- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03889327
Intervention to Reduce Perceived Cognitive Impairment in Multiple Sclerosis
Intervention to Reduce Distress From Perceived Cognitive Impairment in Multiple Sclerosis
Study Overview
Status
Conditions
Detailed Description
Concern over worsening cognitive functioning has been shown to significantly impact patients' lives. More than half of all MS patients demonstrate clinically significant cognitive dysfunction, making it one of the leading causes of disability in MS. Cognitive deficits often manifest in areas associated with information processing speed, memory, and executive functioning. Resulting sequela can have profound implications on employment, interpersonal relationships, and activities of daily living. Despite the prevalence of cognitive dysfunction in MS, most studies find little to no relationship between perceived and objective cognition in MS. Research shows that some patients overestimate the extent of their cognitive deficits. PCI is associated with poor self-efficacy, social, and occupational difficulties. Evidence suggests that negative emotional states may contribute to overestimated PCI in MS. Exaggerated perceptions of impaired cognition may be intensified by the presence of other MS symptoms, which can affect the way patients report disease activity to healthcare providers and complicate detection of relevant disease symptomatology.
Overestimating cognitive impairment has been observed in other patient populations, but it is especially problematic in MS and can provide an opportunity to inform patients about discrepancies between perceived and objective cognitive functioning. Since physicians spend significant amounts of time negating unsubstantiated healthcare concerns, an intervention aimed at decreasing PCI in MS may improve long-term healthcare outcomes as well as the quality of time that physicians spend with patients. Neuropsychological test results can be used as objective evidence against perceived cognitive impairment to change patients perceptions, if conveyed in an appropriate and nonthreatening manner.
Educating patients about the influence of emotional dysfunction and misattribution as it relates to PCI may also decrease concern regarding cognitive decline and MS. Specifically, internal processes such as emotional dysfunction, including a globally negative world view can increase dissociative experiences that cause patients to misattribute normal cognitive errors as MS-related cognitive decline. This model may inform patients understanding of medically unsubstantiated PCI, allowing them to consider alternative factors associated with common cognitive errors aside from MS.
Although many studies have aimed to improve cognition in MS through pharmacological treatments, cognitive rehabilitation, and psychotherapy, to the investigators knowledge, this is the first study to examine a psychoeducational intervention to decrease exaggerated perceptions of cognitive impairment in MS. For the present study, the investigators will develop a brief computer-based intervention for MS patients who perceive cognitive decline incongruent with objective measures of cognition. The proposed intervention will incorporate feedback from neuropsychological tests, including comparisons of perceived and objective performance. The intervention will also introduce psychoeducation about causes of PCI, such as emotional distress, attention, and misattribution. It is hoped that by combining neuropsychological test feedback and psychoeducation, patients may better understand differences between perceived and objective cognition, which in turn, may reduce concern and offer alternative explanations for PCI.
Goals and Hypotheses
For the current study, the investigators will develop a brief computer-based intervention for MS patients who perceive cognitive decline that is incongruent with objective measures of cognitive functioning. The project will accomplish the following specific aims:
- Develop and assess the feasibility and acceptability of a brief, single-session, computerized intervention (cognitive feedback and psychoeducation; CFP) as part of a randomized controlled pilot trial to reduce perceived cognitive impairment and distress associated with perceived cognitive impairment that is incongruent with objective measures of cognition in MS patients.
- Examine whether the intervention reduces distress related to perceived cognitive deficits. The investigators hypothesize that patients in the CFP group will report less distress over perceived cognitive impairment compared to the control group immediately after and one week following the intervention.
- Examine patients understanding of factors that contribute to perceived and objective cognitive impairment in MS. The investigators hypothesize that patients in the CFP group will have an increased understanding of the role that negative emotion, misattribution, and other secondary factors play in the formation of perceived cognitive deficits when compared to patients assigned to the HEH group.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
Kansas
-
Kansas City, Kansas, United States, 66160
- University of Kansas Department of Neurology
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- diagnosis of MS by a board-certified neurologist
- a total score > 40 on the Perceived Deficits Questionnaire (PDQ) based on previous research that identifies this cutoff score as clinically significant in the MS population and two standard deviations below average in the general population (Ruth Ann Marrie, Gordon J. Chelune, Deborah M. Miller, & Jeffrey A. Cohen, 2005)
- score in the low average or better range on the Wechsler Test of Adult Reading (WTAR)
- average score equal to or greater than the 16th percentile on the Hopkins Verbal Learning Test (HVLT), Symbol Digit Modalities Test (SDMT), Controlled Oral Word Association Test (COWAT), and Wisconsin Card Sorting Task (WCST)
- average T score on the HVLT, SDMT, COWAT, and WCST no more than one standard deviation below the WTAR T score
- access to a computer and a personal email account
- English-speaking
Exclusion Criteria:
- no severe sensory, motor, physical, or neurological impairment that would make participation in the study insurmountable
- no history of nervous system disorder other than MS
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Quadruple
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Cognitive Feedback and Psychoeducation (CFP)
Participants assigned to the cognitive feedback and psychoeducation (CFP) treatment group will watch a brief video integrating both neuropsychological test feedback and psychoeducation.
The computerized intervention will cover MS disease-related information, define objective cognition, explain neuropsychological assessment, and inform patients of their cognitive test performance outcomes.
The CFP intervention will also define and explain perceived cognition and subjective measures of cognition, and compare objective performance on neuropsychological tests to a subjective measure of perceived cognition.
The intervention will also discuss emotion, attention, and misattribution related to PCI.
The proposed intervention will incorporate expert testimony on MS disease course and related symptomology and interpretations of neuropsychological test performance.
|
The customary practice of providing feedback on neuropsychological test performance can address patient misperceptions of cognitive impairment by distinguishing between perceived and objective neuropsychological test performance.
Explaining how normative data is derived by comparison to same age peers, patients are able to better understand their current cognitive functioning.
The proposed intervention will employ both psychoeducation and neuropsychological feedback for participants assigned to the treatment group, and psychoeducation for participants assigned to the control group.
Both groups will watch 3 brief videos (exactly the same length in time) and answer two qualitative questions following each video.
|
Active Comparator: Healthy Eating Habits (HEH)
The control group, healthy eating habits (HEH) group, will watch a brief psychoeducational video of same length in time as the treatment group.
The control intervention will include information on importance of healthy eating habits and benefits of a healthy diet including medical outcomes such as reduced blood pressure, and decreased risk of stroke and cardiovascular disease.
This intervention will also cover recommended serving sizes for daily helpings of fruits and vegetables, and ways to incorporate fruits and vegetables into meals throughout the day.
The proposed control intervention will include expert testimony from a nutritionist and expert dietician.
|
Information on importance of healthy eating habits and benefits of a healthy diet including medical outcomes such as reduced blood pressure, and decreased risk of stroke and cardiovascular disease.
This intervention will also cover recommended serving sizes for daily helpings of fruits and vegetables, and ways to incorporate fruits and vegetables into meals throughout the day.
The control intervention will include expert testimony from a nutritionist and expert dietician.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Feasibility and Acceptability Questionnaire
Time Frame: 5 minutes
|
All participants complete a feasibility and acceptability questionnaire upon study completion.
The questionnaire will address satisfaction with study participation, effectiveness and convenience of the intervention, and short answer questions on newly acquired information, application of information learned, and feelings about the new information.
Participants will also be asked if they perceived the intervention as helpful and if they would be willing to recommend it to other MS patients.
This measure will be scored quantitatively, ranging from 0-85 possible points, where higher scores indicated greater feasibility and acceptability of the intervention.
|
5 minutes
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Cognition Quiz
Time Frame: 5 minutes
|
Examine patients understanding of factors that contribute to perceived and objective cognitive impairment in MS.
All participants will complete the cognition quiz.
Scores range from 0-21, where higher scores indicated greater knowledge of perceived and objective cognition.
Within participant analysis will be used to compare changes in score from baseline to immediate post intervention.
|
5 minutes
|
Perceived Cognitive Impairment-Distress (PCI-D)
Time Frame: 5 minutes
|
Examine distress related to perceived cognitive deficits.
Within subject comparisons will be made, examining baseline and immediate post intervention responses on this questionnaire.
Scores range from 0-60, higher scores indicate greater distress over perceived cognitive deficits.
|
5 minutes
|
Collaborators and Investigators
Collaborators
Investigators
- Study Chair: Jared Bruce, PhD, UMKC Faculty
Publications and helpful links
General Publications
- Amato MP, Ponziani G, Rossi F, Liedl CL, Stefanile C, Rossi L. Quality of life in multiple sclerosis: the impact of depression, fatigue and disability. Mult Scler. 2001 Oct;7(5):340-4. doi: 10.1177/135245850100700511.
- Kujala P, Portin R, Ruutiainen J. The progress of cognitive decline in multiple sclerosis. A controlled 3-year follow-up. Brain. 1997 Feb;120 ( Pt 2):289-97. doi: 10.1093/brain/120.2.289.
- Beier M, Amtmann D, Ehde DM. Beyond depression: Predictors of self-reported cognitive function in adults living with MS. Rehabil Psychol. 2015 Aug;60(3):254-62. doi: 10.1037/rep0000045. Epub 2015 Jul 20.
- Benedict RH, Cookfair D, Gavett R, Gunther M, Munschauer F, Garg N, Weinstock-Guttman B. Validity of the minimal assessment of cognitive function in multiple sclerosis (MACFIMS). J Int Neuropsychol Soc. 2006 Jul;12(4):549-58. doi: 10.1017/s1355617706060723.
- Olazaran J, Cruz I, Benito-Leon J, Morales JM, Duque P, Rivera-Navarro J. Cognitive dysfunction in multiple sclerosis: methods and prevalence from the GEDMA Study. Eur Neurol. 2009;61(2):87-93. doi: 10.1159/000177940. Epub 2008 Nov 28.
- Kinsinger SW, Lattie E, Mohr DC. Relationship between depression, fatigue, subjective cognitive impairment, and objective neuropsychological functioning in patients with multiple sclerosis. Neuropsychology. 2010 Sep;24(5):573-80. doi: 10.1037/a0019222.
- Benedict RH. Effects of using same- versus alternate-form memory tests during short-interval repeated assessments in multiple sclerosis. J Int Neuropsychol Soc. 2005 Oct;11(6):727-36. doi: 10.1017/S1355617705050782.
- Bruce JM, Bruce AS, Hancock L, Lynch S. Self-reported memory problems in multiple sclerosis: influence of psychiatric status and normative dissociative experiences. Arch Clin Neuropsychol. 2010 Feb;25(1):39-48. doi: 10.1093/arclin/acp092. Epub 2009 Dec 3.
- Kalmar JH, Gaudino EA, Moore NB, Halper J, Deluca J. The relationship between cognitive deficits and everyday functional activities in multiple sclerosis. Neuropsychology. 2008 Jul;22(4):442-9. doi: 10.1037/0894-4105.22.4.442.
- Rao SM, Leo GJ, Ellington L, Nauertz T, Bernardin L, Unverzagt F. Cognitive dysfunction in multiple sclerosis. II. Impact on employment and social functioning. Neurology. 1991 May;41(5):692-6. doi: 10.1212/wnl.41.5.692.
- Basso MR, Shields IS, Lowery N, Ghormley C, Combs D, Arnett PA, Johnson J. Self-reported executive dysfunction, neuropsychological impairment, and functional outcomes in multiple sclerosis. J Clin Exp Neuropsychol. 2008 Nov;30(8):920-30. doi: 10.1080/13803390801888733.
- Middleton LS, Denney DR, Lynch SG, Parmenter B. The relationship between perceived and objective cognitive functioning in multiple sclerosis. Arch Clin Neuropsychol. 2006 Aug;21(5):487-94. doi: 10.1016/j.acn.2006.06.008. Epub 2006 Aug 1.
- Akbar N, Honarmand K, Feinstein A. Self-assessment of cognition in Multiple Sclerosis: the role of personality and anxiety. Cogn Behav Neurol. 2011 Sep;24(3):115-21. doi: 10.1097/WNN.0b013e31822a20ae.
- Akbar N, Honarmand K, Kou N, Feinstein A. Validity of a computerized version of the symbol digit modalities test in multiple sclerosis. J Neurol. 2011 Mar;258(3):373-9. doi: 10.1007/s00415-010-5760-8. Epub 2010 Oct 6.
- Cull A, Hay C, Love SB, Mackie M, Smets E, Stewart M. What do cancer patients mean when they complain of concentration and memory problems? Br J Cancer. 1996 Nov;74(10):1674-9. doi: 10.1038/bjc.1996.608.
- Sawrie SM, Martin RC, Kuzniecky R, Faught E, Morawetz R, Jamil F, Viikinsalo M, Gilliam F. Subjective versus objective memory change after temporal lobe epilepsy surgery. Neurology. 1999 Oct 22;53(7):1511-7. doi: 10.1212/wnl.53.7.1511.
- Sawrie SM, Marson DC, Boothe AL, Harrell LE. A method for assessing clinically relevant individual cognitive change in older adult populations. J Gerontol B Psychol Sci Soc Sci. 1999 Mar;54(2):P116-24. doi: 10.1093/geronb/54b.2.p116.
- van Gorp WG, Satz P, Hinkin C, Selnes O, Miller EN, McArthur J, Cohen B, Paz D. Metacognition in HIV-1 seropositive asymptomatic individuals: self-ratings versus objective neuropsychological performance. Multicenter AIDS Cohort Study (MACS). J Clin Exp Neuropsychol. 1991 Sep;13(5):812-9. doi: 10.1080/01688639108401091.
- Maor Y, Olmer L, Mozes B. The relation between objective and subjective impairment in cognitive function among multiple sclerosis patients--the role of depression. Mult Scler. 2001 Apr;7(2):131-5. doi: 10.1177/135245850100700209.
- Arnett PA, Rao SM, Grafman J, Bernardin L, Luchetta T, Binder JR, Lobeck L. Executive functions in multiple sclerosis: an analysis of temporal ordering, semantic encoding, and planning abilities. Neuropsychology. 1997 Oct;11(4):535-44. doi: 10.1037//0894-4105.11.4.535.
- Mittenberg W, Canyock EM, Condit D, Patton C. Treatment of post-concussion syndrome following mild head injury. J Clin Exp Neuropsychol. 2001 Dec;23(6):829-36. doi: 10.1076/jcen.23.6.829.1022.
- Bruce JM, Bruce AS, Arnett PA. Response variability is associated with self-reported cognitive fatigue in multiple sclerosis. Neuropsychology. 2010 Jan;24(1):77-83. doi: 10.1037/a0015046.
- Carone DA. But the Scores Don't Show How I Really Function: A Feedback Method to Reveal Cognitive Distortions Regarding Normal Neuropsychological Test Performance. Appl Neuropsychol Adult. 2017 Mar-Apr;24(2):160-168. doi: 10.1080/23279095.2015.1116074. Epub 2016 Apr 4.
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Mental Disorders
- Pathologic Processes
- Nervous System Diseases
- Immune System Diseases
- Demyelinating Autoimmune Diseases, CNS
- Autoimmune Diseases of the Nervous System
- Demyelinating Diseases
- Autoimmune Diseases
- Neurocognitive Disorders
- Cognition Disorders
- Multiple Sclerosis
- Sclerosis
- Cognitive Dysfunction
Other Study ID Numbers
- 17-180
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Multiple Sclerosis
-
University Hospital, Basel, SwitzerlandSwiss National Science FoundationRecruitingMultiple Sclerosis (MS) | Relapsing-remitting Multiple Sclerosis (RRMS) | Secondary-progressive Multiple Sclerosis (SPMS) | Primary Progressive Multiple Sclerosis (PPMS)Switzerland
-
University of California, Los AngelesUnknownRelapsing-remitting Multiple Sclerosis | Secondary-progressive Multiple Sclerosis | Primary-progressive Multiple SclerosisUnited States
-
BiogenCompletedMultiple Sclerosis | Relapsing-Remitting Multiple Sclerosis | Secondary Progressive Multiple Sclerosis | Multiple Sclerosis, Primary Progressive | Multiple Sclerosis, Remittent ProgressiveJapan
-
The Cleveland ClinicUniversity Hospitals Cleveland Medical CenterCompletedRelapsing-Remitting Multiple Sclerosis | Secondary Progressive Multiple Sclerosis | Progressive Relapsing Multiple SclerosisUnited States
-
Rigshospitalet, DenmarkOdense University Hospital; Aarhus University Hospital; Hvidovre University Hospital and other collaboratorsRecruitingRelapsing Remitting Multiple Sclerosis | Primary Progressive Multiple Sclerosis | Secondary Progressive Multiple SclerosisDenmark
-
University of California, San FranciscoUnited States Department of DefenseRecruitingMultiple Sclerosis, Chronic Progressive | Multiple Sclerosis, Relapsing-Remitting | Multiple Sclerosis (MS) | Multiple Sclerosis Relapse | Multiple Sclerosis, Primary Progressive | Multiple Sclerosis Brain Lesion | Multiple Sclerosis BenignUnited States
-
Icahn School of Medicine at Mount SinaiColumbia University; New York Stem Cell Foundation Research InstituteCompletedClinically Isolated Syndrome | Relapsing-Remitting Multiple Sclerosis | Primary Progressive Multiple Sclerosis | Secondary Progressive Multiple SclerosisUnited States
-
Brigham and Women's HospitalMassachusetts General HospitalRecruitingMultiple Sclerosis | Relapsing Multiple Sclerosis | Primary Progressive Multiple Sclerosis | Secondary Progressive Multiple SclerosisUnited States
-
University of MinnesotaMallinckrodtTerminatedPrimary Progressive Multiple Sclerosis | Secondary Progressive Multiple Sclerosis | Progressive Relapsing Multiple SclerosisUnited States
-
Banc de Sang i TeixitsVall d'Hebron Research Institute (VHIR)CompletedRelapsing-Remitting Multiple Sclerosis | Secondary Progressive Multiple SclerosisSpain
Clinical Trials on Neuropsychological Feedback & Psychoeducation (Cognition)
-
Association de Recherche Bibliographique pour les...Centre Hospitalier Universitaire de Nice; Centre Hospitalier Princesse GraceCompletedHealthy | Clinically Isolated Syndrome | Multiple Sclerosis (MS) | Radiologically Isolated Syndrome | Multiple Sclerosis (MS) Relapsing Remitting | Multiple Sclerosis (MS) Primary Progressive | Multiple Sclerosis (MS) Secondary ProgressiveMonaco
-
Hospices Civils de LyonCompletedParkinson DiseaseFrance
-
Assistance Publique - Hôpitaux de ParisNot yet recruitingAlzheimer's Disease (AD) | Lewy Body Dementia (LBD) | Frontotemporal Degeneration (FTD)France
-
Hôpital le VinatierRecruitingAutism Spectrum DisorderFrance
-
University of PittsburghNational Institute on Alcohol Abuse and Alcoholism (NIAAA)Completed
-
Mclean HospitalBrain & Behavior Research FoundationRecruitingBorderline Personality DisorderUnited States
-
Instituto de Investigación Hospital Universitario...Carlos III Health Institute; European Regional Development FundCompletedSchizophrenia and Disorders With Psychotic Features | Psychotic EpisodeSpain
-
Mental Health Services in the Capital Region, DenmarkCopenhagen Trial Unit, Center for Clinical Intervention Research; Center for...CompletedPatients at Ultra-high Risk of PsychosisDenmark