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

项目总结/摘要 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， 越来越多的人认识到这是这种疾病的主要致残症状之一。虽然许多研究 虽然已经解决了MS的情绪和身体影响，但很少关注 可能有助于管理MS患者通常经历的认知变化。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（记忆，注意力和问题 解决MS患者的技能）。MAPSS-MS整合了团体干预的强大效果， 建立自我效能的新的认知补偿策略/行为与个人家庭为基础的计算机- 认知技能的辅助练习。计算机培训将帮助个人发展认知技能， 他们可以运用在课堂上学到的补偿策略应用到日常生活中。在我们最近 完成了61例MS患者的探索性研究（R21 NR 011076），为期8周的MAPSS-MS 干预是可接受的和可行的，对使用代偿性 在非文字记忆的神经心理学测试中的策略和表现。拟议的研究将测试 在多个研究中心使用更大更多样化的样本（N=180）进行改良的MAPSS-MS干预， 干预后随访期为6个月，并确定 神经心理学测试对改善日常生活中的神经认知功能起到了重要作用。 本研究的具体目的是：（1）评估MAPSS-MS认知康复的疗效 干预改善MS患者日常生活活动中的整体神经认知能力， 包括非文字记忆的表现，补偿认知策略的使用，以及 认知相关工具性日常生活活动能力（IADL）;（2）评估MAPSS-MS的疗效 提高自我效能和认知表现相关方面的干预措施（非语言 学习/记忆，信息处理速度和注意力，语言流畅性和复杂扫描， （3）确定达到以下目标的干预参与者的数量， 在干预后三个月和六个月保持他们自我确定的认知目标。的影响 将采用随机对照试验设计评估对结果变量的干预， 对照组接受常规护理电脑游戏。研究变量的测量将在 基线，MAPSS-MS干预后立即，以及 干预已经完成。统计分析将包括描述性统计和HLM分析，以说明 嵌套设计。将使用意向治疗方法。

PROJECT SUMMARY / ABSTRACT 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 neuro-cognitive 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 neuro-cognitive 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.