Review article
Efficacy of computer-based cognitive training in neuropsychological performance of patients with multiple sclerosis: A systematic review and meta-analysis

https://doi.org/10.1016/j.msard.2017.12.017Get rights and content

Highlights

  • Multiple sclerosis (MS) is chronic inflammatory disease of the central nervous system.

  • MS may lead to accumulation of physical and cognitive disability.

  • Cognitive training interventions seem to improve cognitive performance of MS patients.

  • We performed a systematic review and meta-analysis of studies that performed computer-based cognitive training in MS patients.

  • Computer-based cognitive training may affect in the performance of memory domain.

Abstract

Importance

Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system characterized by relapses and a progressive course that may lead to accumulation of physical and cognitive disability. Cognitive training interventions seem to improve the cognitive performance of MS patients. The aim of the present meta-analysis is to quantitatively investigate the effect of computer-based cognitive rehabilitation on the neuropsychological performance of patients with MS.

Methods

We performed a systematic review of the PubMed database to identify available studies that performed computer-based cognitive training in MS patients. Studies should have reported pre- and post-cognitive training neuropsychological tests scores and included both intervention and placebo/no-intervention MS groups. We analyzed the effect of computer-based cognitive rehabilitation on individual neuropsychological tests, on specific functional domains, and on overall cognition performance. The effect-size of cognitive training pre- and post-treatment compared to placebo/ no-intervention was estimated using the standardized mean difference (SMD). The 95% confidence intervals (CI) were estimated using a Z test by comparing the final values. Baseline between-group differences in selected outcomes were estimated with ANOVA.

Results

In total, 9 studies fulfilled the criteria for inclusion and were inserted in the quantitative analysis. Computer-based cognitive training was found to improve the performance in the memory domain of MS patients compared to control interventions (SMD, 0.22; 95% CI 0.01–0.43; p = 0.04). Moreover, in the subgroup analysis, cognitive training demonstrated significant effects in Selective Reminding Test (SRT) delay memory (SMD, 0.58; 95% CI 0.29–0.87; p < 0.001).

Conclusions

The present meta-analysis revealed a significant effect for computer-based cognitive training on the performance of the memory domain of patients with MS. This finding may have significant implications in the current treatment practice when cognitive decline is detected in MS patients.

Introduction

Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system (CNS) characterized by relapses, residual neurological defects and a progressive course that may lead to gradual accumulation of physical and cognitive disability (Dardiotis et al., 2017, Ghasemi et al., 2017, Prosiegel and Michael, 1993). MS negatively affects several aspects of cognitive function including attention, information processing, memory and learning (Msfocus.org, 2017), executive function (Leavitt et al., 2014), and visuospatial abilities that may significantly impair quality of life, employment status, daily functioning, independence, and participation in social activities (Graziano et al., 2014, Perez-Martin et al., 2017).

To date, and in spite of intensive research to decipher MS pathophysiology [reviewed in (Dendrou et al., 2015, Mahad et al., 2015, Mentis et al., 2017a, Mentis et al., 2017b)], no effective pharmacological treatment for improving or even delaying cognitive decline in MS has been established. As an alternative, initial evidence suggests that cognitive rehabilitation may improve cognitive performance of MS patients. Cognitive training is administered by neuropsychologists in the form of guided practice of specific cognitive tasks or by using computer-assisted cognitive stimulation programs (Reijnders et al., 2013). Some studies using computer-based cognitive training have focused on improving specific domains such as attention, executive functions (Amato et al., 2014, Cerasa et al., 2013, Mattioli et al., 2010) or memory (delay and working) (Carr et al., 2014, das Nair et al., 2016, Rilo et al., 2016, Stuifbergen et al., 2012), while others have shown a positive effect on multiple cognitive skills (Chiaravalloti et al., 2013, Rilo et al., 2016).

A previous systematic review and meta-analysis on cognitive rehabilitation in MS included in the analysis various cognitive-improving techniques, part of which were computerized programs and a number of different endpoints such as memory, mood, or quality of life. In particular, in a recent review of the Cochrane Database, das Nair et al. (2016) reported low-level evidence for positive effects of various cognitive-improving techniques on memory, mood, and quality of life in MS (das Nair et al., 2016).

In the present meta-analysis, we were interested only on the effects of computer-based cognitive rehabilitation on the neuropsychological performance of patients with MS, as computerized programs that focus on several domains are broadly accessible to MS patients, who can devote a sufficient number of training hours. In addition, the study aimed to systematically evaluate whether computer-based cognitive rehabilitation positively affects individual neuropsychological tests, specific functional domains or overall cognition performance. Possible significant findings may alter current management practice when cognitive decline is detected in MS patients.

Section snippets

Search strategy and data extraction

Eligible studies were selected by searching the PubMed database. Combinations of the following terms: “computer”, “cognitive training” and “multiple sclerosis” were used. The complete search algorithm is presented in Supplementary file 1. The final literature search was performed on July 1st, 2017. The reference lists of all the retrieved articles were also reviewed in order to identify studies that may have been missed by the initial database search. The following inclusion criteria were

Study selection

The initial PubMed database search yielded 46 studies published until July 1, 2017. After title and abstract screening, 10 potentially eligible studies were retained. However, one study was excluded, as there were no available data regarding the mean and SD of neuropsychological tests in the control MS group (GÜÇLÜ Altun et al., 2015). Thus, 9 studies were finally included in the quantitative meta-analysis, involving in total 342 MS patients, 176 of whom were in the intervention groups and 166

Discussion

Changes in the brain caused by damage to the myelin and axons are the primary cause of cognitive dysfunction in MS. Some studies provided evidence that there may be an even better correlation between cognitive dysfunction in MS and deep gray matter atrophy (Zalonis et al., 2009). Damage to different locations of the brain affect different types of cognitive function, such as attention, processing speed, executive function, and memory. Since specific pharmacological treatments for cognitive

Acknowledgements

None.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.

Role of funding source

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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