Author Of 2 Presentations
P1102 - Manual Dexterity Improves with Cognitive Remediation in Relapsing but not in Progressive Multiple Sclerosis (ID 1928)
Abstract
Background
There is increasing evidence that upper extremity (UE) motor functioning, measured by speeded pegboard completion, correlates with cognitive functioning in multiple sclerosis (MS). To date, studies have characterized this correlation with single assessment points in cross-sectional studies. However, to be validated as a behavioral biomarker of cognition, pegboard completion should also reflect change in cognitive functioning over time.
Objectives
To characterize changing of pegboard completion and cognitive functioning at baseline and following cognitive remediation program.
Methods
In this large RCT of n=135, n=74 participants with MS (EDSS 0-8, relapsing-remitting and progressive subtypes) completed an adaptive cognitive remediation program (60 hours x 12 weeks) that led to a significant improvement in cognitive functioning compared to a control condition (n=61). Cognitive functioning was assessed by a composite score from a comprehensive battery of neuropsychological measures, while UE functioning was assessed by the 9-Hole Peg Test (9-HPT). Study outcomes were evaluated at baseline and treatment end.
Results
Participants in the active condition (median EDSS 3.5, age 48 ± 13 years, 67.5% female; 69% relapsing-remitting) significantly improved in cognitive functioning (composite neuropsychological z-score: -0.77 vs. -0.68, p<0.001) and in the 9-HPT completion for the dominant hand (9-HPT z-score: -4.1 vs -3.3, p=0.013). Within the active condition group, only those with relapsing-remitting subtype were found to have a significant improvement in the completion time of 9-HPT (dominant hand 9-HPT z-score: -3.4 vs. -2.4, p<0.001; non-dominant hand 9-HPT z-score: -3.0 vs. -2.5, p=0.04). In the control condition, where no significant improvement in cognitive functioning was found, there was not an improvement in the 9-HPT completion.
Conclusions
Routine pegboard completion is a quick and efficient measure of both cognitive and fine motor involvement in MS at one point in time and in response to change in cognitive functioning. However, this relation is specific to those with relapsing-remitting subtype, likely due to higher motor impairment in those with progressive disease.
P1112 - Transcranial Direct Current Stimulation (tDCS) Results in Lasting Reduction in MS-Related Fatigue (ID 1916)
Abstract
Background
Fatigue is a common and often debilitating symptom of multiple sclerosis (MS) that remains without an effective treatment. Noninvasive brain stimulation with transcranial direct current stimulation (tDCS) is a promising therapeutic approach with controlled clinical trials demonstrating its near-term benefit in reducing MS fatigue. However, the persisting benefit of treatment has not yet been characterized.
Objectives
To test whether there is persisting benefit for the treatment of MS-related fatigue with noninvasive brain stimulation using tDCS.
Methods
As part of a larger study participants with MS-related fatigue completed the Modified Fatigue Impact Scale (MFIS) and the Fatigue Severity Scale (FSS) at baseline and following 20 daily at-home remotely supervised or RS-tDCS sessions (open-label, 20min x 2.0mA, anode over left DLPFC and cathode over right DLPFC) paired with computerized cognitive training (BrainHQ). Assessments were repeated at 3-months post-treatment.
Results
Participants were n=17 with MS, mean age 49.1 ± 10.8, EDSS median 5.0 (0-7) and clinically significant fatigue at baseline (FSS= 51.2 ± 10.4). Consistent with prior studies, there was a significant reduction in fatigue following 20 daily treatment sessions (51.6 ± 15.5 vs. 37.9 ± 13.1, mean difference -13.7, p= 0.007). Statistically significant reductions in fatigue were further seen across all MFIS sub scores: physical (24.1 ± 7.3 vs. 19.0 ± 7.55, p= 0.024), cognitive (22.5 ± 9.1 vs. 14.9 ± 7.8, p= 0.004), and psychological/social (5.0 ± 2.0 vs. 4.0 ± 1.6, p= 0.033). At three months post treatment, fatigue benefit persisted (51.6 ± 15.5 vs. 41.4 ± 11.7, mean difference -10.2, p= 0.02). Statistically significant reductions in fatigue were maintained 3-months post-treatment in the social (p= 0.004) and physical (p= 0.02) MFIS sub scores.
Conclusions
A period of repeated daily treatment with left anodal dorsolateral prefrontal cortex tDCS can lead to persisting reductions in MS-related fatigue 3-months post treatment.
Presenter Of 1 Presentation
P1102 - Manual Dexterity Improves with Cognitive Remediation in Relapsing but not in Progressive Multiple Sclerosis (ID 1928)
Abstract
Background
There is increasing evidence that upper extremity (UE) motor functioning, measured by speeded pegboard completion, correlates with cognitive functioning in multiple sclerosis (MS). To date, studies have characterized this correlation with single assessment points in cross-sectional studies. However, to be validated as a behavioral biomarker of cognition, pegboard completion should also reflect change in cognitive functioning over time.
Objectives
To characterize changing of pegboard completion and cognitive functioning at baseline and following cognitive remediation program.
Methods
In this large RCT of n=135, n=74 participants with MS (EDSS 0-8, relapsing-remitting and progressive subtypes) completed an adaptive cognitive remediation program (60 hours x 12 weeks) that led to a significant improvement in cognitive functioning compared to a control condition (n=61). Cognitive functioning was assessed by a composite score from a comprehensive battery of neuropsychological measures, while UE functioning was assessed by the 9-Hole Peg Test (9-HPT). Study outcomes were evaluated at baseline and treatment end.
Results
Participants in the active condition (median EDSS 3.5, age 48 ± 13 years, 67.5% female; 69% relapsing-remitting) significantly improved in cognitive functioning (composite neuropsychological z-score: -0.77 vs. -0.68, p<0.001) and in the 9-HPT completion for the dominant hand (9-HPT z-score: -4.1 vs -3.3, p=0.013). Within the active condition group, only those with relapsing-remitting subtype were found to have a significant improvement in the completion time of 9-HPT (dominant hand 9-HPT z-score: -3.4 vs. -2.4, p<0.001; non-dominant hand 9-HPT z-score: -3.0 vs. -2.5, p=0.04). In the control condition, where no significant improvement in cognitive functioning was found, there was not an improvement in the 9-HPT completion.
Conclusions
Routine pegboard completion is a quick and efficient measure of both cognitive and fine motor involvement in MS at one point in time and in response to change in cognitive functioning. However, this relation is specific to those with relapsing-remitting subtype, likely due to higher motor impairment in those with progressive disease.