Around half of all people with MS have difficulties at some time with aspects of thinking such as memory, concentration or problem solving, known as cognitive problems.
In this study, (Lincoln, Bradshaw, Constantinescu et al, 2020) a programme designed to improve cognitive skills (CRAMMS) was tested in a large clinical trial. A total of 449 people were recruited from five MS centres in England.
Just over half were assigned to the cognitive rehabilitation programme (CR group) and the remaining 204 received standard advice on how to manage cognitive difficulties from an MS nurse or occupational therapist (SA group).
A trainee psychologist presented the cognitive rehabilitation programme to groups of four to six participants who met weekly for 10 sessions.
The sessions covered techniques and exercises to retrain cognitive skills and taught practical ways to cope with memory issues in daily life.
Participants and a partner or friend were asked to complete a number of questionnaires at the beginning of the study, and at six months and 12 months.
The main measure for the effectiveness of the programme was the psychological impact of MS on quality of life at 12 months.
To get a standardised measure of concentration, planning and memory, participants also completed a set of cognitive tests at the beginning of the study, and at 6 and 12 months.
There was no difference in psychological impact of MS between the two groups at 12 months.
However, there was a small improvement in psychological impact of MS for the CR group at 6 months.
Other measures showed some improvements; at 6 and 12 months, those in the CR group reported fewer memory problems in day to day life (as reported by both participants as well as relatives) and better mood.
There were no differences in cognitive tests, levels of fatigue, employment status or stress experienced by carers at both 6 and 12 months.
The researchers questioned whether quality of life was appropriate as the main measure of effectiveness.
Quality of life is complex and influenced by many factors; it may be unrealistic to expect to achieve a measurable improvement from
a treatment which focuses on a single aspect of MS.
They recommend that future studies of cognitive rehabilitation use measures which more directly assess the impact of cognitive ability in daily life.
The researchers conclude that the results support providing cognitive rehabilitation, given the short-term improvements and the lack of alternative, more effective, treatments.
They also suggest that future studies should consider how improvements can be maintained and whether or not some people benefit more than others.
