Computer-Assisted Cognitive Rehabilitation of Attention Deficits for Multiple Sclerosis: A Randomized Trial With fMRI Correlates
Computer-Assisted Cognitive Rehabilitation of Attention Deficits for Multiple Sclerosis: A Randomized Trial With fMRI Correlates
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DOI：
10.1177/1545968312465194
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发表时间：
2013-05-01
影响因子：
4.2
通讯作者：
Quattrone, Aldo
中科院分区：
文献类型：
--
作者：
Cerasa, Antonio;Gioia, Maria Cecilia;Quattrone, Aldo
背景虽然越来越多的证据强调了认知康复（CR）在多发性硬化症（MS）认知功能障碍管理中的作用，但仍然没有证据表明有一种有效的治疗方法。Objective.我们提出了一种新的治疗策略，其特点是以计算机为基础的集中注意力训练计划，在MS患者占主导地位的注意力缺陷。我们的目的是调查我们的康复程序的有效性，为那些有能力受损，使用功能性磁共振成像（fMRI）。方法.使用双盲随机对照研究，我们招募了12名MS患者，他们接受了CR程序（实验组），和11名年龄性别匹配的MS患者，他们接受了安慰剂干预（对照组）。在广泛用于评估MS患者注意力能力的认知任务（起搏视觉序列加法测试）的执行期间记录fMRI。结果在表型和中间表型水平均检测到显著影响。CR后，实验组，与对照组相比，表现出特定的增强性能的注意力能力的Stroop任务的影响大小为0.88，这是与增加活动在小脑后小叶和上级顶叶小叶。结论.我们的研究表明，为那些能力受损的人量身定制的强化CR会影响神经可塑性，并改善MS患者认知缺陷的某些方面。报告的神经生理和行为效应证实了我们的治疗方法的益处，这可能在MS认知缺陷的临床管理中具有可靠的应用。
Background. Although a growing body of evidence has highlighted the role of cognitive rehabilitation (CR) in the management of cognitive dysfunctions in multiple sclerosis (MS), there is still no evidence for a validated therapeutic approach. Objective. We propose a new therapeutic strategy characterized by a computer-based intensive attention training program in MS patients with predominant attention deficits. We aim to investigate the effectiveness of our rehabilitation procedure, tailored for those with impaired abilities, using functional magnetic resonance imaging (fMRI). Methods. Using a double-blind randomized controlled study, we enrolled 12 MS patients, who underwent a CR program (experimental group), and 11 age-gender-matched MS patients, who underwent a placebo intervention (control group). fMRI was recorded during the execution of a cognitive task broadly used for assessing attention abilities in MS patients (paced visual serial addition test). Results. Significant effects were detected both at a phenotypic and at an intermediate phenotypic level. After CR, the experimental group, in comparison with the control group, showed a specific enhanced performance in attention abilities as assessed by the Stroop task with an effect size of 0.88, which was associated with increased activity in the posterior cerebellar lobule and in the superior parietal lobule. Conclusions. Our study demonstrates that intensive CR tailored for those with impaired abilities affects neural plasticity and improves some aspects of cognitive deficits in MS patients. The reported neurophysiological and behavioral effects corroborate the benefits of our therapeutic approach, which might have a reliable application in the clinical management of cognitive deficits in MS.