A large international clinical trial (called CogEx) tested whether a 12-week program of aerobic exercise or computer-based cognitive rehabilitation, or a combination of both, could improve thinking speed in people with progressive MS who had signs of cognitive changes.
The results suggested that regardless of which group they were in, two-thirds of the participants showed improvements and half of those still showed improvements 6 months later. The combination of both approaches did not enhance the benefits. This study adds to evidence that cognitive problems can be improved in people with progressive MS.
The trial was led by Prof. Anthony Feinstein, MPhil, PhD, FRCP (University of Toronto) and was supported by MS Canada. The National MS Society (U.S.A.) supported a sub-study at the University of Alabama, Birmingham that added MRI scanning to enhance information to be learned from the larger trial.
A total of 311 participants from Belgium, Canada, Denmark, Italy, the United Kingdom, and the U.S. They all had progressive MS and had experienced cognitive changes. The interventions were:
- Cognitive rehabilitation with a computer-based, incremental approach to improve processing speed (called the RehaCom program).
- Exercise involving individualized aerobic training using a recumbent arm–leg stepper.
- Sham cognitive task consisted of internet training provided individually.
- Sham exercise consisted of non-aerobic stretching and balance tasks.
Participants were assigned to one of four groups, where they received the following interventions twice a week over 12-weeks:
- Cognitive rehabilitation plus sham exercise
- Aerobic exercise plus sham cognitive task
- Cognitive rehabilitation plus aerobic exercise (combined intervention)
- Sham cognitive task and sham exercise
Cognitive testing was done using the Symbol Digit Modalities Test (SDMT) which measures thinking speed.
After 12 weeks, there were no significant differences in the cognitive tests between the four treatment groups. However, two-thirds of all participants, regardless of the type of intervention received, showed significant improvements in processing speed at 12 weeks of intervention compared with their test scores at the start of the study. Almost 50% of participants retained these improvements in processing speed at the 6-month follow-up.
Why Does This Matter?
This large trial provides evidence that cognition can be improved in people living with progressive MS. It is possible that the participants who showed improvements may have benefited from being more active in the trial, pointing to the potential benefits of enhancing a person’s intellectual, physical, and social activities that build a resistance to damage in the brain, known as “cognitive reserve.”
“Cognitive rehabilitation and aerobic exercise for cognitive impairment in people with progressive multiple sclerosis (CogEx): a randomised, blinded, sham-controlled trial
,” by Anthony Feinstein, Maria Pia Amato, Giampaolo Brichetto, Jeremy Chataway, Nancy D Chiaravalloti, Gary Cutter, Ulrik Dalgas, John DeLuca, Rachel Farrell, Peter Feys, Massimo Filippi, Jennifer Freeman, Matilde Inglese, Cecilia Meza, Robert W Motl, Maria Assunta Rocca, Brian M Sandroff, Amber Salter, on behalf of the CogEx Research Team, was published online in Lancet Neurology
for its October 2023 issue.