Research Article| Volume 334, ISSUE 1-2, P154-160, November 15, 2013

Neuropsychological rehabilitation has beneficial effects on perceived cognitive deficits in multiple sclerosis during nine-month follow-up

Published:September 05, 2013DOI:



      Systematic reviews have indicated a low level of evidence for the positive effects of neuropsychological and cognitive rehabilitation in multiple sclerosis (MS). How permanent the positive effects are, is unknown.


      The aim of the present study was to evaluate whether short-term neuropsychological rehabilitation has long-term beneficial effects in a nine-month follow-up.


      102 relapsing–remitting MS patients with subjective and objective attentional deficits were randomized into intervention and control groups. Altogether 78 out of 102 patients (76%) completed the longitudinal follow-up (intervention group 83%, control group 67%). Intervention group received strategy-oriented neuropsychological rehabilitation conducted once a week in 60-minute sessions during thirteen consecutive weeks. The control group received no intervention. Cognitive deficits, mood, fatigue, impact of disease, and quality of life were evaluated with self-reports at baseline, six months, and one year from baseline.


      The positive effects of neuropsychological rehabilitation on perceived cognitive deficits were maintained for nine months. Among a subgroup of patients with moderate to severe attentional deficits, positive rehabilitation outcome was even more evident.


      The beneficial effects of strategy-oriented neuropsychological rehabilitation on perceived cognitive deficits in MS may be maintained for at least one year after the beginning of the intervention.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of the Neurological Sciences
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Chiaravalloti N.D.
        • DeLuca J.
        Cognitive impairment in multiple sclerosis.
        Lancet Neurol. 2008; 7: 1139-1151
        • Langdon D.W.
        Cognition in multiple sclerosis.
        Curr Opin Neurol. 2011; 24: 244-249
        • Rogers J.M.
        • Panegyres P.K.
        Cognitive impairment in multiple sclerosis: evidence-based analysis and recommendations.
        J Clin Neurosci. 2007; 14: 919-927
        • DeLuca J.
        • Nocentini U.
        Neuropsychological, medical and rehabilitative management of persons with multiple sclerosis.
        NeuroRehabilitation. 2011; 29: 197-217
        • Chiaravalloti N.D.
        Could behavioral therapies target specific deficits in multiple sclerosis patients?.
        Expert Rev Neurother. 2012; 12: 755-757
        • Thomas P.W.
        • Thomas S.
        • Hillier C.
        • Galvin K.
        • Baker R.
        Psychological interventions for multiple sclerosis.
        Cochrane Database Syst Rev. 2006; 1: CD004431
        • O'Brien A.R.
        • Chiaravalloti N.
        • Goverover Y.
        • Deluca J.
        Evidenced-based cognitive rehabilitation for persons with multiple sclerosis: a review of the literature.
        Arch Phys Med Rehabil. 2008; 89: 761-769
        • Rosti-Otajärvi E.M.
        • Hämäläinen P.I.
        Neuropsychological rehabilitation for multiple sclerosis.
        Cochrane Database Syst Rev. 2011; 11: CD009131
        • Vogt A.
        • Kappos L.
        • Stöcklin M.
        • Gschwind L.
        • Opwis K.
        • Penner I.
        BrainStim - wirksamkeit eines neu entwickelten kognitiven trainingsprogramms bei MS.
        Neurol Rehabil. 2008; 14: 93-101
        • Brenk A.
        • Laun K.
        • Haase C.G.
        Short-term cognitive training improves mental efficiency and mood in patients with multiple sclerosis.
        Eur Neurol. 2008; 60: 304-309
        • Mattioli F.
        • Stampatori C.
        • Zanotti D.
        • Parrinello G.
        • Capra R.
        Efficacy and specificity of intensive cognitive rehabilitation of attention and executive functions in multiple sclerosis.
        J Neurol Sci. 2010; 288: 101-105
        • Stuifbergen A.K.
        • Becker H.
        • Perez F.
        • Morison J.
        • Kullberg V.
        • Todd A.
        A randomized controlled trial of a cognitive rehabilitation intervention for persons with multiple sclerosis.
        Clin Rehabil. 2012; 26: 882-893
        • Tesar N.
        • Bandion K.
        • Baumhackl U.
        Efficacy of a neuropsychological training programme for patients with multiple sclerosis — a randomised controlled trial.
        Wien Klin Wochenschr. 2005; 117: 747-754
        • Mäntynen A.
        • Rosti-Otajärvi E.
        • Koivisto K.
        • Lilja A.
        • Huhtala H.
        • Hämäläinen P.
        Neuropsychological rehabilitation does not improve cognitive performance but reduces perceived cognitive deficits in patients with multiple sclerosis: a randomised, controlled, multi-centre trial.
        Mult Scler. 2013; 26 ([Epub ahead of print])
        • Poser C.M.
        • Paty D.W.
        • Scheinberg L.
        • McDonald W.I.
        • Davis F.A.
        • Ebers G.C.
        • et al.
        New diagnostic criteria for multiple sclerosis: guidelines for research protocols.
        Ann Neurol. 1983; 13: 227-231
        • Kurtzke J.F.
        Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS).
        Neurology. 1983; 33: 1444-1452
        • Benedict R.H.
        • Munschauer F.
        • Linn R.
        • Miller C.
        • Murphy E.
        • Foley F.
        • et al.
        Screening for multiple sclerosis cognitive impairment using a self-administered 15-item questionnaire.
        Mult Scler. 2003; 9: 95-101
      1. Rao S.M. A manual for the brief repeatable battery of neuropsychological tests in multiple sclerosis. National Multiple Sclerosis Society, New York, NY1990
        • Kiresuk T.
        • Sherman R.
        Goal attainment scaling: a general method of evaluating comprehensive mental health programmes.
        Community Ment Health J. 1968; 4: 443-453
        • Sullivan J.J.L.
        • Edgley K.
        • Dehoux E.
        A survey of multiple sclerosis: part I: perceived cognitive problems and compensatory strategy used.
        Can J Rehabil. 1990; 4: 99-105
        • Fischer J.S.
        • LaRocca N.G.
        • Miller D.M.
        • Ritvo P.G.
        • Andrews H.
        • Paty D.W.
        Recent developments in the assessment of quality of life in multiple sclerosis (MS).
        Mult Scler. 1999; 5: 251-259
        • Marrie R.A.
        • Miller D.M.
        • Chelune G.J.
        • Cohen J.A.
        Validity and reliability of the MSQLI in cognitively impaired patients with multiple sclerosis.
        Mult Scler. 2003; 9: 621-626
        • Beck A.T.
        • Ward C.H.
        • Mendelson M.
        • Mock J.
        • Erbaugh J.
        An inventory for measuring depression.
        Arch Gen Psychiatry. 1961; 4: 561-571
        • Hobart J.
        • Lamping D.
        • Fitzpatrick R.
        • Riazi A.
        • Thompson A.
        The multiple sclerosis impact scale (MSIS-29). A new patient-based outcome measure.
        Brain. 2001; 124: 962-973
        • WHOQOL Group
        Development of the world health organization WHOQOL-BREF quality of life assessment.
        Psychol Med. 1998; 28: 551-558
        • Penner I.K.
        • Raselli C.
        • Stöcklin M.
        • Opwis K.
        • Kappos L.
        • Calabrese P.
        The fatigue scale for motor and cognitive functions (FSMC): validation of a new instrument to assess multiple sclerosis-related fatigue.
        Mult Scler. 2009; 15: 1509-1517
        • Stroop J.R.
        Studies of interference in serial verbal reactions.
        J Exp Psychol. 1935; 18: 643-662
        • Reitan R.M.
        Validity of the trail making test as an indicator of organic brain damage.
        Percept Mot Skills. 1958; 8: 271-276
        • Chiaravalloti N.D.
        • DeLuca J.
        • Moore N.B.
        • Ricker J.H.
        Treating learning impairments improves memory performance in multiple sclerosis: a randomized clinical trial.
        Mult Scler. 2005; 11: 58-68
        • Jonsson A.
        • Korfitzen E.M.
        • Heltberg A.
        • Ravnborg M.H.
        • Byskov-Ottosen E.
        Effects of neuropsychological treatment in patients with multiple sclerosis.
        Acta Neurol Scand. 1993; 88: 394-400
        • Fink F.
        • Rischkau E.
        • Butt M.
        • Klein J.
        • Eling P.
        • Hildebrandt H.
        Efficacy of an executive function intervention programme in MS: a placebo-controlled and pseudo-randomized trial.
        Mult Scler. 2010; 16: 1148-1151
        • Solari A.
        • Motta A.
        • Mendozzi L.
        • Pucci E.
        • Forni M.
        • Mancardi G.
        • et al.
        Computer-aided retraining of memory and attention in people with multiple sclerosis: a randomized, double-blind controlled trial.
        J Neurol Sci. 2004; 222: 99-104
        • Lincoln N.B.
        • Dent A.
        • Harding J.
        • Weyman N.
        • Nicholl C.
        • Blumhardt L.D.
        • et al.
        Evaluation of cognitive assessment and cognitive intervention for people with multiple sclerosis.
        J Neurol Neurosurg Psychiatry. 2002; 72: 93-98
        • Cicerone K.D.
        • Dahlberg C.
        • Kalmar K.
        • Langenbahn D.M.
        • Malec J.F.
        • Berqquist T.F.
        • et al.
        Evidence-based cognitive rehabilitation: recommendations for clinical practice.
        Arch Phys Med Rehabil. 2000; 81: 1596-1615
        • Higgins J.P.T.
        • Green S.
        Cochrane handbook for systematic reviews of interventions version 5.1.0.
        The Cochrane Collaboration, 2011 ([Available from []])
        • Van Tulder M.
        • Furlan A.
        • Bombardier C.
        • Bouter L.
        • Editorial Board of the Cochrane Collaboration Back Review Group
        Updated method guidelines for systematic reviews in the Cochrane collaboration back review group.
        Spine. 2003; 28: 1290-1299
        • Benedict R.
        • Amato M.P.
        • Boringa J.
        • Brochet B.
        • Foley F.
        • Fredrikson S.
        • et al.
        Brief international cognitive assessment for MS (BICAMS): international standards for validation.
        BMC Neurol. 2012; 12: 55
        • Fischer J.S.
        • Rudick R.A.
        • Cutter G.R.
        • Reingold S.C.
        The multiple sclerosis functional composite measure (MSFC): an integrated approach to MS clinical outcome assessment.
        Mult Scler. 1999; 5: 244-250