Early cognitive impairment in MS has been shown to predict more disability and worse prognosis (Giovannoni, 2016). The concept of brain reserve is a hypothetical notion that illustrates the individual’s specific innate and finite capacity to withstand injury to the brain and maintain normal function (Krieger, 2018). Based off recent work in the cognitive and brain reserve literature, there is evidence that reading early in life is associated with preserved memory and larger hippocampal volumes in multiple sclerosis (Sumowski J. R., 2016). Many cognitively enriching activities exist including reading, writing, playing a musical instrument, and certain hobbies, but only reading and writing are consistently shown to have an impact on cognitive reserve (Sumowski J. R., 2016).
The primary endpoint was to determine whether cognitively effortful reading activities impact cognitive processing and learning over 1 year in patients with multiple sclerosis.
A one-year prospective, randomized, blinded study. A total of 22 patients completed the study with 14 patients randomized to the intervention group and 8 patients to the control group. Participants were 18 year of age and older with an established diagnosis of multiple sclerosis. Two established neuro-cognitive testing measures, the symbol digit modalities test (SDMT) and the California verbal learning test version II (CVLT-2) were used as primary endpoints for cognitive status. Neuro-cognitive testing was performed at the initial enrollment for baseline status and then at completion of 1 year.
SDMT scores for the intervention group were significant (7/14 versus 0/8 patients in the control group; p=0.04885). 14% of patients (2/14) in the intervention group had worse SDMT scores versus 25% in the control group. Short-delayed free recall (SDFR) demonstrated clinically significant improvement versus the control group (p=0.0034). Retroactive interference was clinically significant with 3/14 (21.4%) patients in the intervention group versus 1/8 (12.5%) in the control group (p=0.0169).
The SDMT and portions of the CVLT-II can be practically and feasibly implemented into the clinical setting. Effortful reading programs can be employed easily into the treatment models of multiple sclerosis management. The prescription of reading challenging classic literature has the potential to stabilize and, in some cases, improve certain domains of cognition.