Are cognitive interventions for multiple sclerosis effective and feasible?

Purpose: Fifty percent of patients with Multiple Sclerosis (MS) are estimated to have cognitive impairments leading to considerable
decline in productivity and quality of life. Cognitive intervention has been considered to complement pharmacological
treatments. However, a lack of agreement concerning the efficacy of cognitive interventions in MS still exists. A systematic
review and meta-analysis was conducted to assess the effects of cognitive interventions in MS.
Methods: To overcome limitations of previous meta-analyses, several databases were searched only for Randomized Clinical
Trials (RCTs) with low risk of bias.
Results: Five studies (total of 139 participants) met our eligibility criteria. Although good completion and adherence rates were
evident, we found no evidence of intervention effects on cognition or mood in post-intervention or follow-up assessments.
Conclusions: This is the first meta-analysis assessing the effects of cognitive intervention in MS including only RCTs with
comparable conditions. Research regarding efficacy, cost-effectiveness and feasibility is still in its infancy. Caution is advised
when interpreting these results due to the small number of RCTs meeting the inclusion criteria. Considering the costs of disease,
good completion and adherence rates of this approach, further research is warranted. Recommendations concerning improved
research practices in the field are presented as well.
R.M. and J.A. are supported by doctoral Grants
from Fundac¸ao para a Ci ˜ encia e Tecnologia (FCT) ˆ
(SFRH/BD/65213/2009, SFRH/BD/64457/2009 and
co-funded by FSE/POPH). A.S. is funded for the
project PIC/IC/83290/2007, supported by FEDER
(POFC–COMPETE) and FCT to develop and assess
the effectiveness of a cognitive stimulation tool for
Portuguese clinicians.