Mental Health and Clinical Neurosciences Unit, School of Medicine, Institute of Mental Health, University of Nottingham, Nottingham, UK.
College of Social Science, University of Lincoln, Lincoln, UK.
Mult Scler. 2023 Oct;29(11-12):1482-1492. doi: 10.1177/13524585231189470. Epub 2023 Aug 1.
Up to 70% of people with multiple sclerosis (MS) experience cognitive difficulties. Cognitive rehabilitation is a type of therapy that helps manage cognitive problems.
The Cognitive Rehabilitation for Attention and Memory in MS (CRAMMS) trial showed some evidence of effectiveness of cognitive rehabilitation in improving cognitive function, with some participants benefitting more than others. We therefore conducted a secondary analysis of the CRAMMS data to understand who benefits most.
We grouped baseline data into four categories of possible predictors. We used regression models to identify specific factors/characteristics that could predict the likelihood that an individual will benefit from cognitive rehabilitation.
The models predicted whether a participant improved or did not improve in neuropsychological function following cognitive rehabilitation in up to 86% of participants. Results suggest that younger participants with medium to high education, diagnosed with relapsing-remitting multiple sclerosis (RRMS) and primary-progressive multiple sclerosis (PPMS) who have not experienced any recent relapses, with mild to moderate cognitive difficulties were most likely to benefit from cognitive rehabilitation.
We can predict which participants are most likely to demonstrate significant improvements in neuropsychological function following group-based cognitive rehabilitation. Clinically, this allows us to optimise limited neuropsychology resources by offering such cognitive rehabilitation to those most likely to benefit.
多达 70%的多发性硬化症（MS）患者会出现认知困难。认知康复是一种帮助管理认知问题的治疗方法。
认知康复治疗多发性硬化症注意力和记忆力（CRAMMS）试验表明，认知康复在改善认知功能方面具有一定的有效性证据，一些参与者比其他人受益更多。因此，我们对 CRAMMS 数据进行了二次分析，以了解谁受益最多。
我们将基线数据分为四个可能的预测因素类别。我们使用回归模型来确定哪些特定的因素/特征可以预测个体接受认知康复后获益的可能性。
在多达 86%的参与者中，这些模型预测了他们在认知康复后神经心理学功能的改善或未改善情况。结果表明，年龄较小、受教育程度较高、诊断为复发缓解型多发性硬化症（RRMS）和原发性进展型多发性硬化症（PPMS）、最近没有经历过复发、认知困难程度较轻至中度的参与者最有可能从认知康复中获益。
我们可以预测哪些参与者在接受基于群体的认知康复后，在神经心理学功能方面最有可能显著改善。从临床角度来看，这使我们能够通过向最有可能受益的患者提供认知康复，优化有限的神经心理学资源。
