Advertisement

The Italian Journal of Neurological Sciences

, Volume 19, Supplement 6, pp S431–S438 | Cite as

Computer-assisted memory retraining of patients with multiple sclerosis

  • L. Mendozzi
  • L. Pugnetti
  • A. Motta
  • E. Barbieri
  • A. Gambini
  • C. L. Cazzullo
Cognitive Dysfunction in MS

Abstract

This study aimed to assess the efficacy and specificity of direct computer-assisted memory retraining (CR) in MS patients, in comparison to non-specific retraining, while controlling for severity of impairment, psychiatric symptoms and retest effects. Sixty patients with definite MS and a stable clinical condition were selected. All were assessed neuropsychologically and divided into three matched groups. One group received an 8-week specific CR programme (SCRP) and another received a non-specific 8-week CR programme (NCRP) to retrain attention; a third (control) group received no treatment. After the programmes were completed, all patients were reexamined with the same test battery. Patients were impaired on all 11 memory and attention tests at baseline. Those who received SCRP improved on 7 memory outcome measures, compared to only 1 in the NCRP group and none in the control group. Attention training had no significant effect on relevant outcome measures. Some non-retrained patients showed deterioration of cognitive performance at retest. These results indicate that direct memory training in MS patients is effective in the short-term and is specific. In selected cases, benefits extended to everyday life activities.

Key words

Multiple sclerosis Memory Attention Cognitive impairments Cognitive retraining 

Sommario

Abbiamo valutato l'efficacia e la specificità della riabilitazione diretta della memoria in pazienti con sclerosi multipla (SM) clinicamente definita. Sessanta pazienti con SM in fase stabile sono stati suddivisi in tre gruppi di pari numerosità e paragonabili per disabilità alla EDSS (expanded disability status scale) e durata di malattia e valutati con una batteria di 11 test di memoria e attenzione. Al primo gruppo è stato offerto un training della memoria assistito da computer consistente in due sedute settimanali di 45 min ciascuna per un periodo di 8 settimane. Al secondo gruppo è stato offerto un analogo training mirato a migliorare l'attentione. Il terzo gruppo estato solo sottoposto alle valutazioni neuropsicologiche di ingresso e termine dello studio. All' ingresso, i pazienti hanno mostrato deficit significativi alla batteria di valutazione. Dopo il trattamento , il gruppo sottoposto a training specifico ha mostrato miglioramenti significativi in 7 degli 11 test, il gruppo assegnato al training aspecifico ha migliorato in un solo test, mentre il gruppo non trattato e rimasto sostanzialmente stabile, nonostante alcuni componenti abbiano evidenziato un decremento delle prestazioni cognitive. Il training dell'attenzione non ha prodotto variazioni significative della velocità di risposta I risultati di questo studio suggeriscono the il training diretto della memoria sia, almeno a breve termine, efficace, e the sia specifico. In alcuni casi abbiamo potuto rilevare the i benefici si estendono alle attivitd della vita quotidiana.

References

  1. 1.
    Schwartz CE, Kozora E, Zeng Q (1996) Towards patient collaboration in cognitive assessment: Specificity, sensitivity and incremental validity of self-report. Ann Behav Med 18:177–184Google Scholar
  2. 2.
    Richardson JTE (1996) Memory impairment in multiple sclerosis: Reports of patients and relatives. Br J Clin Psychol 35:205–219Google Scholar
  3. 3.
    Rao SM (1997) Neuropsychological aspects of multiple sclerosis. In: Raine CS, McFarland HE Tourtelotte WW (eds) Multiple sclerosis: Clinical and pathogenetic basis. Chapman & Hall, London, pp 357–363Google Scholar
  4. 4.
    Beatty WW, Monson N (1991) Metamemory in multiple sclerosis. J Clin Exp Neuropsychol 13:309–327Google Scholar
  5. 5.
    Kujala P, Portin R, Ruutiainen J (1996) Memory deficits and early cognitive deterioration in MS. Acta Neurol Scand 93:329–335Google Scholar
  6. 6.
    Thornton AE, Raz N (1997) Memory impairment in multiple sclerosis: A quantitative review. Neuropsychology 11(3):357–366Google Scholar
  7. 7.
    Amato MP, Ponziani G, Pracucci G et al (1995) Cognitive impairment in early onset multiples clerosis. Pattern, predictors, and impact on everyday life in a 4-year follow up. Arch Neurol 52:168–172Google Scholar
  8. 8.
    Kujala P, Portin R, Ruutiainen J (1997) The progress of cognitive decline in multiple sclerosis. A controlled 3-year follow-up. Brain 120:289–297Google Scholar
  9. 9.
    Rao SM, Leo GJ, Bernardin L, Unverzagt F (1991) Cognitive dysfunction in multiple sclerosis. I. Frequency, pattern and prediction. Neurology 41:685–691Google Scholar
  10. 10.
    Thompson AJ (1996) Multiple sclerosis: Symptomatic treatment. J Neurol 243:559–565Google Scholar
  11. 11.
    Robertson IH (1993) Cognitive rehabilitation in neurologic disease. Curr Opin Neurol 6:756–760Google Scholar
  12. 12.
    Poser CM, Paty DW, Scheinberg L et al (1983) New diagnostic criteria for multiple sclerosis — guidelines for research protocols. Ann Neurol 13:227–231Google Scholar
  13. 13.
    Mendozzi L, Pugnetti L, Saccani M, Motta A (1993) Frontal lobe dysfunction in multiple sclerosis asassessed by means of Lurian tasks: Effect of age at onset. J Neurol Sci 115:S42-S50Google Scholar
  14. 14.
    Wechsler DA (1945) A standardized memory scale for clinical use. J Psychol 19:87–95Google Scholar
  15. 15.
    Golden CJ, Hammeke TA, Purish AD (1980) The LuriaNebraska neuropsychological battery: Manual (revised). Western Psychological Service, Los AngelesGoogle Scholar
  16. 16.
    Jonsson A, Korfitzen EM, Heltberg A et al (1993) Effects of neuropsychological treatment in patients with multiple sclerosis. Acta Neurol Scand 88:394–400Google Scholar
  17. 17.
    Nyenhuis DL, Rao SM, Zajecka JM et al (1995) Mood disturbance versus other symptoms of depression in multiple sclerosis. J Int Neuropsychol Soc 1:291–296Google Scholar
  18. 18.
    Plohmann AM, Kappos L, Ammann W et al (1998) Computer assisted retraining of attentional impairments in patients with multiple sclerosis. J Neurol Neurosurg Psychiatry 64:455–462Google Scholar
  19. 19.
    Sohlberg MM, Mateer CA (1987) Effectiveness of an attention-training program. J Clin Exp Neuropsychol 9:117–130Google Scholar
  20. 20.
    Sturm W, Willmes K (1991) Efficacy of a reaction training on various attentional and cognitive functions in stroke patients. Neuropsychol Rehabil 1:259–280Google Scholar
  21. 21.
    Mariani C, Farina E, Cappa SF et al (1991) Neuropsychological assessment in multiple sclerosis:A follow-up study with magnetic resonance imaging. J Neurol 238:395–400Google Scholar
  22. 22.
    Hohol MJ, Guttmann CRG, Orav J, et al. (1997) Serial neuropsychological assessment and magnetic resonance imaging analysis in multiple sclerosis. Arch Neurol 54:1018–1025Google Scholar

Copyright information

© Springer-Verlag 1998

Authors and Affiliations

  • L. Mendozzi
    • 1
  • L. Pugnetti
    • 1
  • A. Motta
    • 2
  • E. Barbieri
    • 1
  • A. Gambini
    • 3
  • C. L. Cazzullo
    • 1
  1. 1.Scientific Institute “S. Maria Nascente” “Don Gnocchi” FoundationMilanoItaly
  2. 2.Psychiatric UnitCasa di Cura Policlinico di MonzaMonzaItaly
  3. 3.Institute of StatisticsUniversity of GenovaGenovaItaly

Personalised recommendations