Cogito Center for Applied Neurocognition and Neuropsychological Research, Düsseldorf, Germany.
Department of Experimental Psychology, Heinrich Heine University, Düsseldorf, Germany.
J Neurol. 2023 Jun;270(6):3058-3071. doi: 10.1007/s00415-023-11616-2. Epub 2023 Feb 25.
We aimed at examining the effects of a known metacognitive training in MS (MaTiMS) and its modification with an additional neuroeducational module and mindfulness-based exercises (MaTiMS-modified) on neuropsychiatric and cognitive outcomes in people with progressive multiple sclerosis (pwpMS). Exploratively, we investigated whether the modification may show an additional benefit.
Both interventions were administered in small groups of ambulatory patients. Neuropsychological testing before and after the 3- to 4-week intervention phase comprised patient reported outcomes and cognitive tests. After 3, 6 and 12 months, participants completed online surveys. Analysis of change scores (between baseline and retest) with t-tests (Mann-Whitney U and Wilcoxon tests, respectively) and mixed ANCOVAs with repeated measures for comparison of both interventions were conducted.
A total of 65 pwpMS turned to a final sample of 50 (n = 15 excluded due to drop-outs, occurrence of relapse or steroid treatment). Change scores within MaTiMS revealed no significant effect on the PDQ-20 total score and only a significant effect on the subscale retrospective memory lasting 3 months with a moderate effect size. In contrast, MaTiMS-modified revealed a highly significant change in PDQ-20 total compared to baseline and significant improvements with small to moderate effect sizes on all PDQ-20 subscales (lasting until 3 months), in self-efficacy, stress, visuo-spatial working memory (moderate effect sizes), and fatigue (small effect size). While no interaction effect between time and group could be revealed, a significant main effect for time was found in PDQ-20 total.
Both MaTiMS and MaTiMS-modified positively affected perceived cognitive deficits. However, our data speak in favor of additional benefits by adding neuroeducational and mindfulness-based exercises thus being valuable methods to support brain health including self-efficacy, perceived stress, and fatigue, even in patients with a chronic and progressive brain disease.
我们旨在研究一种已知的多发性硬化症（MS）元认知训练（MaTiMS）及其通过额外的神经教育模块和基于正念的练习进行修改（MaTiMS 改良）对进展性多发性硬化症（pwpMS）患者的神经精神和认知结果的影响。探索性地，我们调查了这种修改是否可能显示出额外的益处。
两种干预措施均以小组形式在门诊患者中进行。在 3 至 4 周的干预阶段前后，进行神经心理学测试，包括患者报告的结果和认知测试。在 3、6 和 12 个月后，参与者完成在线调查。使用 t 检验（Mann-Whitney U 和 Wilcoxon 检验，分别）和混合重复测量方差分析对变化分数（与基线和复测之间）进行分析，并对两种干预措施进行比较。
共有 65 名 pwpMS 最终纳入 50 名（n=15 名因脱落、复发或类固醇治疗而排除）。MaTiMS 内的变化分数在 PDQ-20 总分上没有显著影响，仅在回顾性记忆子量表上持续 3 个月具有中等效应量的显著影响。相比之下，MaTiMS 改良与基线相比，PDQ-20 总分有显著变化，所有 PDQ-20 子量表（持续至 3 个月）、自我效能、压力、视空间工作记忆（中等效应量）和疲劳（小效应量）均有显著改善。虽然时间和组之间没有显示出交互效应，但 PDQ-20 总分上存在显著的时间主效应。
MaTiMS 和 MaTiMS 改良都对感知到的认知缺陷产生了积极影响。然而，我们的数据表明，通过添加神经教育和基于正念的练习可以带来额外的益处，因此是支持大脑健康的有价值的方法，包括自我效能、感知压力和疲劳，即使在患有慢性和进行性脑疾病的患者中也是如此。
