Highlights
- •Cogmed Working Memory Training (CWMT) has the potential to improve attention in persons with MS
- •As a secondary effect, CWMT has the potential to improve mood symptoms
- •CWMT's effect on the Color-Word test is likely due to training gains transferred to a similar task
- •No significant cognitive changes were observed in the treatment as usual group
Abstract
Background
Cognitive deficits, especially in attention, are common in persons with MS (PwMS)
and are associated with clinically meaningful outcomes, such as work disability and
lower quality of life (QOL). In this study, we aimed to determine whether Cogmed Working
Memory Training (CWMT) improves attention/working memory in PwMS displaying impairment
in these domains.
Methods
This single blind, randomized controlled, pilot study compared the effects of CWMT,
a five-week evidenced-based computer-assisted training program that is supported by
weekly meetings with a coach, to standard medical care (treatment as usual). We recruited
PwMS from one MS center (London (ON) Canada), aged 18-64, with an Expanded Disability
Status Scale (EDSS) score of ≤ 7.0, and a visual acuity (corrected) of at least 20/70.
Potential subjects had to demonstrate impaired attention on at least two of three
measures (Paced Auditory Serial Addition Test [PASAT], Symbol Digit Modalities Test
[SDMT], and/or DKEFS Color-Word Interference Test); these measures also served as
the primary study outcomes. Subjects were randomized to either the CWMT or treatment
as usual. Secondary cognitive outcomes included other measures of attention, memory,
as well as a self-reported cognitive function measure. Self-reported measures of mood
(depression and anxiety), pain, and QOL were also included as other secondary outcomes.
Subjects received assessments at baseline, post-treatment, and 6-month follow-up,
or an equivalent time period for the treatment as usual group. The two groups were
compared at baseline on background measures using independent samples t-tests, Chi-Square tests, and Mann-Whitney U tests. To analyze primary and secondary outcomes, a non-parametric approach was used
due the small sample size and that many of our outcomes did not meet assumptions for
parametric analyses. Friedman's test was conducted followed by post hoc pairwise comparisons
within each group using Wilcoxon Signed-Rank tests with Bonferroni corrected post
hoc contrasts, which allowed us to examine for differences between time points.
Results
Of 30 subjects, 15 were assigned to CWMT. Significant training effects were noted
in 1 of 3 primary attentional outcomes (DKEFS Color-Word Interference Test), 2 of
3 secondary attentional outcomes (Letter-Number Sequencing, Digit Span), and 1 mood
scale (Hospital Anxiety and Depression scale (HADS) - Depression Subscale), ps < .025. No significant changes were observed in the treatment as usual group.
Conclusion
This pilot study demonstrates that cognitive training with CWMT has the potential
to improve attention/working memory in PwMS, as well as a potential positive effect
on mood, in PwMS. Further exploration of this intervention in PwMS with attention/working
memory impairment is warranted.
Keywords
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Article info
Publication history
Published online: January 16, 2021
Accepted:
January 14,
2021
Received in revised form:
January 6,
2021
Received:
November 10,
2020
Identification
Copyright
© 2021 Elsevier B.V. All rights reserved.
