Institute of Neuroimmunology and Multiple Sclerosis (INIMS), Center for Molecular Neurobiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany.
Mult Scler Relat Disord. 2022 Mar;59:103687. doi: 10.1016/j.msard.2022.103687. Epub 2022 Feb 13.
Multiple sclerosis (MS) is an inflammatory and neurodegenerative disease of the central nervous system of potential autoimmune origin that is frequently associated with neuropsychiatric symptoms and cognitive deficits, as well as with fatigue, stress and psychosocial burden. In the present controlled multi-centre trial we investigated whether two specific neuropsychological interventions (1. metacognitive training (MaTiMS); 2. computerized working memory training (BrainStim) in combination with MaTiMS) applied as add-on therapies to real life standard rehabilitation lead to increased benefit in self-perceived cognitive deficits (the primary outcome) in MS patients compared to standard rehab.
288 adult persons in three German rehab centers with a confirmed diagnosis of MS were sequentially allocated to one of the three intervention groups. 249 (87%) participants completed the post assessment and 187 (63%) the online survey after 12 months. Perceived cognitive deficits, mood, fatigue, coping, and activity were evaluated by self-reports and neuropsychological tests at baseline and 4 weeks postintervention. All self-reports were additionally administered digitally at three, six, and twelve months from baseline.
We could not show differential effects on the primary outcome between the intervention groups and the control group (p=.369, p=.934). Immediately after each intervention we could show beneficial time effects in all three groups on self-perceived cognitive deficits as well as on most of the other outcomes. The reported effects were however not sustained at 6 months follow-up.
Our findings could not show an additional effect of specific cognitive training on cognitive deficit perception in MS. However, findings indicate that MS rehabilitation may improve patient reported outcomes in the short term. They also underline the need for concepts to maintain rehabilitation gains when patients return back home.
多发性硬化症（MS）是一种潜在自身免疫性的中枢神经系统炎症性和神经退行性疾病，常伴有神经精神症状和认知缺陷，以及疲劳、压力和心理社会负担。在本项对照多中心试验中，我们研究了两种特定的神经心理学干预措施（1. 元认知训练（MaTiMS）；2. 计算机化工作记忆训练（BrainStim）与 MaTiMS 相结合）作为附加疗法应用于现实生活中的标准康复治疗是否会导致 MS 患者自我感知的认知缺陷（主要结局）得到改善，与标准康复相比。
三个德国康复中心的 288 名成人患者确诊为 MS，他们按顺序分配到三个干预组之一。249 名（87%）参与者完成了后评估，187 名（63%）参与者在 12 个月后完成了在线调查。在基线和干预后 4 周通过自我报告和神经心理学测试评估认知缺陷、情绪、疲劳、应对和活动。所有自我报告在基线后 3、6 和 12 个月时也通过数字方式进行评估。
我们无法显示干预组与对照组之间在主要结局上的差异效应（p=.369，p=.934）。在每次干预后，我们可以立即看到所有三组的自我感知认知缺陷以及其他大多数结果都有有益的时间效应。然而，报告的效果在 6 个月的随访中没有持续。
我们的研究结果无法显示特定认知训练对 MS 患者认知缺陷感知的额外效果。然而，研究结果表明，MS 康复可能在短期内改善患者报告的结果。它们还强调了需要维持康复效果的概念，当患者返回家中时。
