Attention/Working Memory Rehabilitation in Multiple Sclerosis: A Pilot Project Using Cogmed Working Memory Training

Patients diagnosed with any type of multiple sclerosis (MS) who show objective evidence of attention problems will be randomized to standard medical care (treatment as usual) or attention training, which will be completed at their home using a commercially available attention training task (Cogmed Working Memory Training - CWMT) for 5 weeks. Patients will undergo cognitive testing before and after intervention and at 6 months follow up.

Study Overview

• Status: Completed
• Conditions: Multiple Sclerosis
• Intervention / Treatment: Behavioral: Cogmed Working Memory Training (CWMT)

Detailed Description

MS patients who meet the inclusion criteria of the study showing deficits on at least 2 of 3 attention/working measures who will then be randomized to either a treatment group (cognitive rehabilitation training) or a control group (standard clinical care). Patients must show mild to moderate-severe impairment on 2 out of 3 test measures of processing speed and sustained attention to be included in the study. Participants will undergo cognitive testing (Minimal Assessment of Cognitive Function in MS [MACFIMS] performed at Dr. Morrow's cognitive clinic at Parkwood Hospital) at pre- and post-treatment, and also at 6-months follow-up. Participants will also fill out non-cognitive measures in the form of questionnaires regarding quality of life (QoL), self-efficacy, stress, and copying strategies at both pre and post treatment. In addition, the intervention group will undergo attention training using CWMT for 5 days per week (30-45 minutes daily) for 5 weeks. They will complete this training by themselves in their home. The assigned Cogmed coach will set up the Cogmed program for the duration of the trail on the training group participant's computers. The study will not be able to continue to pay for the Cogmed program after the 5 week training sessions. Participants are welcome to purchase the software themselves after the entire study has ended if they would like at: http://www.cogmed.com/. The CWMT (Cogmed) method consists of 25 training sessions done online. Each participant assigned to the training group will complete eight exercises for five weeks with five sessions every week. The Cogmed program uses an adaptive training approach in which the difficulty level of the training is adjusted in real time (trial by trial basis) based on the trainee's performance. Each session consists of a selection of various tasks that target the different aspects of attention/working memory. Specifically, each session will involve training on visuospatial working memory tasks (e.g., remembering the position of objects in a 4 x 4 Grid) as well as verbal working memory tasks (e.g., remembering phonemes, letters, or digits). Given that adults will be involved in this study, Cogmed QM will be used, a version of the CWMT program adapted for adults. Participants will engage in weekly discussions over the phone for about 1 hour with an assigned Cogmed coach who will provide support and encouragement over the 5 weeks. Additional calls will be made if the Cogmed coaches see the participant is not completing their online training. Each participant will be assigned a Cogmed qualified coach who is responsible for providing structure, motivation, and feedback on training progress in order to optimize training gains. Before Cogmed training begins, each participant in the training group will be visited once by their respective Cogmed coach who will ensure that participants' daily Cogmed sessions will be conducted in a space in their home that is conducive to attention training (e.g., little clutter, private area of the home) and ensure consistency between participants. During training, each participant's performance will be tracked online and will be reviewed by the participant and his/her coach in weekly telephone meetings throughout the five week period. The participant's performance will be tracked online on the Cogmed platform. The Cogmed coaches set up the program for the participants and assign them a username. The Cogmed coaches can track the individual's performance and see who has completed the training based on their username. No Internet Protocol (IP) information will be collected. At the end of training, the coach will summarize the training by telephone with the participant.

• Study Type: Interventional
• Enrollment (Actual): 31
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Canada
  • Ontario
    • London, Ontario, Canada, N6A 5A5
      • London Health Sciences Centre

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 64 years (Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Gender Both: both female and male participants are being studied

Age Limits Minimum Age: 18 years Maximum Age: 64 years

Accepts Healthy Volunteers? No

Eligibility Criteria

Inclusion Criteria:

• Males/Females, Ages 18-64, with any type of MS
• Lower to moderate physical disability
• Demonstrated impaired attention/working memory on 2 of 3 measures (Patients with a z-score lower than -1.5 on at least 2 of the 3 measures will be characterized as showing attention/working memory deficits)
• Patients must have a Mac or personal computer (PC) computer at home with access to the internet

Exclusion Criteria:

• Clinical relapse/steroid treatment 1 month prior to study entry
• Physical disability that prevents completion of study measures or training
• History of severe mental illness or daily marijuana use
• Those who do not meet the inclusion criteria.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
No Intervention: Treatment as Usual; This group will not any training with the Cogmed training program.
Experimental: Training Group; This group will receive intervention with the Cogmed training program and coach over a period of 5 weeks.	Behavioral: Cogmed Working Memory Training (CWMT); The CWMT (Cogmed) method consists of 25 training sessions done online. Each participant assigned to the training group will complete eight exercises for five weeks with five sessions every week. Each session consists of a selection of various tasks that target the different aspects of attention/working memory. Participants will engage in weekly discussions over the phone for about 1 hour with an assigned Cogmed coach who will provide support and encouragement over the 5 weeks.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Paced Auditory Serial Addition Test	Cognitive test; Change pre- to post-test between groups	7 months
Symbol Digit Modalities Test	Cognitive test; Change pre- to post-test between groups	7 months
Stroop colour word test	Cognitive test; Change pre- to post-test between groups	7 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Judgement of Line Orientation	Cognitive test; Change pre- to post-test between groups	7 months
Controlled Oral Word Association Test	Cognitive test; Change pre- to post-test between groups	7 months
California Verbal Learning Test	Cognitive test; Change pre- to post-test between groups	7 months
Brief Visual Memory Test	Cognitive test; Change pre- to post-test between groups	7 months
Delis-Kaplan Executive Function System Sorting Test	Cognitive test; Change pre- to post-test between groups	7 months
Beck Depression Inventory - Fast Screen	Non-cognitive Questionnaire; Change pre- to post-test between groups	7 months
Hospital Anxiety and Depression Scale	Non-cognitive Questionnaire; Change pre- to post-test between groups	7 months
Fatigue Severity Scale	Non-cognitive Questionnaire; Change pre- to post-test between groups	7 months
Short Form Health Survey	Non-cognitive Questionnaire; Change pre- to post-test between groups	7 months
Dysexecutive Questionnaire	Non-cognitive Questionnaire; Change pre- to post-test between groups in terms of the amount of self-reported issues with executive functions.	7 months
Cognitive Failures Questionnaire	Non-cognitive Questionnaire; Change pre- to post-test between groups in terms of the amount of self-reported cognitive issues	7 months
BRIEF Cope	Non-cognitive Questionnaire; Change pre- to post-test between groups	7 months
Social Stress and Support Interview	Non-cognitive Questionnaire; Change pre- to post-test between groups	7 months
Multiple Sclerosis Neuropsychological Screening Questionnaire	Non-cognitive Questionnaire; Change pre- to post-test between groups	7 months
Perceived Deficits Questionnaire	Non-cognitive Questionnaire; Change pre- to post-test between groups	7 months
Visual Spatial Span Board Assessment	Cognitive Test; Change pre- to post-test between groups in the amount of correct sequencing of repeated taping blocks in forward or reverse order from sequence presented by the examiner.	7 months
Digit Span	Cognitive Test; Change pre- to post-test between groups in terms of digit sequence memorized and repeated. A span of 3-9 digits will be repeated forwards and backwards after presentation from the examiner.	7 months
Arithmetic	Cognitive Test; Change pre- to post-test between groups, elementary math presented and solved without a pencil and paper.	7 months
Letter-Number Sequencing	Cognitive Test; Change pre- to post-test between groups, presented with a combination of letters and numbers; must repeat numbers in ascending order and letters in alphabetical order to examiner.	7 months

Collaborators and Investigators

• Sponsor: London Health Sciences Centre
• Investigators: Principal Investigator: Sarah A Morrow, MD, MS, FRCPC (Neurology), London Health Sciences Centre

Study record dates

Study Major Dates

• Study Start: April 1, 2016
• Primary Completion (Actual): November 1, 2018
• Study Completion (Actual): December 1, 2018

Study Registration Dates

• First Submitted: December 11, 2015
• First Submitted That Met QC Criteria: December 15, 2015
• First Posted (Estimate): December 18, 2015

Study Record Updates

• Last Update Posted (Actual): August 13, 2019
• Last Update Submitted That Met QC Criteria: August 12, 2019
• Last Verified: August 1, 2019

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Pathologic Processes; Nervous System Diseases; Immune System Diseases; Demyelinating Autoimmune Diseases, CNS; Autoimmune Diseases of the Nervous System; Demyelinating Diseases; Autoimmune Diseases; Multiple Sclerosis; Sclerosis
• Other Study ID Numbers: 107343