A Multi-Site Trial of a Cognitive Rehabilitation Intervention for Persons with MS

描述（由申请人提供）：多发性硬化症（MS）对认知的影响，被认为发生在50-75%的MS患者中，已经越来越多地被认为是该疾病的主要致残症状之一。虽然许多研究已经解决了MS的情绪和身体的影响，很少注意到可能有助于管理MS患者通常经历的认知变化的策略。拟议的研究将测试一种新的计算机辅助认知康复干预，MAPSS-MS（MS患者的记忆，注意力和解决问题的技能）。MAPSS-MS整合了团体干预的强大效果，以建立新的认知补偿策略/行为的自我效能，并结合个人基于家庭的计算机辅助认知技能练习。计算机培训将帮助个人发展认知技能，他们可以应用到日常生活中使用的补偿策略在课堂上学到的。在我们最近完成的探索性研究中，61名MS患者（R21 NR 011076），为期8周的MAPSS-MS干预是可接受的和可行的，并对补偿策略的使用和言语记忆神经心理学测试的表现产生了中等至较大的影响。拟议的研究将在多个地点使用更大更多样化的样本（N=180）测试改进的MAPSS-MS干预，将干预后随访期延长至6个月，并确定神经心理学测试的表现改善是否会在日常生活中改善神经认知功能。本研究的具体目的是：（1）评估MAPSS-MS认知康复干预对改善MS患者日常生活活动中的整体神经认知能力的疗效，包括言语记忆表现、补偿性认知策略的使用和认知相关工具性日常生活活动（IADL）表现;（2）评估MAPSS-MS干预在提高自我效能和认知表现相关方面的效果（非语言学习/记忆、信息处理速度和注意力、语言流畅性和复杂的扫描和跟踪）;以及（3）确定在干预后三个月和六个月达到并保持自我确定的认知目标的干预参与者的数量。干预的效果 结果变量将使用随机对照试验设计进行评估，对照组接受常规护理电脑游戏。研究变量的测量将在基线时、MAPSS-MS干预后即刻以及干预完成后3个月和6个月进行。统计分析将包括描述性统计 和HLM分析来解释嵌套设计。将使用意向治疗方法。

DESCRIPTION (provided by applicant): The effects of multiple sclerosis (MS) on cognition, thought to occur in 50-75% of persons with MS, have gained increasing recognition as one of the major disabling symptoms of the disease. While numerous studies have addressed the emotional and physical impact of MS, little attention has been given to strategies that might help manage the cognitive changes commonly experienced by persons with MS. The proposed study will test a novel computer-assisted cognitive rehabilitation intervention, MAPSS-MS (Memory, Attention, & Problem Solving Skills for Persons with MS). The MAPSS-MS integrates the powerful effects of group interventions to build self-efficacy for new cognitive compensatory strategies/behaviors with individual home-based computer- assisted practice of cognitive skills. The computer training will assist individuals to develop cognitive skills that they can apply to everyday life using the compensatory strategies learned in the class sessions. In our recently completed exploratory study with 61 persons with MS (R21NR011076), the eight-week MAPSS-MS intervention was acceptable and feasible and had medium to large effects on the use of compensatory strategies and performance on neuropsychological tests of verbal memory. The proposed study will test the refined MAPSS-MS intervention with a larger more diverse sample (N=180) across multiple sites, extend the period of post-intervention follow-up to 6 months and establish whether performance improvements on neuropsychological tests make the important transfer to improved neurocognitive functioning in everyday life. The specific aims of this study are to: (1) Evaluate the efficacy of the MAPSS-MS cognitive rehabilitation intervention in improving overall neurocognitive competence of persons with MS in activities of daily living, including verbal memory performance, use of compensatory cognitive strategies, and performance on cognitive-related instrumental activities of daily living (IADL); (2) Evaluate the efficacy of the MAPSS-MS intervention in improving self-efficacy and related aspects of cognitive performance (non-verbal learning/memory, information processing speed and attention, verbal fluency and complex scanning and tracking) among persons with MS; and (3) Determine the number of intervention participants who achieve and maintain their self-identified cognitive goals at three and six months following the intervention. The effects of the intervention on outcome variables will be assessed using a randomized controlled trial design with a comparison group receiving usual care computer games. Measurements of study variables will occur at baseline, immediately after the MAPSS-MS intervention, and three months and six months after the intervention is complete. Statistical analysis will include descriptive statistics and HLM analysis to account for the nested design. The intent-to-treat approach will be used.