Nancy B. Moore

Treating learning impairments improves memory performance in multiple sclerosis : a randomized clinical trial

This randomized clinincal trial utilized established techniques to improve new learning and memory performance in multiple sclerosis (MS) participants with learning impairment. Participants were 29 individuals with clinincally definite MS with documented learning deficits, randomly assigned to the experimental or control group. The experimental group underwent eight sessions of the Story Memory Technique (SMT), while the control group participated in eight sessions of memory exercises. Neuropsychological assessment was conducted at baseline, immediately following treatment and 5 weeks later to assess outcome. When stratifying participants by degree of learning deficits, a significant treatment effect was noted. MS participants with moderate-severe impairment in learning showed a significant improvement in learning abilities when compared to controls, (t(19)-3.32, P<0.01) evident in 88% of participants in the experimental group. Little improvement was noted in MS participants with mild learning impairments. Significant self-reported improvements in memory were noted in MS participants that underwent treatment, but not those that did not undergo treatment (t(26)-2.55, P<0.01). Results indicate that learning and memory deficits in MS can be effectively treated through a memory rehabilitation program utilizing context and imagery to improve new learning. Appropriate patient selection is important, with moderately-severely impaired individuals showing significantly greater benefit from treatment.

The relationship between cognitive deficits and everyday functional activities in multiple sclerosis.

Considerable evidence indicates that cognitive dysfunction and impairments in everyday life activities are common in multiple sclerosis (MS). However, the relationship between these cognitive and functional deficits has not been thoroughly investigated. The purpose of this study was to examine the role of cognitive dysfunction in the functional status of individuals with MS. Participants were 74 adults with MS and 35 healthy comparison participants (HCs) who underwent neuropsychological testing and completed the Executive Functions Performance Test (EFPT; Baum, Morrison, Hahn, & Edwards, 2003), an objective measure of everyday life activities. Between-groups comparisons and correlational analyses were conducted to examine the relationship between cognition and functional capacity. Significant differences in EFPT performance were revealed between individuals with MS with and without cognitive impairment and HCs. In individuals with MS, performance on cognitive constructs was related to performance on the EFPT. Furthermore, a linear regression model comprised of indices of cognitive functioning explained a significant portion of the variance in everyday life activities. Findings suggest that individuals with and without cognitive impairment differ in functional status and that aspects of cognition are predictive of functional status in MS.

An RCT to treat learning impairment in multiple sclerosis The MEMREHAB trial

Objective: To examine the efficacy of the modified Story Memory Technique (mSMT), a 10-session behavioral intervention teaching context and imagery to facilitate learning, to improve learning and memory abilities in persons with multiple sclerosis (MS). Methods: This double-blind, placebo-controlled, randomized clinical trial included 86 participants with clinically definite MS, 41 in the treatment group and 45 in the placebo control group. Participants completed a baseline neuropsychological assessment, including questionnaires assessing everyday memory, a repeat assessment immediately posttreatment, and a long-term follow-up assessment 6 months after treatment. After completion of the treatment phase, persons in the treatment group were assigned to a booster session or a non–booster session group to examine the efficacy of monthly booster sessions in facilitating the treatment effect over time. Results: The treatment group showed a significantly improved learning slope relative to the placebo group posttreatment. Similar results were noted on objective measures of everyday memory, general contentment, and family report of apathy and executive dysfunction. Long-term follow-up data showed that posttreatment improvement in the treatment group continued to be noted on the list learning and self-report measures. The provision of booster sessions demonstrated little benefit. Conclusion: The mSMT is effective for improving learning and memory in MS. Classification of evidence: This study provides Class I evidence that the mSMT behavioral intervention improves both objective memory and everyday memory in patients with MS over 5 weeks, with treatment effects lasting over a 6-month period.

Unemployment in multiple sclerosis (MS): utility of the MS Functional Composite and cognitive testing

Unemployment is a significant concern among individuals with multiple sclerosis (MS). Determinations regarding ability to work are highly dependent on measurement tools used by neurologists and allied professionals. However, little is known of the usefulness of these tools when determining issues pertaining to employment status. The purpose of the present investigation was to examine the utility of the Multiple Sclerosis Functional Composite (MSFC) and a brief cognitive test battery when examining employment status in MS. Seventy-seven individuals with MS completed the MSFC and a brief cognitive test battery. On the MSFC, unemployed individuals demonstrated worse upper extremity functioning. There was no difference on the Paced Auditory Serial Addition Task (PASAT), the sole cognitive measure of the MSFC. On cognitive testing, unemployed individuals performed worse on measures of memory, information processing speed, and executive functioning. Through logistic regression analysis, the Symbol Digit Modalities Test (SDMT) was found to be the sole predictor of employment status among the significant disease, MSFC and cognitive variables. Consistent with previous findings, logistic regression found the SDMT to be a significant predictor of employment status. Given the lack of significant group differences on the PASAT, continued consideration of replacing the PASAT with the SDMT in the MSFC appears warranted.

Actual reality: a new approach to functional assessment in persons with multiple sclerosis.

OBJECTIVE To examine the use of an innovative approach for assessing everyday life activities of people with multiple sclerosis (MS): Actual Reality. Actual Reality is a performance-based assessment approach that involves the use of the internet to perform real, everyday life activities. DESIGN A between-subjects design. SETTING Outpatient rehabilitation institute. PARTICIPANTS Persons (n=21) with clinically definite MS and healthy controls (HCs) (n=18) without any reported neurologic disabilities participated in this study. Participants were between the ages of 21 to 60 years, and the sample consisted of volunteer sample. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Participants were asked to access the internet to purchase airline tickets for a round trip flight and were administered the Minimal Assessment of Cognitive Functioning in Multiple Sclerosis. Participants also completed questionnaires to assess quality of life (Functional Assessment of Multiple Sclerosis), functional status (Functional Behavior Profile), and prior Internet experience. RESULTS The MS group displayed significantly more difficulties than the HC group in accurately and independently completing the Actual Reality task primarily because of cognitive impairment. Self-report of quality of life and functional status were not correlated with Actual Reality performance in the group of people with MS. However, the self-report measures were significantly associated with affective symptomatology. CONCLUSIONS These results provide initial evidence supporting the use of the Actual Reality approach in assessing persons with MS performing everyday life activities. Actual Reality is a significant step forward in increasing the sensitivity, accessibility, and relevancy of functional assessments in people with cognitive and physical disabilities.

The Open-Trial Selective Reminding Test (OT-SRT) as a Tool for the Assessment of Learning and Memory

The Open Trial Selective Reminding Test (OT-SRT) is a modification of the SRT that also evaluates new learning abilities. The examinee is asked to learn a list of 10 words over a maximum of 15 trials. Using a criterion-referenced approach, the list is repeatedly administered until a criterion of complete recall on two consecutive trials is achieved. Training to criterion provides a better assessment of learning ability than the traditional fixed trial list-learning paradigm. Recall and recognition is then tested 30 and 90 minutes following the learning trials. This paper presents normative data on the OT-SRT for 117 healthy controls (Study 1) and 151 participants with clinically definite multiple sclerosis (Study 2).

The relative contributions of processing speed and cognitive load to working memory accuracy in multiple sclerosis

Cognitive symptoms of multiple sclerosis (MS) include processing-speed deficits and working memory impairment. The precise manner in which these deficits interact in individuals with MS remains to be explicated. We hypothesized that providing more time on a complex working memory task would result in performance benefits for individuals with MS relative to healthy controls. Fifty-three individuals with clinically definite MS and 36 matched healthy controls performed a computerized task that systematically manipulated cognitive load. The interval between stimuli presentations was manipulated to provide increasing processing time. The results confirmed that individuals with MS who have processing-speed deficits significantly improve in performance accuracy when given additional time to process the information in working memory. Implications of these findings for developing appropriate cognitive rehabilitation interventions are discussed.

Learning and Generalization Deficits in Patients With Memory Impairments Due to Anterior Communicating Artery Aneurysm Rupture or Hypoxic Brain Injury

Human anterograde amnesia can result from a variety of etiologies, including hypoxic brain injury and anterior communicating artery (ACoA) aneurysm rupture. Although each etiology can cause a similarly severe disruption in declarative memory for verbal and visual material, there may be differences in incrementally acquired, feedback-based learning, as well as generalization. Here, 6 individuals who survived hypoxic brain injury, 7 individuals who survived ACoA aneurysm rupture, and 13 matched controls were tested on 2 tasks that included a feedback-based learning phase followed by a transfer phase in which familiar information is presented in new ways. In both tasks, the ACoA group was slow on initial learning, but those patients who completed the learning phase went on to transfer as well as controls. In the hypoxic group, 1 patient failed to complete either task; the remaining hypoxic group did not differ from controls during learning of either task, but was impaired on transfer. These results highlight a difference in feedback-based learning in 2 amnesic etiologies, despite similar levels of declarative memory impairment.

Processing Speed Versus Working Memory: Contributions to an Information-Processing Task in Multiple Sclerosis

Individuals with multiple sclerosis (MS) often experience cognitive impairments in information processing. However, the relative contributions of processing speed abilities and working memory abilities to information-processing tasks are not yet fully understood. The current study examined the extent to which processing speed and/or working memory abilities contributed to an information-processing task, the Keeping Track Task (KTT). Forty-nine individuals with MS were given tests to assess processing speed and working memory, as well as the KTT. Regression analyses indicated that in the MS group, processing speed abilities accounted for the majority of the explained variance in KTT performance. The findings suggest that processing speed plays a significant role on KTT performance in MS. Implications for cognitive rehabilitation treatments aimed at improving processing speed abilities in MS are discussed.

The Relationship between Neurocognitive Behavior of Executive Functions and the EFPT in Individuals with Multiple Sclerosis

The current study examined the relationship between two separate but complementary methods of assessing executive functions in individuals with multiple sclerosis (MS): (1) a neurocognitive approach with the Tower of London−DX (TOL-DX) test and (2) a functional top-down approach with the Executive Function Performance Test (EFPT). Sixty-eight individuals with MS (79% female) and 38 healthy controls (68% female) were administered both the TOL-DX test and the EFPT. For the group with MS, significant differences were found on the TOL-DX test and the EFPT executive components and functional tasks. For the group with MS, the number of moves to complete the TOL-DX tasks was significantly positively correlated to the Organization and Sequencing executive components of the EFPT and the Simple Cooking and Bill Payment tasks of the EFPT. The results demonstrate the relationship of executive function behavior and performance of instrumental activities of daily living tasks.