Impact of a Cognitive Rehabilitation Intervention on Depressive Symptoms

Background: The effects of multiple sclerosis (MS) on cognition have gained increasing recognition as one of the major disabling symptoms of the disease. Cognitive symptoms often co-occur with depressive symptoms and may increase the impact of cognitive changes on quality of life.

Objectives: The purpose of this study was to determine if participants in a trial of a novel cognitive rehabilitation intervention (MAPSS-MS; Memory, Attention, Problem Solving Skills in MS) would experience improvements in depressive symptoms and sustain these improvements over the 6-month follow-up.

Methods: Persons with MS (N=183) were randomly assigned to either the 8-week MAPSS-MS intervention (n=93; group sessions plus prescribed computer training) or usual care plus freely available computer games (n=90). The majority were female (87%), white (75%), married (64%), well educated and had a mean age of 49.6 + 8.0 years. On average, this sample had mild to moderate impairment from MS with mean EDSS score of 5.2 + 1.56.
Participants completed self-report and performance measures of cognitive functioning and depressive symptoms at baseline, and immediately, 3 and 6 months post-intervention. The 10-item Center for Epidemiologic Studies Depression Scale (CES-D) was used as a measure of depressive symptoms during the past week.
Changes in study outcomes were analyzed using a repeated measures ANOVA design to determine time and time by group effects on outcomes. Because of the large variability among individuals with MS, we used Analysis of Covariance (ANCOVA) to determine the differences between the intervention group and comparison groups at T2, T3, and T4, after controlling for baseline scores.

Results: On the CESD, the time by group effect was significant (F=2.01, P<.05); the intervention group’s reported depressive symptoms decreased, while the control group remained about the same. The ANCOVA analysis revealed that immediately following the intervention, the intervention group scored significantly lower on the CESD (F=7.63, p=.006). At 3 months post-intervention, the intervention group scored significantly lower on the CESD (F=5.04, p<.05) but this effect did not persist at 6 months.

Conclusions: These findings suggest that the impact of the MAPSS-MS intervention is not limited to cognitive functioning. The statistically significant time by group effect on the CESD speaks to the power of the group intervention in helping participants reframe the challenges they face, particularly in the area of cognitive abilities.