BOSTON – Multiple sclerosis patients with cognitive impairment who played a brain-training video game on a regular basis had significant improvement in cognitive test results that correlated with an increase in functional connectivity between the thalamus and cortex in a small, randomized pilot study.
The results of the study provide some preliminary evidence that improvement in measures of the functional connectivity between thalamic and cortical areas serve as the functional substrate underlying clinical recovery, Dr. Laura De Giglio said at the joint meeting of the European and Americas Committees for Treatment and Research in Multiple Sclerosis.
Dr. Laura De Giglio
Dr. De Giglio and her associates at Sapienza University of Rome based the premise of the current study on their research team’s recent functional MRI study in MS patients with cognitive impairment, which indicated that worse performance on cognitive testing is associated with increased functional thalamo-cortical connectivity in the thalamic resting state network (Radiology 2014 June [doi:http://dx.doi.org/10.1148/radiol.14131688]). That association could be interpreted to mean that "there are some neuroplastic changes in the thalamic resting state in MS that are not able to fully compensate for tissue damage to prevent cognitive dysfunction," Dr. De Giglio said.
Given the success of recent studies in cognitive rehabilitation of MS patients with face-to-face, computer-assisted, and home-based treatments, she and her colleagues sought to understand how this might work by randomizing 24 patients with cognitive impairment to 8 weeks of training with the video game, "Dr. Kawashimas Brain Training," or to a wait-list group that later received the same training after the study period. Patients used the Italian version of the video game at home for 30 minutes per day, 5 days per week during an 8-week period; their compliance with its use was recorded on the console. The patients had a similar mean level of education (14 years), disease duration (13 years), and Expanded Disability Status score (2).
The investigators assessed attention, processing speed, and working memory before and after the video game training with the Paced Auditory Serial Addition Test (PASAT) with a 3-second pace (0-60, higher scores better), the Symbol Digit Modalities Test (SDMT; 0-110, higher scores better), and the Stroop Test (higher scores better) while patients underwent 3-Tesla functional MRI.
The investigators defined cognitive impairment as failure on at least one of the three neuropsychological tests, based on a score below the 10th percentile of normative data in the Italian population.
Mean scores improved significantly in the intervention group, compared with the wait-list group, on the PASAT (from 35.5 to 46.2 vs. from 32.64 to 36.60) and the Stroop Test (from 22.83 to 28.83 vs. from 24.43 to 25.36). The intervention led to numerically greater mean improvement on the SDMT, but the results were not statistically significant.
Improvement on the PASAT correlated with patterns of increased thalamic connectivity to the left superior temporal gyrus and bilateral locations in the lingual, fusiform, and pre-central gyri. On the Stroop Test, improvement was correlated with improved connectivity between the right angular and supramarginal gyri and the thalamus. Improvement on the SDMT was associated with increased thalamic connectivity to bilateral locations on the temporal, occipital, and lateral parietal cortex.
The investigators observed no relapses or worsening of Expanded Disability Status Scale scores in the patients.
Dr. De Giglio had nothing to disclose. Two coauthors had consulting or lecture fees from pharmaceutical companies marketing MS therapies.