Memory Rehabilitation in Multiple Sclerosis

Summary

A Cochrane review [Abstract] 1 included 15 RCTs with a total of 989 patients with multiple sclerosis. All types of MS were included (relapsing remitting, secondary progressive, primary progressive). Most participants were in their 40s. The interventions involved various memory retraining techniques, such as computerised programmes and training on internal and external memory aids. Control groups varied in format from assessment-only groups, discussion and games, non-specific cognitive retraining and attention or visuospatial training. The studies used a range of outcome measures. There was a significant effect of intervention, either immediately (follow-up: 1 to 5 months) or long-term (follow-up: 3 to 8 months), on objective assessments of memory: SMD 0.23 (95% CI 0.05 to 0.41; 11 studies, n=503) and SMD 0.26 (95% CI 0.03 to 0.49; 6 studies, n=302), respectively. There was also a significant effect of intervention for quality of life in the immediate follow-up (follow-up: 1.5 to 4 months) (SMD 0.23, 95% CI 0.05 to 0.41; 7 studies, n=485). These findings showed that the intervention group performed significantly better than the control group. There was also a significant difference for activities of daily living (ADL) in the long-term follow-up (follow-up: 7 to 8 months) (SMD -0.33, 95% CI -0.63 to -0.03; 2 studies, n=186), showing that the control groups had significantly less difficulty completing ADLs than the intervention groups. There were no significant effects, either immediate or long-term, on subjective reports of memory problems (SMD 0.04, 95% CI -0.19 to 0.27; 5 studies, n=314 and SMD 0.04, 95% CI -0.19 to 0.27; 5 studies, n=305, respectively); on mood (SMD 0.02, 95% CI -0.16 to 0.20 and SMD -0.01, 95% CI -0.21 to 0.20, respectively); and on immediate follow-up for ADL (SMD -0.13 (95% CI -0.60 to 0.33)) and in the long term for quality of life (SMD 0.16 (95% CI -0.03 to 0.36)).

Comment: The quality of the evidence is downgraded by inconsistency (heterogeneity in patients, interventions and outcomes) and indirectness (short follow-up times).