MS Cognitive Problems Can Ease With Rehab, Mindfulness Training

Two alternative treatments for the cognitive challenges people with multiple sclerosis (MS) can face in daily life — cognitive rehabilitation therapy (CRT) and mindfulness-based cognitive therapy (MBCT) — were found to helpful in a clinical trial.

Patients randomized to either treatment approach in the REMIND-MS study had fewer complaints about their cognition, although most benefits were lost within six months of the sessions’ ending.

CRT was successful in helping patients to achieve cognitive goals in the long term, while MBCT improved cognitive performance, the researchers reported. Those with fewer cognitive problems before treatment also benefited the most from these approaches.

Trial results “provide insight in the specific contributions of available cognitive treatments for MS patients,” the team wrote.

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The study, “Cognitive rehabilitation and mindfulness reduce cognitive complaints in multiple sclerosis (REMIND-MS): a randomized controlled trial,” was published in the journal Multiple Sclerosis and Related Disorders.

In MS, the inflammation that leads to brain and spinal cord damage can cause cognitive difficulties, which can affect daily function and quality of life.

However, studies evaluating interventions to improve MS-related cognitive problems are limited, the researchers noted, with most using interventions that focused on improving objective measures of cognition and failing to adequately capture real-world cognitive problems.

CRT refers to a set of interventions that aim to improve a person’s ability to perform cognitive tasks after a brain injury. CRT falls into two types: a restorative approach to retrain lost cognitive skills and compensatory CRT, which involves providing strategies to compensate for the lost skills.

MBCT teaches an individual to direct their attention to the present moment in a nonjudgmental manner.

The REMIND-MS study, which enrolled patients in Amsterdam between May 2017 and January 2020, evaluated the impact of compensatory CRT and MBCT compared to “enhanced” treatment as usual (ETAU) on MS patient-reported cognitive problems.

Most of its 110 patients (mean age of 48.7, 75% female) had relapsing-remitting MS (66%). Among participants, 37 were randomly assigned to CRT, 36 to MBCT, and 37 to ETAU, or a single meeting with an MS nurse specialist plus usual care.

CRT and MBCT were applied during nine weekly group-based sessions, each lasting 2.5 hours. CRT focused on providing strategies to compensate for impairments in processing speed, memory, executive function, mental fatigue, emotional and behavioral changes, and grief.

MBCT combined mindfulness-based stress reduction with elements of cognitive behavioral therapy. Participants were trained to self-regulate attention and nonjudgmental awareness of moment-to-moment experiences (emotions, thoughts, and behaviors). The final MBCT session was a silent retreat that lasted five hours.

Patients in both groups also received homework assignments that took 30 to 45 minutes, six days a week.

Those given ETAU met once with an MS specialist nurse for psychological education, which was also added to CRT and MBCT for consistency.

The trial’s main goal was to determine changes in patient-reported cognitive complaints, as assessed by the Cognitive Failures Questionnaire (CFQ), whose 25 items focus on cognitive mistakes during everyday tasks.

Researchers also measured cognitive problems related to executive functioning using the Behavior Rating Inventory of Executive Function–Adult Version (BRIEF-A). Outcomes were examined immediately after treatment and again six months later.

Gains evident at close of treatment sessions, but not months later

At the first assessment, patients given either CRT or MBCT reported significantly fewer cognitive mistakes on the CFQ than those given enhanced usual care. Similarly, MBCT showed improvement in the BRIEF-A behavioral regulation domain, or self-regulation in everyday life.

CRT and MBCT also positively affected the BRIEF-A metacognition domain (thinking about thinking).

At the six-month assessment, in contrast, neither CRT nor MBCT showed an effect on cognitive problems relative to ETAU.

In secondary examinations, however, CRT positively affected goal attainment scaling (GAS) at six months. GAS assessed two cognitive goals set by each patient before treatment that concerned daily life problems due to cognitive difficulties.

MBCT did not affect GAS, but improved processing speed at six months.

The team also noted that participants with fewer cognitive complaints before treatment benefited more from CRT on the CFQ at the post-treatment assessment. Likewise, patients with better processing speed at treatment start benefited more from MBCT regarding cognitive mistakes.

“Both CRT and MBCT positively affected cognitive problems experienced by MS patients in their daily lives,” the researchers concluded.

The findings help understand how specific cognitive treatments affect cognition in MS patients, they added, which may “contribute to customized healthcare decisions to treat cognitive problems in MS.”