22 February 2012

Patients with Multiple Sclerosis Benefit with Cognitive Rehabilitation Therapy for Improved Brain Performance

Cognitive rehabilitation therapy is a program to help brain-injured or otherwise cognitively impaired individuals to restore normal brain functions, or to compensate for cognitive loss or deficits. Cognitive rehabilitation primarily focuses on restoring or normalizing the following brain functions: attention, remembering, producing and understanding language, solving problems, and making decisions.

There are two parts to Cognitive therapy:

1. Improving the ability to perform the impaired function through therapy techniques and at home practice
2. Developing strategies for compensating for any residual deficits.

Furthermore, cognitive rehabilitation therapy break down the brain functions into their individual components so that the broken links can be found and addressed.

In a new study published in the March issue of Radiology, functional magnetic resonance imaging (fMRI) shows that cognitive rehabilitation changes brain function and improves cognitive performance in patients with relapsing-remitting multiple sclerosis (MS).

"These results prompt the use of specific computer-based rehabilitation programs to treat deficits in selected neuropsychological domains in patients with relapsing-remitting MS," said the study's lead author, Massimo Filippi, M.D., professor of neurology at the San Raffaele Vita-Salute University and director of the "BrainMap" interdepartmental research program and the Neuroimaging Research Unit, Department of Neuroscience, Scientific Institute San Raffaele, Milan, Italy. "They also suggest that fMRI might provide useful metrics to monitor the effects of rehab in MS."

Video: Multiple Sclerosis and Cognitive Rehabilitation Therapy

MS is a nervous system disease affecting the brain and spinal cord. MS damages a material called the myelin sheath that surrounds and protects nerve cells. This damage disrupts messages between the brain and other parts of the body, leading to symptoms such as muscle weakness, coordination and balance difficulties, numbness, problems with vision, memory loss and other cognitive issues. MS affects women more than men and often becomes symptomatic between the ages of 20 and 40.

In relapsing-remitting MS, the most common type, patients experience a series of attacks followed by partial or complete disappearance of symptoms. The interval between relapses can range from weeks to years.

Cognitive impairment affects a large proportion of patients with MS in the areas of attention, information processing, executive functions, memory and visual-spatial abilities. Cognitive dysfunction impacts a range of activities, including work, driving and social integration.

For the study, Dr. Filippi and colleagues recruited 20 patients with relapsing-remitting MS. Patients were randomized into two groups of 10. The first group received a 12-week program of computer-assisted cognitive rehabilitation of attention and information processing and executive functions, and the second (control) group received no cognitive rehabilitation.

Aspects of the rehabilitation program included a day-planning task, which employed realistic simulations of a set of scheduled dates and duties to address the patient's ability to organize, plan and develop solution strategies; and an attention task requiring the patient to simulate driving a train, carefully observing the control panel of the train and the countryside while encountering several distractions at increasing levels of difficulty.

All of the patients underwent neuropsychological assessment and MRI exams at baseline and after 12 weeks. As compared to their performance at baseline, the patients in the treatment group improved in tests of attention and information processing and executive functions. The fMRI results showed modifications in activity in several brain regions in the rehabilitation group, compared to the non-rehabilitation group. These fMRI modifications were correlated with cognitive improvement.

Analysis after cognitive rehabilitation found no structural changes in the gray matter or normal-appearing white matter of the brain in the treatment group.

"The findings demonstrated that computer-assisted cognitive rehabilitation in patients with MS results in an improvement of the trained cognitive functions," Dr. Filippi said. "However, the structural integrity of the brain's gray matter and white matter showed no modifications in these patients, suggesting an impairment of structural plasticity."


Radiological Society of North America
San Raffaele Vita-Salute University
New Developments on Degenerative Effects of Multiple Sclerosis
Scientists Study Secret Behind Chinese Herbal Medicine
New guideline: Caution needed when choosing seizure drugs for people with HIV/AIDS
Researchers Study Visual Intelligence Through Facebook Users
Decaffeinated Coffee Improves Brain Metabolism in Patients with Type 2 Diabetes
MIT News: How Conflict Influences Empathy.
Group Settings Can Diminish Expressions of Intelligence, Especially Among Women
MIT NEWS: The Advantage Of Ambiguity in Language
Healthy Diet Leads to Better Mental Performance and Minimizes Brain Shrinkage
Alzheimer's Disease Risk Minimized by Eating Fish