The psychological benefits of neuropsychological assessment feedback as a psycho-educational therapeutic intervention: A randomized-controlled trial with cross-over in multiple sclerosis.

ABSTRACTEvidence supporting the direct therapeutic benefits of neuropsychological assessment (NPA) feedback relies mostly upon post-feedback consumer surveys. This randomized-controlled trial with cross-over investigated the benefits of NPA feedback in multiple sclerosis (MS). Seventy-one participants were randomly allocated to NPA with feedback or a "delayed-treatment" control group. The primary hypotheses were that NPA feedback would lead to improved knowledge of cognitive functioning and improved coping. Outcome instruments were administered by a research assistant blinded to group allocation. At 1-week post-NPA feedback there were no significant group-by-time interaction effects, indicating no improvement. But nor was there any significant deterioration in psychological wellbeing, despite most participants receiving "bad news" confirming cognitive impairment. At 1-month follow-up, within-subjects' analyses not only found no evidence of any delayed deterioration, but showed clinically significant improvement (small-medium effects) in perceived everyday cognitive functioning, MS self-efficacy, stress and depression. Despite lack of improvement in the RCT component at 1-week post-NPA feedback, the absence of deterioration at this time, in addition to significant improvements in perceived cognitive functioning, self-efficacy and mood at follow-up, together with high satisfaction ratings, all support NPA feedback as a safe psycho-educational intervention that is followed by improved psychological wellbeing over time.Trial registration: Uniform Trial Number identifier: U1111-1127-1585.Trial registration: Australian New Zealand Clinical Trials Registry identifier: ACTRN12612000161820.

Computerised cognitive training in acquired brain injury: A systematic review of outcomes using the International Classification of Functioning (ICF).

Computerised cognitive training (CCT) is an increasingly popular intervention for people experiencing cognitive symptoms. This systematic review evaluated the evidence for CCT in adults with acquired brain injury (ABI), focusing on how outcome measures used reflect efficacy across components of the International Classification of Functioning, Disability and Health. Database searches were conducted of studies investigating CCT to treat cognitive symptoms in adult ABI. Scientific quality was rated using the PEDro-P and RoBiNT Scales. Ninety-six studies met the criteria. Most studies examined outcomes using measures of mental functions (93/96, 97%); fewer studies included measures of activities/participation (41/96, 43%) or body structures (8/96, 8%). Only 14 studies (15%) provided Level 1 evidence (randomised controlled trials with a PEDro-P score ≥ 6/10), with these studies suggesting strong evidence for CCT improving processing speed in multiple sclerosis (MS) and moderate evidence for improving memory in MS and brain tumour populations. There is a large body of research examining the efficacy of CCT, but relatively few Level 1 studies and evidence is largely limited to body function outcomes. The routine use of outcome measures of activities/participation would provide more meaningful evidence for the efficacy of CCT. The use of body structure outcome measures (e.g., neuroimaging) is a newly emerging area, with potential to increase understanding of mechanisms of action for CCT.

Evidence for deficits in facial affect recognition and theory of mind in multiple sclerosis.

Multiple sclerosis (MS) is a white matter disease associated with neurocognitive difficulties. More recently the potential for white matter pathology to also disrupt important aspects of emotion understanding has been recognized. However, no study to date has assessed whether capacity for facial affect recognition and theory of mind (ToM) is disrupted in MS, or whether any observed deficits are related to more general cognitive impairment. In the present study MS participants (n = 27) and nonclinical controls (n = 30) were administered measures of facial affect recognition, ToM, and cognitive functioning. MS participants were significantly impaired on the ToM task, and also presented with specific deficits decoding facial emotions of anger and fear. Performance on the measures of facial affect recognition and ToM were related to general cognitive functioning, and in particular, measures sensitive to executive dysfunction and information processing speed. These data highlight the need for future research to more fully delineate the extent and implications of emotion understanding difficulties in this population.

Disability in major depression related to self-rated and objectively-measured cognitive deficits: a preliminary study.

BACKGROUND: Although major depression (MD) is associated with high levels of disability, the relationships between cognitive dysfunction and self-rated disability are poorly understood. This study examined the relationships between self-rated disability in persons with MD and both self-rated and objectively-measured cognitive functioning. METHODS: Twenty-one persons with MD and 21 control participants underwent neuropsychological assessment and z-scores representing deviations from control performance were calculated and averaged across the domains of psychomotor speed, initial learning, memory retention and executive function. Self-ratings of cognitive deficits (SRCDs) were reported on a 6-point scale for overall rating of cognitive change, speed of thinking, concentration, and short-term memory. Disability scores for self-rated physical, mental-health and functional (ie. days out of role) disability were computed from the Brief-Disability Questionnaire and the SF-12 'mental component' subscale. RESULTS: Persons with MD had a mean age of 53.9 years (SD = 11.0, 76% female) and had moderate to high depression severity (mean HDRS 21.7, sd = 4.4). As expected, depression severity was a strong predictor of physical (r = 0.7, p < 0.01), mental-health (r = 0.7, p < 0.01) and functional (r = 0.8, p < 0.001) disability on the Brief Disability Questionnaire. Additionally, for physical disability, both overall SRCDs and objectively-measured psychomotor speed continued to be independent significant predictors after controlling for depression severity, uniquely accounting for 13% and 16% of variance respectively. For functional disability scores, objectively-measured memory impairment and overall SRCDs were no longer significant predictors after controlling for depression severity. CONCLUSION: While depression severity is associated with disability, the contributions of both self-rated and objectively-measured cognitive deficits are substantial and contribute uniquely and differentially to various forms of disability. Efforts directed at reducing cognitive deficits in depression may have the potential to reduce disability.

Symptom change with exercise is a temporary phenomenon for people with multiple sclerosis.

OBJECTIVE: To determine the impact of a single exercise session on function, fatigue, and sensory symptoms for people with multiple sclerosis (MS). DESIGN: This pilot study was designed as a before-after trial. Demographic and response-to-exercise measures were taken before exercise, repeated immediately after exercise, and followed up again 24 hours later. SETTING: Three metropolitan centers of an MS society. PARTICIPANTS: A prospective sample of 34 subjects with MS who were referred for physiotherapy for an exercise program and who could attend an MS society center. INTERVENTIONS: Subjects performed an individually prescribed exercise session, which was at a commencement level and included strengthening, stretches, and fitness exercises. Subjects exercised for between 5 to 45 minutes (mean, 17.4 min) at an intensity of 7 to 17 (median, 12) on the Borg rating of perceived exertion (RPE) scale. MAIN OUTCOME MEASURES: All outcome measures were self-rated by subjects and included the Borg RPE scale, a questionnaire for sensory symptom description, and visual analog scales for rating of fatigue, function, and intensity of sensory symptoms. RESULTS: Subjective levels of fatigue and function immediately postexercise and 24 hours postexercise did not differ significantly from pre-exercise levels. However, over 40% of subjects experienced a temporary increase in number of sensory symptoms, 44% experienced an increase in the intensity of sensory symptoms, and 29% experienced an increase in both number and intensity immediately postexercise. CONCLUSIONS: This small study found that when people with MS undertake exercise at a commencement level, they can expect that sensory symptoms may change temporarily, but they are unlikely to have any deleterious changes in fatigue and function.