Cognitive rehabilitation of working memory in
juvenile multiple sclerosis–effects on cognitive functioning, functional MRI and network related connectivity
Affiliations: [a] Department of Cognitive Psychology and Methodology, University of Basel, Basel, Switzerland | [b] Kessler Foundation, West Orange, NJ, USA and Department of Physical Medicine & Rehabilitation and of Neurology & Neurosciences, Rutgers New Jersey Medical School, NJ, USA | [c] Division of Pediatric Neurology and Developmental Medicine, University Children’s Hospital Basel, Basel, Switzerland | [d] Department of Neuropediatrics, University Children’s Hospital Inselspital Bern, Switzerland | [e] Department of Neurology, University Hospital Basel, Basel, Switzerland
Correspondence:
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Corresponding author: PD Dr. Iris-Katharina Penner, Dipl.-Psych., Department of Cognitive Psychology and Methodology, University of Basel, Missionsstrasse 60/62, CH 4055 Basel,Switzerland. Tel.: +41 61 267 3525; Fax: +41 61 267 3526; ik.penner@unibas.ch
Abstract:
Purpose: To assess possible effects of working memory (WM) training on cognitive functionality, functional MRI and brain connectivity in patients with juvenile MS.
Methods: Cognitive status, fMRI and inter-network connectivity were assessed in 5 cases with juvenile MS aged between 12 and 18 years. Afterwards they received a computerized WM training for four weeks. Primary cognitive outcome measures were WM (visual and verbal) and alertness. Activation patterns related to WM were assessed during fMRI using an N-Back task with increasing difficulty. Inter-network connectivity analyses were focused on fronto-parietal (left and right), default-mode (dorsal and ventral) and the anterior salience network. Cognitive functioning, fMRI and inter-network connectivity were reassessed directly after the training and again nine months following training.
Results: Response to treatment was seen in two patients. These patients showed increased performance in WM and alertness after the training. These behavioural changes were accompanied by increased WM network activation and systematic changes in inter-network connectivity. The remaining participants were non-responders to treatment. Effects on cognitive performance were maintained up to nine months after training, whereas effects observed by fMRI disappeared.
Conclusions: Responders revealed training effects on all applied outcome measures. Disease activity and general intelligence may be factors associated with response to treatment.
Keywords: Connectivity, cognitive rehabilitation, working memory, juvenile multiple sclerosis
