kindness that ties your shoes
        and sends you out into the day to mail letters and purchase bread,
        only kindness that raises its head
        from the crowd of the world to say
        It is I you have been looking for,
        and then goes with you everywhere
        like a shadow or a friend.
        —Naomi Shihab Nye
        Doesn't that connect to chronic illness somehow? The poem puts words to the way sorrow feels, and reminds (without being preachy) that there are still good things, kindness, around you.
        Liv do you have a favorite uplifting poem?


        • #5
          Very nice bit of prose Suebee. I like a lot of what Mary Oliver has written. One of my favorites of hers is "The Summer Day." The last two lines of that poem always inspire me:

          "Tell me, what is it you plan to do
          with your one wild and precious life?"


          My Two Numb Feet - An MS Diary