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Cappon D, Fox R, den Boer T, Yu W, LaGanke N, Cattaneo G, Perellón-Alfonso R, Bartrés-Faz D, Manor B, Pascual-Leone A. Tele-supervised home-based transcranial alternating current stimulation (tACS) for Alzheimer's disease: a pilot study. Front Hum Neurosci 2023; 17:1168673. [PMID: 37333833 PMCID: PMC10272342 DOI: 10.3389/fnhum.2023.1168673] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 04/27/2023] [Indexed: 06/20/2023] Open
Abstract
Background Over 55 million people worldwide are currently diagnosed with Alzheimer's disease (AD) and live with debilitating episodic memory deficits. Current pharmacological treatments have limited efficacy. Recently, transcranial alternating current stimulation (tACS) has shown memory improvement in AD by normalizing high-frequency neuronal activity. Here we investigate the feasibility, safety, and preliminary effects on episodic memory of an innovative protocol where tACS is administered within the homes of older adults with AD with the help of a study companion (HB-tACS). Methods Eight participants diagnosed with AD underwent multiple consecutive sessions of high-definition HB-tACS (40 Hz, 20-min) targeting the left angular gyrus (AG), a key node of the memory network. The Acute Phase comprised 14-weeks of HB-tACS with at least five sessions per week. Three participants underwent resting state electroencephalography (EEG) before and after the 14-week Acute Phase. Subsequently, participants completed a 2-3-month Hiatus Phase not receiving HB-tACS. Finally, in the Taper phase, participants received 2-3 sessions per week over 3-months. Primary outcomes were safety, as determined by the reporting of side effects and adverse events, and feasibility, as determined by adherence and compliance with the study protocol. Primary clinical outcomes were memory and global cognition, measured with the Memory Index Score (MIS) and Montreal Cognitive Assessment (MoCA), respectively. Secondary outcome was EEG theta/gamma ratio. Results reported as mean ± SD. Results All participants completed the study, with an average of 97 HB-tACS sessions completed by each participant; reporting mild side effects during 25% of sessions, moderate during 5%, and severe during 1%. Acute Phase adherence was 98 ± 6.8% and Taper phase was 125 ± 22.3% (rates over 100% indicates participants completed more than the minimum of 2/week). After the Acute Phase, all participants showed memory improvement, MIS of 7.25 ± 3.77, sustained during Hiatus 7.00 ± 4.90 and Taper 4.63 ± 2.39 Phases compared to baseline. For the three participants that underwent EEG, a decreased theta/gamma ratio in AG was observed. Conversely, participants did not show improvement in the MoCA, 1.13 ± 3.80 after the Acute Phase, and there was a modest decrease during the Hiatus -0.64 ± 3.28 and Taper -2.56 ± 5.03 Phases. Conclusion This pilot study shows that the home-based, remotely-supervised, study companion administered, multi-channel tACS protocol for older adults with AD was feasible and safe. Further, targeting the left AG, memory in this sample was improved. These are preliminary results that warrant larger more definite trials to further elucidate tolerability and efficacy of the HB-tACS intervention. NCT04783350. Clinical trial registration https://clinicaltrials.gov/ct2/show/NCT04783350?term=NCT04783350&draw=2&rank=1, identifier NCT04783350.
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Affiliation(s)
- Davide Cappon
- Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife, Boston, MA, United States
- Deanna and Sidney Wolk Center for Memory Health at Hebrew SeniorLife, Boston, MA, United States
- Department of Neurology, Harvard Medical School, Boston, MA, United States
| | - Rachel Fox
- Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife, Boston, MA, United States
- Deanna and Sidney Wolk Center for Memory Health at Hebrew SeniorLife, Boston, MA, United States
| | - Tim den Boer
- Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife, Boston, MA, United States
| | - Wanting Yu
- Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife, Boston, MA, United States
| | - Nicole LaGanke
- Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife, Boston, MA, United States
| | - Gabriele Cattaneo
- Institut Guttmann, Institut Universitari de Neurorehabilitació Adscrit a la UAB, Barcelona, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
- Fundació Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
| | - Ruben Perellón-Alfonso
- Department of Medicine, Faculty of Medicine and Health Sciences, Institute of Neurosciences, University of Barcelona, Barcelona, Spain
- Institute of Biomedical Research August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - David Bartrés-Faz
- Department of Medicine, Faculty of Medicine and Health Sciences, Institute of Neurosciences, University of Barcelona, Barcelona, Spain
- Institute of Biomedical Research August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Brad Manor
- Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife, Boston, MA, United States
- Department of Medicine, Harvard Medical School, Boston, MA, United States
| | - Alvaro Pascual-Leone
- Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife, Boston, MA, United States
- Deanna and Sidney Wolk Center for Memory Health at Hebrew SeniorLife, Boston, MA, United States
- Department of Neurology, Harvard Medical School, Boston, MA, United States
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Fakolade A, Akbar N, Mehelay S, Phadke S, Tang M, Alqahtani A, Pullattayil AK, Busse M. Mapping two decades of multiple sclerosis rehabilitation trials: A systematic scoping review and call to action to advance the study of race and ethnicity in rehabilitation research. Mult Scler Relat Disord 2023; 72:104606. [PMID: 36917889 DOI: 10.1016/j.msard.2023.104606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 01/16/2023] [Accepted: 03/04/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND Multiple sclerosis (MS), is prevalent across many racial and ethnic groups, and disproportionately impacts racially minoritized populations. Rehabilitation interventions are an important component of comprehensive MS care. Yet, we do not know the extent to which MS rehabilitation trials consider race and ethnicity in defining eligibility criteria, planning recruitment strategies, selecting outcome measures, supporting intervention delivery, and designing approaches to promote adherence and retention. METHODS We conducted a scoping review of five databases (MEDLINE, CINAHL, Cochrane Central, EMBASE, and Web of Science) to locate randomized controlled rehabilitation trials published from January 2002 to March 2022. We extracted data from relevant studies, assessed their methodological quality, and narratively summarized results. Reporting of this review is in line with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). RESULTS Fifty-six studies of neurorehabilitation (n = 3), cognitive rehabilitation (n = 6), exercise training (n = 9) and self-management (n = 38) interventions were included in this review. The studies were predominantly from North America (n = 44; 73%) or Europe (n = 12; 20%) and included 4280 participants. Most participants (n = 3669; 86%) were Caucasians. Less than 10% of participants were Black (n = 282), Latinx/Hispanic (n = 60), Asian (n = 46), Indigenous (n = 7), or Arab (n = 2). Few studies discussed how race and/or ethnicity were considered in trial planning or execution. CONCLUSIONS Without consistent and systematic attention to race and ethnicity, both in terms of trial design and reporting, it is impossible to know how MS rehabilitation interventions will translate into real-world applications. This call to action - to the MS rehabilitation research community to ensure trial and intervention processes that accommodate the needs of diverse racial and ethnic groups - is an important first step in addressing inequities in rehabilitation care for persons with MS.
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Affiliation(s)
- Afolasade Fakolade
- School of Rehabilitation Therapy, Queen's University, Louise D. Acton Building, 31 George Street, Kingston K7L 3N6, Canada.
| | - Nadine Akbar
- School of Rehabilitation Therapy, Queen's University, Louise D. Acton Building, 31 George Street, Kingston K7L 3N6, Canada; Research Department, Humber River Hospital, Toronto, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Sumaya Mehelay
- Faculty of Health Sciences, Queen's University, Kingston, Canada
| | - Siona Phadke
- Department of Psychology, Queen's University, Kingston, Canada; Department of Biology, Queen's University, Kingston, Canada
| | - Matthew Tang
- Faculty of Health Sciences, Queen's University, Kingston, Canada
| | - Ashwaq Alqahtani
- School of Rehabilitation Therapy, Queen's University, Louise D. Acton Building, 31 George Street, Kingston K7L 3N6, Canada; Department of Physical Therapy, College of Medical Rehabilitation, Qassim University, Buraydah 52645, Saudi Arabia
| | | | - Monica Busse
- Centre for Trials Research, Cardiff University, Cardiff, United Kingdom
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Bonnechère B, Klass M. Cognitive Computerized Training for Older Adults and Patients with Neurological Disorders: Do the Amount and Training Modality Count? An Umbrella Meta-Regression Analysis. Games Health J 2023; 12:100-117. [PMID: 36920851 DOI: 10.1089/g4h.2022.0120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
Numerous applications have been created to train cognition and challenge the brain, a process known as computerized cognitive training (CCT). Despite potential positive results, important questions remain unresolved: the appropriate training duration, the efficacy of CCT depending on its type (commercial or developed in-house for the rehabilitation of specific patients) and delivery mode (at-home or on-site), and the patients most likely to benefit such intervention. This study aims to perform an umbrella meta-analysis and meta-regression to determine if the type of CCT, the delivery mode, the amount of training, and participants' age at inclusion influence the improvement of the cognitive function. To do so, we performed a umbrella meta-analysis. One hundred studies were included in this analysis representing 6407 participants. Statistical improvements were found for the different conditions after the training. We do not find statistical difference between the type of intervention or the delivery mode. No dose-response relationship between the total amount of training and the improvement of cognitive functions was found. CCT is effective in improving cognitive function in patients suffering from neurological conditions and in healthy aging. There is therefore an urgent need for health care systems to recognize its therapeutic potential and to evaluate at a larger scale their integration into the clinical pipeline as preventive and rehabilitation tool.
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Affiliation(s)
- Bruno Bonnechère
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium.,Technology-Supported and Data-Driven Rehabilitation, Data Sciences Institute, Hasselt University, Diepenbeek, Belgium
| | - Malgorzata Klass
- Laboratory of Applied Biology and Neurophysiology, ULB Neuroscience Institute (UNI), Université Libre de Bruxelles (ULB), Brussels, Belgium
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Das J, Morris R, Barry G, Vitorio R, Oman P, McDonald C, Walker R, Stuart S. Exploring the feasibility of technological visuo-cognitive training in Parkinson's: Study protocol for a pilot randomised controlled trial. PLoS One 2022; 17:e0275738. [PMID: 36206239 PMCID: PMC9543984 DOI: 10.1371/journal.pone.0275738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 08/19/2022] [Indexed: 11/12/2022] Open
Abstract
Visual and cognitive dysfunction are common in Parkinson's disease and relate to balance and gait impairment, as well as increased falls risk and reduced quality of life. Vision and cognition are interrelated (termed visuo-cognition) which makes intervention complex in people with Parkinson's (PwP). Non-pharmacological interventions for visuo-cognitive deficits are possible with modern technology, such as combined mobile applications and stroboscopic glasses, but evidence for their effectiveness in PwP is lacking. We aim to investigate whether technological visuo-cognitive training (TVT) can improve visuo-cognitive function in PwP. We will use a parallel group randomised controlled trial to evaluate the feasibility and acceptability of TVT versus standard care in PwP. Forty PwP who meet our inclusion criteria will be randomly assigned to one of two visuo-cognitive training interventions. Both interventions will be carried out by a qualified physiotherapist in participants own homes (1-hour sessions, twice a week, for 4 weeks). Outcome measures will be assessed on anti-parkinsonian medication at baseline and at the end of the 4-week intervention. Feasibility of the TVT intervention will be assessed in relation to safety and acceptability of the technological intervention, compliance and adherence to the intervention and usability of equipment in participants homes. Additionally, semi structured interviews will be conducted to explore participants' experience of the technology. Exploratory efficacy outcomes will include change in visual attention measured using the Trail Making Test as well as changes in balance, gait, quality of life, fear of falling and levels of activity. This pilot study will focus on the feasibility and acceptability of TVT in PwP and provide preliminary data to support the design of a larger, multi-centre randomised controlled trial. This trial is registered at isrctn.com (ISRCTN46164906).
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Affiliation(s)
- Julia Das
- Department of Sport, Exercise & Rehabilitation, Northumbria University, Newcastle upon Tyne, United Kingdom
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, United Kingdom
| | - Rosie Morris
- Department of Sport, Exercise & Rehabilitation, Northumbria University, Newcastle upon Tyne, United Kingdom
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, United Kingdom
| | - Gill Barry
- Department of Sport, Exercise & Rehabilitation, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Rodrigo Vitorio
- Department of Sport, Exercise & Rehabilitation, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Paul Oman
- Department of Mathematics, Physics & Electrical Engineering, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Claire McDonald
- Gateshead Health NHS Foundation Trust, Gateshead, United Kingdom
| | - Richard Walker
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, United Kingdom
| | - Samuel Stuart
- Department of Sport, Exercise & Rehabilitation, Northumbria University, Newcastle upon Tyne, United Kingdom
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, United Kingdom
- * E-mail:
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Bonnechère B, Rintala A, Spooren A, Lamers I, Feys P. Is mHealth a Useful Tool for Self-Assessment and Rehabilitation of People with Multiple Sclerosis? A Systematic Review. Brain Sci 2021; 11:brainsci11091187. [PMID: 34573208 PMCID: PMC8466296 DOI: 10.3390/brainsci11091187] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 08/30/2021] [Accepted: 09/02/2021] [Indexed: 12/19/2022] Open
Abstract
The development of mobile technology and mobile Internet offers new possibilities in rehabilitation and clinical assessment in a longitudinal perspective for multiple sclerosis management. However, because the mobile health applications (mHealth) have only been developed recently, the level of evidence supporting the use of mHealth in people with multiple sclerosis (pwMS) is currently unclear. Therefore, this review aims to list and describe the different mHealth available for rehabilitation and self-assessment of pwMS and to define the level of evidence supporting these interventions for functioning problems categorized within the International Classification of Functioning, Disability and Health (ICF). In total, 36 studies, performed with 22 different mHealth, were included in this review, 30 about rehabilitation and six for self-assessment, representing 3091 patients. For rehabilitation, most of the studies were focusing on cognitive function and fatigue. Concerning the efficacy, we found a small but significant effect of the use of mHealth for cognitive training (Standardized Mean Difference (SMD) = 0.28 [0.12; 0.45]) and moderate effect for fatigue (SMD = 0.61 [0.47; 0.76]). mHealth is a promising tool in pwMS but more studies are needed to validate these solutions in the other ICF categories. More replications studies are also needed as most of the mHealth have only been assessed in one single study.
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Affiliation(s)
- Bruno Bonnechère
- REVAL-Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, B-3590 Diepenbeek, Belgium; (A.S.); (I.L.); (P.F.)
- Correspondence:
| | - Aki Rintala
- Faculty of Social Services and Health Care, LAB University of Applied Sciences, FI-15210 Lahti, Finland;
| | - Annemie Spooren
- REVAL-Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, B-3590 Diepenbeek, Belgium; (A.S.); (I.L.); (P.F.)
| | - Ilse Lamers
- REVAL-Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, B-3590 Diepenbeek, Belgium; (A.S.); (I.L.); (P.F.)
- University MS Center Hasselt-Pelt, B-3500 Hasselt, Belgium
| | - Peter Feys
- REVAL-Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, B-3590 Diepenbeek, Belgium; (A.S.); (I.L.); (P.F.)
- University MS Center Hasselt-Pelt, B-3500 Hasselt, Belgium
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Eilam-Stock T, George A, Charvet LE. Cognitive Telerehabilitation with Transcranial Direct Current Stimulation Improves Cognitive and Emotional Functioning Following a Traumatic Brain Injury: A Case Study. Arch Clin Neuropsychol 2021; 36:442-453. [PMID: 33885138 DOI: 10.1093/arclin/acaa059] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/08/2020] [Accepted: 07/12/2020] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE Cognitive deficits following a traumatic brain injury (TBI) are a leading cause of disability in young adults and there is a critical need for novel approaches to improve cognitive outcomes in TBI survivors. Transcranial direct current stimulation (tDCS) paired with cognitive remediation has emerged as a viable, cost-effective, noninvasive approach for treating cognitive impairments in a wide variety of neurological conditions. Here, we report the first case study utilizing remotely supervised tDCS (RS-tDCS) protocol paired with cognitive remediation in a 29-year-old man with persisting cognitive and emotional sequelae following TBI. METHOD Neuropsychological measures were administered before and after the patient completed 20 daily sessions of RS-tDCS (2.0 mA × 20 minutes, left anodal dorsolateral prefrontal cortex montage). During the daily stimulation period, he completed adaptive cognitive training. All treatment procedures were delivered at home and monitored in real time via videoconference with a study technician. RESULTS Following 20 RS-tDCS and cognitive training sessions, he had significant improvements (>1 SD) on tests of attention and working memory, semantic fluency, and information processing speed. Mood was also improved. CONCLUSIONS This is the first demonstration of at-home telerehabilitation with RS-tDCS and cognitive training to improve cognitive outcomes following TBI.
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Affiliation(s)
- Tehila Eilam-Stock
- Department of Neurology, NYU Grossman School of Medicine, New York 10017, USA
| | - Allan George
- Department of Neurology, NYU Grossman School of Medicine, New York 10017, USA
| | - Leigh E Charvet
- Department of Neurology, NYU Grossman School of Medicine, New York 10017, USA
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7
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Treatment and management of cognitive dysfunction in patients with multiple sclerosis. Nat Rev Neurol 2020; 16:319-332. [PMID: 32372033 DOI: 10.1038/s41582-020-0355-1] [Citation(s) in RCA: 97] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2020] [Indexed: 01/19/2023]
Abstract
Cognitive impairment is a common and devastating manifestation of multiple sclerosis (MS). Although disease-modifying therapies have been efficacious for reducing relapse rates in MS, such treatments are ineffective for treating cognitive dysfunction. Alternative treatment approaches for mitigating cognitive problems are greatly needed in this population. To date, cognitive rehabilitation and exercise training have been identified as possible candidates for treating MS-related cognitive impairment; however, cognitive dysfunction is still often considered to be poorly managed in patients with MS. This Review provides a comprehensive overview of recent developments in the treatment and management of cognitive impairment in people with MS. We describe the theoretical rationales, current states of the science, field-wide challenges and recent advances in cognitive rehabilitation and exercise training for treating MS-related cognitive impairment. We also discuss future directions for research into the treatment of cognitive impairment in MS that should set the stage for the inclusion of cognitive rehabilitation and exercise training into clinical practice within the next decade.
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Ayache SS, Riachi N, Ahdab R, Chalah MA. Effects of Transcranial Direct Current Stimulation on Hand Dexterity in Multiple Sclerosis: A Design for a Randomized Controlled Trial. Brain Sci 2020; 10:E185. [PMID: 32210025 PMCID: PMC7139332 DOI: 10.3390/brainsci10030185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 03/20/2020] [Accepted: 03/22/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Cerebellar and motor tracts are frequently impaired in multiple sclerosis (MS). Altered hand dexterity constitutes a challenge in clinical practice, since medical treatment shows very limited benefits in this domain. Cerebellar control is made via several cerebellocortical pathways, of which the most studied one links the cerebellum to the contralateral motor cortex via the contralateral ventro-intermediate nucleus of the thalamus influencing the corticospinal outputs. Modulating the activity of the cerebellum or of the motor cortex could be of help. METHOD The main interest here is to evaluate the efficacy of transcranial direct current stimulation (tDCS), a noninvasive brain stimulation technique, in treating altered dexterity in MS. Forty-eight patients will be recruited in a randomized, double-blind, sham-controlled, and crossover study. They will randomly undergo one of the three interventions: anodal tDCS over the primary motor area, cathodal tDCS over the cerebellum, or sham. Each block consists of five consecutive daily sessions with direct current (2 mA), lasting 20 min each. The primary outcome will be the improvement in manual dexterity according to the change in the time required to complete the nine-hole pegboard task. Secondary outcomes will include fatigue, pain, spasticity, and mood. Patients' safety and satisfaction will be rated. DISCUSSION Due to its cost-effective, safe, and easy-to-use profile, motor or cerebellar tDCS may constitute a potential tool that might improve dexterity in MS patients and therefore ameliorate their quality of life.
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Affiliation(s)
- Samar S. Ayache
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil, 94010 Créteil, France ; (S.S.A.); (M.A.C.)
- Service de Physiologie – Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique–Hôpitaux de Paris, 94010 Créteil, France
| | - Naji Riachi
- Neurology Division, Lebanese American University Medical Center Rizk Hospital, Beirut 113288, Lebanon;
- Gilbert and Rose Mary Chagoury School of Medicine School of Medicine, Lebanese American University, Byblos 4504, Lebanon
| | - Rechdi Ahdab
- Neurology Division, Lebanese American University Medical Center Rizk Hospital, Beirut 113288, Lebanon;
- Gilbert and Rose Mary Chagoury School of Medicine School of Medicine, Lebanese American University, Byblos 4504, Lebanon
| | - Moussa A. Chalah
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil, 94010 Créteil, France ; (S.S.A.); (M.A.C.)
- Service de Physiologie – Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique–Hôpitaux de Paris, 94010 Créteil, France
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Gough N, Brkan L, Subramaniam P, Chiuccariello L, De Petrillo A, Mulsant BH, Bowie CR, Rajji TK. Feasibility of remotely supervised transcranial direct current stimulation and cognitive remediation: A systematic review. PLoS One 2020; 15:e0223029. [PMID: 32092069 PMCID: PMC7039434 DOI: 10.1371/journal.pone.0223029] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 01/08/2020] [Indexed: 01/02/2023] Open
Abstract
With technological advancements and an aging population, there is growing interest in delivering interventions at home. Transcranial Direct Current Stimulation (tDCS) and Cognitive Remediation (CR) as well as Cognitive Training (CT) have been widely studied, but mainly in laboratories or hospitals. Thus, the objectives of this review are to examine feasibility and the interventions components to support the domiciliary administration of tDCS and CR. We performed a systematic search of electronic databases, websites and reference lists of included articles from the first date available until October 31, 2018. Articles included had to meet the following criteria: original work published in English using human subjects, majority of tDCS or CR intervention administered remotely. A total of 39 studies were identified (16 tDCS, 23 CR/CT, 5 using both tDCS & CT). Four studies were single case studies and two were multiple case studies. The remaining 33 studies had a range of 9-135 participants. Five tDCS and nine CR/CT studies were double blind randomized controlled trials. Most studies focused on schizophrenia (8/39) and multiple sclerosis (8/39). Literature examined suggests the feasibility of delivering tDCS or CR/CT remotely with the support of information and communication technologies.
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Affiliation(s)
- Nicole Gough
- Division of Adult Neurodevelopment and Geriatric Psychiatry, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
| | - Lea Brkan
- Division of Adult Neurodevelopment and Geriatric Psychiatry, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
| | - Ponnusamy Subramaniam
- Division of Adult Neurodevelopment and Geriatric Psychiatry, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
- Health Psychology Program & Centre for Healthy Ageing and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Lina Chiuccariello
- Division of Adult Neurodevelopment and Geriatric Psychiatry, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
| | - Alessandra De Petrillo
- Division of Adult Neurodevelopment and Geriatric Psychiatry, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
| | - Benoit H. Mulsant
- Division of Adult Neurodevelopment and Geriatric Psychiatry, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Christopher R. Bowie
- Division of Adult Neurodevelopment and Geriatric Psychiatry, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
- Department of Psychology, Queen’s University, Kingston, Ontario, Canada
| | - Tarek K. Rajji
- Division of Adult Neurodevelopment and Geriatric Psychiatry, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- * E-mail:
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Lampit A, Heine J, Finke C, Barnett MH, Valenzuela M, Wolf A, Leung IHK, Hill NTM. Computerized Cognitive Training in Multiple Sclerosis: A Systematic Review and Meta-analysis. Neurorehabil Neural Repair 2019; 33:695-706. [PMID: 31328637 DOI: 10.1177/1545968319860490] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
Background. Cognitive impairments are common in people with multiple sclerosis (MS). Systematic reviews reported promising evidence for various cognitive interventions in this population. Computerized cognitive training (CCT) has strong evidence for safety and efficacy in several populations, but its effects in MS have yet to be specified. Objective. We aimed to synthesize the evidence from randomized controlled trials (RCTs) investigating the effects of CCT on cognitive, psychosocial, and functional outcomes in adults with MS. Method. We searched MEDLINE, EMBASE, PsycINFO, CINAHL, and CENTRAL from inception to March 2019. We calculated standardized mean difference (Hedges' g) of change from baseline in untrained measures of cognition, individual domains, psychosocial functioning, and daily function between CCT and control groups using a random-effects model. Results. A total of 20 RCTs encompassing 982 participants (78% with relapsing-remitting MS) were included. The overall cognitive effect size was moderate (g = 0.30; 95% CI = 0.18-0.43), with no evidence of small-study effect or between-study heterogeneity (prediction interval = 0.17-0.44). Small to moderate effect sizes were found for attention/processing speed, executive functions, and verbal and visuospatial memory. Evidence for working memory, fatigue, and psychosocial and daily functioning were inconclusive. Cognitive effects waned without further training. Conclusions. CCT is efficacious for overall and key cognitive domains in adults with MS, but efficacy on other outcomes and in progressive subtypes remains unclear. Long-term and well-powered trials with diverse cohorts are needed to optimize and maintain the efficacy of CCT, investigate transfer to daily living, and determine who can benefit and whether CCT is a cost-effective strategy to attenuate cognitive decline in MS.
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Affiliation(s)
- Amit Lampit
- 1 University of Melbourne, Parkville, Victoria, Australia
- 2 Charité-Universitätsmedizin Berlin, Germany
- 3 Humboldt-Universität zu Berlin, Germany
- 4 The University of Sydney, Camperdown, New South Wales, Australia
| | | | - Carsten Finke
- 2 Charité-Universitätsmedizin Berlin, Germany
- 3 Humboldt-Universität zu Berlin, Germany
| | | | | | - Anna Wolf
- 1 University of Melbourne, Parkville, Victoria, Australia
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A Pilot Study to Assess At-Home Speed of Processing Training for Individuals with Multiple Sclerosis. Mult Scler Int 2019; 2019:3584259. [PMID: 31275652 PMCID: PMC6582794 DOI: 10.1155/2019/3584259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 05/19/2019] [Indexed: 11/17/2022] Open
Abstract
Objective Cognitive impairment is a common symptom of multiple sclerosis (MS), yet treatment is currently limited. The primary goal of this pilot study was to assess the feasibility and acceptability of an at-home, five-week computerized speed of processing (SOP) training intervention for MS patients. In addition, we examined the utility of the intervention to improve speed of information processing, memory, executive function, and health-related quality of life (HRQOL). Method Fifteen subjects were assigned five weeks of SOP training, two times per week, for a total of ten sessions. Subjects were trained on five computerized SOP tasks that required processing of increasingly complex visual stimuli in successively shorter presentation times. Subjects were given a neuropsychological test battery that included measures of speed of information processing, verbal memory, visual spatial memory, and executive function. Subjects were also administered patient-reported outcome (PRO) measures to assess HRQOL, depression, and work productivity. Neuropsychological and PRO batteries were completed at baseline and after five weeks. Results Eighty percent of subjects completed the five-week intervention (n = 12). Significant improvements were observed on some, but not all, measures of speed of information processing, verbal memory, and executive function. There were no significant changes in HRQOL. Conclusion This pilot study supports the feasibility of an at-home SOP training intervention for individuals with MS. SOP training was associated with improvements in several cognitive domains. Larger, randomized controlled trials are warranted.
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12
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Withiel TD, Wong D, Ponsford JL, Cadilhac DA, Stolwyk RJ. Feasibility and effectiveness of computerised cognitive training for memory dysfunction following stroke: A series of single case studies. Neuropsychol Rehabil 2018; 30:829-852. [PMID: 30058468 DOI: 10.1080/09602011.2018.1503083] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Computerised cognitive training (CCT) approaches to memory rehabilitation represent an attractive alternative to traditional approaches; however, there is limited empirical evidence to support their use. An AB with follow up single case design was repeated across five participants to explore the feasibility and effectiveness of CCT on subjective memory in patients with stroke. Target behaviour was subjective everyday and prospective memory failures which were assessed weekly. Following baseline (three weeks), participants completed six weeks of LumosityTM training in their homes. Data were analysed visually and statistically. The frequency of prospective memory failures decreased during intervention for one participant, while the frequency of prospective and everyday memory failures decreased significantly during the follow up period for another participant. Yet, significantly more everyday and prospective memory failures were reported following training by one study participant. No significant change in subjective memory ratings was found for remaining participants. Regarding secondary outcomes, meaningful changes on objective measures of memory were not observed, despite considerable inter-individual variability. Three participants reported improvement in individualised memory goals, while two participants described a decline. Overall, LumosityTM training appears feasible; however, no consistent evidence to support effectiveness of this CCT on subjective or objective memory was found.
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Affiliation(s)
- Toni D Withiel
- School of Psychological Sciences, Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne, Australia.,Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, Australia.,Allied Health, Royal Melbourne Hospital, Melbourne, Australia
| | - Dana Wong
- School of Psychological Sciences, Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne, Australia.,School of Psychology and Public Health, La Trobe University, Melbourne, Australia.,Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, Australia
| | - Jennie L Ponsford
- School of Psychological Sciences, Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne, Australia.,Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, Australia
| | - Dominique A Cadilhac
- Stroke and Ageing Research, School of Clinical Sciences, Monash University, Melbourne, Australia.,Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
| | - Renerus J Stolwyk
- School of Psychological Sciences, Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne, Australia.,Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, Australia
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13
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Harris DJ, Wilson MR, Vine SJ. A Systematic Review of Commercial Cognitive Training Devices: Implications for Use in Sport. Front Psychol 2018; 9:709. [PMID: 29867674 PMCID: PMC5958310 DOI: 10.3389/fpsyg.2018.00709] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 04/23/2018] [Indexed: 12/25/2022] Open
Abstract
Background: Cognitive training (CT) aims to develop a range of skills, like attention and decision-making, through targeted training of core cognitive functions. While CT can target context specific skills, like movement anticipation, much CT is domain general, focusing on core abilities (e.g., selective attention) for transfer to a range of real-world tasks, such as spotting opponents. Commercial CT (CCT) devices are highly appealing for athletes and coaches due to their ease of use and eye-catching marketing claims. The extent to which this training transfers to performance in the sporting arena is, however, unclear. Therefore, this paper sought to provide a systematic review of evidence for beneficial training effects of CCT devices and evaluate their application to sport. Methods: An extensive search of electronic databases (PubMed, PsychInfo, GoogleScholar, and SportDiscus) was conducted to identify peer-reviewed evidence of training interventions with commercially available CT devices. Forty-three studies met the inclusion criteria and were retained for quality assessment and synthesis of results. Seventeen studies assessed transfer effects beyond laboratory cognitive tests, but only 1 directly assessed transfer to a sporting task. Results: The review of evidence showed limited support for far transfer benefits from CCT devices to sporting tasks, mainly because studies did not target the sporting environment. Additionally, a number of methodological issues with the CCT literature were identified, including small sample sizes, lack of retention tests, and limited replication of findings by researchers independent of the commercial product. Therefore, evidence for sporting benefits is currently limited by the paucity of representative transfer tests and a focus on populations with health conditions. Conclusions: Currently there is little direct evidence that the use of CCT devices can transfer to benefits for sporting performance. This conclusion, however, stems more from a lack of experimental studies in the sporting field and a lack of experimental rigor, rather than convincing null effects. Subsequently, there is an opportunity for researchers to develop more reliable findings in this area through systematic assessment in athletic populations and major methodological improvements.
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Affiliation(s)
- David J Harris
- Sport and Health Sciences, University of Exeter, Exeter, United Kingdom
| | - Mark R Wilson
- Sport and Health Sciences, University of Exeter, Exeter, United Kingdom
| | - Samuel J Vine
- Sport and Health Sciences, University of Exeter, Exeter, United Kingdom
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14
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Charvet LE, Yang J, Shaw MT, Sherman K, Haider L, Xu J, Krupp LB. Cognitive function in multiple sclerosis improves with telerehabilitation: Results from a randomized controlled trial. PLoS One 2017; 12:e0177177. [PMID: 28493924 PMCID: PMC5426671 DOI: 10.1371/journal.pone.0177177] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 04/21/2017] [Indexed: 11/19/2022] Open
Abstract
Cognitive impairment affects more than half of all individuals living with multiple sclerosis (MS). We hypothesized that training at home with an adaptive online cognitive training program would have greater cognitive benefit than ordinary computer games in cognitively-impaired adults with MS. This was a double-blind, randomized, active-placebo-controlled trial. Participants with MS were recruited through Stony Brook Medicine and randomly assigned to either the adaptive cognitive remediation (ACR) program or active control of ordinary computer games for 60 hours over 12 weeks. Training was remotely-supervised and delivered through a study-provided laptop computer. A computer generated, blocked stratification table prepared by statistician provided the randomization schedule and condition was assigned by a study technician. The primary outcome, administered by study psychometrician, was measured by change in a neuropsychological composite measure from baseline to study end. An intent-to-treat analysis was employed and missing primary outcome values were imputed via Markov Chain Monte Carlo method. Participants in the ACR (n = 74) vs. active control (n = 61) training program had significantly greater improvement in the primary outcome of cognitive functioning (mean change in composite z score±SD: 0·25±0·45 vs. 0·09±0·37, p = 0·03, estimated difference = 0·16 with 95% CI: 0·02–0·30), despite greater training time in the active control condition (mean±SD:56·9 ± 34·6 vs. 37·7 ±23 ·8 hours played, p = 0·006). This study provides Class I evidence that adaptive, computer-based cognitive remediation accessed from home can improve cognitive functioning in MS. This telerehabilitation approach allowed for rapid recruitment and high compliance, and can be readily applied to other neurological conditions associated with cognitive dysfunction. Trial Registration: Clinicaltrials.gov NCT02141386
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Affiliation(s)
- Leigh E. Charvet
- Department of Neurology, NYU School of Medicine, New York, New York, United States of America
- * E-mail:
| | - Jie Yang
- Department of Family, Population, and Preventive Medicine, Stony Brook Medicine, New York, New York, United States of America
| | - Michael T. Shaw
- Department of Neurology, NYU School of Medicine, New York, New York, United States of America
| | - Kathleen Sherman
- Department of Neurology, NYU School of Medicine, New York, New York, United States of America
| | - Lamia Haider
- Taub Institute, Columbia University Medical Center, New York, New York, United States of America
| | - Jianjin Xu
- Department of Applied Mathematics and Statistics, Stony Brook Medicine, Stony Brook, New York, United States of America
| | - Lauren B. Krupp
- Department of Neurology, NYU School of Medicine, New York, New York, United States of America
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15
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Charvet L, Shaw M, Dobbs B, Frontario A, Sherman K, Bikson M, Datta A, Krupp L, Zeinapour E, Kasschau M. Remotely Supervised Transcranial Direct Current Stimulation Increases the Benefit of At-Home Cognitive Training in Multiple Sclerosis. Neuromodulation 2017; 21:383-389. [PMID: 28225155 DOI: 10.1111/ner.12583] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 01/03/2017] [Accepted: 01/06/2017] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To explore the efficacy of remotely-supervised transcranial direct current stimulation (RS-tDCS) paired with cognitive training (CT) exercise in participants with multiple sclerosis (MS). METHODS In a feasibility study of RS-tDCS in MS, participants completed ten sessions of tDCS paired with CT (1.5 mA × 20 min, dorsolateral prefrontal cortex montage). RS-tDCS participants were compared to a control group of adults with MS who underwent ten 20-min CT sessions through the same remotely supervised procedures. Cognitive outcomes were tested by composite scores measuring change in performance on standard tests (Brief International Cognitive Assessment in MS or BICAMS), basic attention (ANT-I Orienting and Attention Networks, Cogstate Detection), complex attention (ANT-I Executive Network, Cogstate Identification and One-Back), and intra-individual response variability (ANT-I and Cogstate identification; sensitive markers of disease status). RESULTS After ten sessions, the tDCS group (n = 25) compared to the CT only group (n = 20) had significantly greater improvement in complex attention (p = 0.01) and response variability (p = 0.01) composites. The groups did not differ in measures of basic attention (p = 0.95) or standard cognitive measures (p = 0.99). CONCLUSIONS These initial findings indicate benefit for RS-tDCS paired with CT in MS. Exploratory analyses indicate that the earliest tDCS cognitive benefit is seen in complex attention and response variability. Telerehabilitation using RS-tDCS combined with CT may lead to improved outcomes in MS.
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Affiliation(s)
- Leigh Charvet
- Department of Neurology, New York University Langone Medical Center, New York, NY, USA
| | - Michael Shaw
- Department of Neurology, New York University Langone Medical Center, New York, NY, USA
| | - Bryan Dobbs
- Department of Neurology, New York University Langone Medical Center, New York, NY, USA
| | | | - Kathleen Sherman
- Department of Neurology, New York University Langone Medical Center, New York, NY, USA
| | - Marom Bikson
- Engineering Department, City College of New York, New York, NY, USA
| | | | - Lauren Krupp
- Department of Neurology, New York University Langone Medical Center, New York, NY, USA
| | - Esmail Zeinapour
- Engineering Department, City College of New York, New York, NY, USA
| | - Margaret Kasschau
- School of Health Technology and Management, Stony Brook Medicine, Stony Brook, NY, USA
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16
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George MF, Holingue CB, Briggs FBS, Shao X, Bellesis KH, Whitmer RA, Schaefer C, Benedict RH, Barcellos LF. Feasibility study for remote assessment of cognitive function in multiple sclerosis. ACTA ACUST UNITED AC 2016; 1:10-18. [PMID: 28255581 DOI: 10.29245/2572.942x/2016/8.1084] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Cognitive impairment is common in multiple sclerosis (MS), and affects employment and quality of life. Large studies are needed to identify risk factors for cognitive decline. Currently, a MS-validated remote assessment for cognitive function does not exist. Studies to determine feasibility of large remote cognitive function investigations in MS have not been published. OBJECTIVE To determine whether MS patients would participate in remote cognitive studies. We utilized the Modified Telephone Interview for Cognitive Status (TICS-M), a previously validated phone assessment for cognitive function in healthy elderly populations to detect mild cognitive impairment. We identified factors that influenced participation rates. We investigated the relationship between MS risk factors and TICS-M score in cases, and score differences between cases and control individuals. METHODS The TICS-M was administered to MS cases and controls. Linear and logistic regression models were utilized. RESULTS 11.5% of eligible study participants did not participate in cognitive testing. MS cases, females and individuals with lower educational status were more likely to refuse (p<0.001). Cases who did complete testing did not differ in terms of perceived cognitive deficit compared to cases that did participate. More severe disease, smoking, and being male were associated with a lower TICS-M score among cases (p<0.001). The TICS-M score was significantly lower in cases compared to controls (p=0.007). CONCLUSIONS Our results demonstrate convincingly that a remotely administered cognitive assessment is quite feasible for conducting large epidemiologic studies in MS, and lay the much needed foundation for future work that will utilize MS-validated cognitive measures.
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Affiliation(s)
- Michaela F George
- Division of Epidemiology, Genetic Epidemiology and Genomics Laboratory, School of Public Health, University of California, Berkeley, CA, USA
| | - Calliope B Holingue
- Division of Epidemiology, Genetic Epidemiology and Genomics Laboratory, School of Public Health, University of California, Berkeley, CA, USA
| | - Farren B S Briggs
- Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Xiaorong Shao
- Division of Epidemiology, Genetic Epidemiology and Genomics Laboratory, School of Public Health, University of California, Berkeley, CA, USA
| | | | | | | | | | - Lisa F Barcellos
- Division of Epidemiology, Genetic Epidemiology and Genomics Laboratory, School of Public Health, University of California, Berkeley, CA, USA; Kaiser Permanente Division of Research, Oakland, CA, USA
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