Memory Rehabilitation May Be Beneficial for Patients With Multiple Sclerosis

Patients with multiple sclerosis (MS) who receive memory rehabilitation have better memory functioning and quality of life compared with those who do not receive memory rehabilitation, and it may be sustained for up to 1 year, according to a study published in the Cochrane Database of Systematic Reviews.

Memory problems are common among patients with MS and can affect their ability to complete daily activities and compromise their quality of life. The interest of memory rehabilitation in this patient population has been growing has been with numerous randomized clinical trials (RCTs). This type of rehabilitation implements specific techniques and strategies that can help a person remember, store, or retrieve memories, but it’s not known whether it’s effective in reducing forgetfulness or improving performance of daily activities, the researchers stated.

In an effort to confirm the effectiveness of memory rehabilitation, researchers conducted a review to determine whether patients with MS who received memory rehabilitation had better immediate, intermediate, or longer-term outcomes compared with patients who received no treatment or active control individuals regarding memory function, other cognitive abilities, and functional abilities for activities of daily living, mood, and quality of life.

They searched multiple databases through September 6, 2020, for RCTs that included patients with relapsing remitting, secondary progressive, or primary progressive MS in which a memory rehabilitation treatment group was compared with a control group.

The primary outcomes were measures of the extent of memory problems in everyday life. Outcomes were categorized into 3 separate time points: immediate (≤1 month), intermediate (1-6 months), and longer-term (>6 months).

The analysis included 44 studies with 2,714 patients who received memory retraining, which included restorative techniques (eg, computerized programs) and compensatory approaches (eg, memory aids such as diaries or calendars).

Researchers found small to moderate differences favoring the rehabilitation group for subjective reports of memory in the immediate, intermediate, and longer-term follow-ups—standardized mean difference (SMD) 0.32; 95% CI, 0.05-0.58; 568 participants, moderate-quality evidence; SMD 0.23; 95% CI, 0.11-0.35; 1045 participants, high-quality evidence; and SMD 0.16; 95% CI, 0.02-0.30; 775 participants, high-quality evidence, respectively. The intervention group showed more improvement than the control group at each follow-up.

The analysis also revealed small to moderate differences in favor of the rehabilitation group for quality of life measures at the immediate, intermediate, and longer-term follow-ups—SMD 0.42; 95% CI, 0.15-0.68; 371 participants, high-quality evidence; SMD 0.30; 95% CI, 0.02-0.58; 683 participants, high-quality evidence; and SMD 0.17; 95% CI, 0.02-0.32; 687 participants, high-quality evidence, respectively. The intervention group had a better performance vs the control group at each follow-up.

There was a moderate difference between groups for mood measures of depression at the immediate follow-up (SMD 0.34; 95% CI, 0.15-0.53; 853 participants, moderate-quality evidence) in favor of the intervention group. Little to no differences were found between groups for visual memory, working memory, or activities of daily living. Memory rehabilitation did not have an effect on anxiety at any time point.

Researchers noted that they only obtained data on whether the studies used intention-to-treat or per-protocol analyses for 8 studies and therefore could not complete a sensitivity analysis of these 2 groups. Also, eliminating studies with a high risk of bias frequently led to a reduction in heterogeneity during the analysis.

“This review examined the evidence from RCTs and quasi-RCTs and found evidence to suggest that memory rehabilitation is effective in improving memory performance on subjective and objective (verbal, visual, and working memory) assessments across immediate and intermediate follow-ups and quality of life in the immediate, intermediate, and longer term, and reducing depression (but only immediately after the intervention),” the researchers concluded.

Disclosure: Some of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

Reference

Taylor LA, Mhizha-Murira JR, Smith L, et al. Memory rehabilitation for people with multiple sclerosis. Cochrane Database Syst Rev. Published online October 18, 2021. doi: 10.1002/14651858.CD008754.pub4