Neuropsychological Rehabilitation Reduces Perceived Cognitive Problems in MS

Background: There is preliminary evidence on the positive effects of neuropsychological rehabilitation in multiple sclerosis (MS), but the generalizability of the findings is limited by methodological problems. Furthermore, the factors contributing to rehabilitation outcome are not well known. Objectives: The aim of the present study was to determine the effects of strategy-oriented neuropsychological rehabilitation on MS and to identify factors associated with neuropsychological rehabilitation outcome. Methods: 102 relapsing-remitting MS patients with subjective and objective attentional deficits were randomized into an intervention and a control group. Neuropsychological assessments were performed and self-rating questionnaires were filled in at baseline, at three months immediately after the intervention, and at six months. Patients in the intervention group received neuropsychological rehabilitation once a week in 60-minute sessions during 13 consecutive weeks. The control group got no intervention. The effects of rehabilitation was evaluated by using  primary and secondary outcome measures, and the role of patient –related, illness –related, and intervention –related factors on rehabilitation outcome were assessed. Results: Neuropsychological rehabilitation including computer-based attention and working memory retraining, psychoeducation, strategy learning, and psychological support had a positive effect on two out of three primary outcome measures. The intervention group perceived significantly fewer cognitive deficits than the control group both immediately after the intervention and at six months. Furthermore, the personal rehabilitation goals were well achieved. On the other hand, the intervention had no significant effect on objective cognitive performance, fatigue, or mood. Patient –related factors were identified as key variables, whereas illness- and intervention factors did not have significant effect on rehabilitation outcome. The results showed that especially MS patients with more severe cognitive, mood and fatigue symptoms and more deficient cognitive performance as well as men, older patients with lower educational level benefitted from the intervention. Conclusions: Neuropsychological rehabilitation has a significant positive effect on perceived cognitive deficits in MS and patient –related factors seem to have an impact on rehabilitation outcome.