Cognitive Rehabilitation, Mindfulness Improve Patient-Reported Outcomes in MS

Both cognitive rehabilitation therapy (CRT) and mindfulness-based cognitive therapy (MBCT) alleviated self-reported cognitive complaints in the short-term among patients with multiple sclerosis (MS), according to the findings of a randomized-controlled trial published in Multiple Sclerosis and Related Disorders.

Objective and subjective cognitive effects are both common among patients with MS. To date, research into behavioral interventions focused on improving these cognitive concerns have focused on objective outcomes, but little is known about patient-reported outcomes, which was the aim of this study.

The REMIND-MS study was a single-blind trial conducted between 2017 and 2020 at the MS Center Amsterdam and Klimmendaal Rehabilitation Center in the Netherlands. Patients (N=110) with MS were randomly assigned in a 1:1:1 ratio to receive CRT (n=37), MBCT (n=36), or enhanced treatment as usual (n=37). The CRT intervention comprised 9 weekly 2.5-hour-long group-based sessions and the MBCT intervention comprised 8 similar sessions plus 1 9-hour long silent retreat. The CRT curriculum focused on compensatory strategies for cognitive functions, such as memory, mental fatigue, and grief, among others. The MBCT intervention involved training in self-regulation of attention and non-judgmental awareness of present experiences.

The patients were mean age, 48.7 (standard deviation [SD], 9.8) years, 75% were women, 56% did not work and received disability pensions, 66% had relapsing remitting MS, the median duration of disease was 13.5 (interquartile range [IQR], 4.0) years, 53% used disease-modifying therapies, and they had an Expanded Disability Status Scale (EDSS) score of 4.0 (range, 2.0-8.0) points.

At baseline 57% were cognitively impaired.

In the 2 active interventions, the median attendance rate was 89%. More of the CRT group completed their homework than the MBCT group (86% vs 63%), respectively. For control individuals, 97% attended their usual care appointment.

Compared with the control intervention, CRT had a significant effect on Cognitive Failures Questionnaire (CFQ) scores (β, -6.2; P =.006) and Behavior Rating Inventory of Executive Function–Adult Version (BRIEF-A) metacognition scores (β, -5.2; P =.008) and MBCT on BRIEF-A behavioral regulation index (β, -3.6; P =.032) and metacognition (β, -5.7; P =.020) scores immediately after treatment. However, no effects remained significant at the 6-month follow-up.

For Goal Attainment Scaling (GAS) outcomes, CRT associated with a positive change at post-treatment (β, 4.1; P =.015) and 6 months (β, 4.8; P =.028) compared with the control intervention. No GAS outcomes were associated with MBCT.

For objective cognitive outcomes, MBCT was associated with significant improvements in processing speed post-treatment (β, 0.2; P =.026) and at 6 months (β, 0.2; P =.027) compared with the control intervention. No objective outcomes were associated with CRT.

Overall, 16% of CRT and 28% of MBCT recipients reliably improved from baseline, however, these rates did not differ from control individuals (both P ≥.058).

This study may have been limited as the control condition was not a group-based intervention.

These data indicated that both CRT and MBCT interventions improved some patient-reported cognitive outcomes among patients with MS immediately after the intervention. The researchers acknowledged that in the long term, CRT led to benefits on personalized cognitive goals while MBCT improved processing speed. “These results thereby provide insight in the specific contributions of available cognitive treatments for MS patients,” they concluded.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.