Mandell Center for Multiple Sclerosis, Mount Sinai Rehabilitation Hospital, Trinity Health Of New England, Hartford, CT, USA.
Psychology Service, VA Connecticut Healthcare System, West Haven, CT, USA.
Neuropsychol Rehabil. 2020 May;30(4):767-786. doi: 10.1080/09602011.2018.1491408. Epub 2018 Jul 5.
Cognitive impairment affects more than half of persons with multiple sclerosis (PwMS), and it is associated with difficulties in multiple aspects of daily functioning. There is a growing body of literature that has explored the use of cognitive-focused interventions in PwMS, which aim to improve cognition-related function through drill and practice exercises, training in compensatory strategies, or a combination of the two. The current study aimed to expand upon previously published meta-analyses in this area, exploring the effects of cognitive-focused interventions on objective and subjective functioning in PwMS, as well as determining demographic and treatment-related factors that may influence intervention efficacy. Thirty-three studies, with a total of 1890 participants, were included in the meta-analysis. Outcome measures were categorised based on the domain they presumably assessed. For objective cognitive functioning, weighted effect-size analysis revealed small effects of cognitive-focused interventions on working memory ( = 0.31) and visual learning ( = 0.32). Small mean effect sizes were also noted on self-reported anxiety ( = -0.30) and depression ( = -0.23). Cognitive-focused interventions did not produce changes in subjective cognitive functioning. Moderating variables and clinical applications are also discussed.
认知障碍影响了半数以上的多发性硬化症患者（PwMS），并与日常生活多个方面的功能障碍有关。越来越多的文献探索了在 PwMS 中使用以认知为重点的干预措施，这些措施旨在通过练习和实践练习、补偿策略训练或两者的结合来提高与认知相关的功能。本研究旨在扩展该领域之前发表的荟萃分析，探索以认知为重点的干预措施对 PwMS 客观和主观功能的影响，并确定可能影响干预效果的人口统计学和治疗相关因素。共有 33 项研究，总计 1890 名参与者被纳入荟萃分析。根据它们推测评估的领域对结果测量进行分类。对于客观认知功能，加权效应大小分析显示，以认知为重点的干预措施对工作记忆（ = 0.31）和视觉学习（ = 0.32）有较小的影响。自我报告的焦虑（ = -0.30）和抑郁（ = -0.23）也有较小的平均效应量。以认知为重点的干预措施并未改变主观认知功能。还讨论了调节变量和临床应用。
