Computer Assisted Cognitive Rehabilitation for Persons With Multiple Sclerosis
Overview
- Phase
- Not Applicable
- Intervention
- Not specified
- Conditions
- Multiple Sclerosis
- Sponsor
- University of Texas at Austin
- Enrollment
- 183
- Locations
- 1
- Primary Endpoint
- Use of Compensatory Cognitive Strategies
- Status
- Completed
- Last Updated
- last year
Overview
Brief Summary
The effects of multiple sclerosis (MS) on cognition, thought to occur in 50-75% of persons with MS, have gained increasing recognition as one of the major disabling symptoms of the disease. While numerous studies have addressed the emotional and physical impact of MS, little attention has been given to strategies that might help manage the cognitive changes commonly experienced by persons with MS. The proposed study will test a novel computer-assisted cognitive rehabilitation intervention, MAPSS-MS (Memory, Attention, & Problem Solving Skills for Persons with MS). The MAPSS-MS integrates the powerful effects of group interventions to build self-efficacy for new cognitive compensatory strategies/behaviors with individual home-based computer-assisted training. The computer training will assist individuals to develop cognitive skills that they can apply to everyday life using the compensatory strategies learned in the class sessions. In the recently completed exploratory study with 61 persons with MS (R21NR011076), the eight-week MAPSS-MS intervention was acceptable and feasible and had medium to large effects on the use of compensatory strategies and performance on neuropsychological tests of verbal memory. The proposed study will test the refined MAPSS-MS intervention with a larger more diverse sample (N=180) across multiple sites, extend the period of post-intervention follow-up to 6 months and establish whether performance improvements on neuropsychological tests make the important transfer to improved neuro-cognitive functioning in everyday life.
The specific aims of this study are to: (1) Evaluate the efficacy of the novel MAPSS-MS cognitive rehabilitation intervention to improve overall neuro-cognitive competence in activities of daily living including verbal memory performance, use of compensatory cognitive strategies and performance on cognitive-related instrumental activities of daily living (IADL) among persons with MS; (2) Evaluate the efficacy of the MAPSS-MS intervention to improve self-efficacy and related aspects of cognitive performance (non-verbal learning/memory, information processing speed and attention, verbal fluency and complex scanning and tracking) among persons with MS; and (3) Determine the number of intervention participants who achieve and maintain their self-identified cognitive goals three and six months following the intervention. The effects of the intervention on outcome variables will be assessed using a randomized controlled trial design with a comparison group receiving usual care computer games. Measurements of study variables will occur at baseline, immediately after the MAPSS-MS intervention, and three months and six months after the intervention is complete. Statistical analysis will include descriptive statistics and HLM analysis to account for the nested design. The intent-to-treat approach will be used.
Public Health Statement: This research will provide new knowledge about an innovative intervention to improve memory, use of compensatory strategies, and performance of cognitive activities and instrumental activities of daily living for persons with MS. If effective, the intervention would provide a new and feasible approach to target a serious, debilitating problem commonly experienced by persons with MS.
Investigators
Alexa Stuifbergen
Professor and Dean
University of Texas at Austin
Eligibility Criteria
Inclusion Criteria
- •Clinically definite diagnosis of MS;
- •Age 18 to 60;
- •Capable of understanding and complying with the study protocol;
- •Able to read and write in English;
- •Visual acuity of at least 20/70 with correction in order to work on the computer screen;
- •Stable disease at the time of entry into the study (relapse free for at least 90 days);
- •Subjective concerns about their cognitive functioning (based on the Perceived Deficits Questionnaire); and
- •Home internet access;
Exclusion Criteria
- •Other medical causes of dementia or other neurological disorders that may impact cognition or emotions;
- •Evidence of major psychiatric disorder; or
- •Major functional limitations that preclude them from participating in the study.
Outcomes
Primary Outcomes
Use of Compensatory Cognitive Strategies
Time Frame: 6 months post-intervention
Scores on the Strategy Subscale of the Multi-Factorial Memory Memory Questionnaire. The subscale includes 19 various memory aids and strategies and respondents are asked to rate how frequently they used each strategy during the past 2 weeks using a 5 point scale (never to all the time). Scores can range from 0 to 76. HIgher scores indicate greater use of compensatory memory strategies.
Neuro-cognitive Competence in Daily Living - California Verbal Learning Test-II
Time Frame: 6 months post-intervention
Verbal memory performance (verbal learning and remembering) as measured by performance on the California Verbal Learning Test II (CVLT-II). Total score represents the number of words recalled from a 16 item list over 5 trials. Higher scores represent greater verbal learning and remembering. Scores can range from 0 to 80.
Cognitive-related Instrumental Activities of Daily Living (IADL) Among Persons With MS
Time Frame: 6 months post intervention
Scores on the Everyday Problems Test - Revised (EPT-R). This scale assess the cognitive ability to reason and solve problems encountered in daily living. The revised version included 30 items and scores can range from 0 to 30. HIgher scores indicate better performance on problem solving.
Secondary Outcomes
- Self-Efficacy(6 months post intervention)
- Nonverbal Learning and Memory(6 months post intervention)
- Auditory Information Processing Speed and Flexibility(6 months post intervention)
- Verbal Fluency(6 months post intervention)
- Psychomotor Processing Speed(6 months post intervention)