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Hope for Cognitive Improvements in Progressive MS: The CogEx Study

20 December 2023

  • The CogEx clinical trial investigated the impact of exercise and cognitive rehabilitation as treatments for cognitive difficulties in individuals with progressive MS.
  • Participants receiving different combinations of exercise and cognitive rehabilitation were analysed to observe any additional benefits in cognitive thinking speed after 12 weeks of treatment.
  • The trial’s results underscored the importance of both exercise and cognitive therapy for individuals with progressive MS.

 Brief Summary

In a recent clinical trial known as CogEx, researchers investigated cognitive issues in individuals with progressive MS and explored whether cognitive rehabilitation and/or exercise could improve cognitive issues.

Unlike previous studies that mainly concentrated on those with relapsing-remitting MS, this study focused exclusively on people with progressive MS, where cognitive problems are less understood.

Prior research indicated some benefits of cognitive rehabilitation for relapsing-remitting MS, but the impact of exercise as a treatment for cognitive issues has remained uncertain.

CogEx aimed to test whether these treatments could be useful for treating cognitive challenges in progressive MS.

What did the researchers do?

Researchers funded by MS Canada conducted CogEx across 11 medical centres and rehabilitation facilities in various countries, including Belgium, Canada, Denmark, Italy, the UK, and the USA.

They included individuals aged 25 to 65 with progressive MS who were experiencing impaired processing (thinking) speed. To be eligible, participants needed to score below a certain level on a standard cognitive test called the Symbol Digit Modalities Test (SDMT).

Participants were randomly divided into four groups. One group received both cognitive rehabilitation, which is a personalised computer-based program to improve processing or thinking speed, and a tailored exercise program, which involved individualised aerobic training using a special machine.

Another group received cognitive rehabilitation along with sham exercise, which means they did stretching and balance tasks without inducing cardiovascular strain.

The third group received the tailored exercise program with sham cognitive rehabilitation, where they did general online training.

The last group received both sham exercise and sham cognitive rehabilitation.

Nobody involved in the clinical trial, including the participants, those assessing the outcomes, the investigators, and the data assessment team, knew which group the participants were in, in a process called blinding.

The study lasted 12 weeks, with sessions conducted twice weekly. After this period, participants’ cognitive processing speed was measured using the SDMT test.

What did the researchers find?

Between December 2018 and April 2022, 311 people with progressive MS took part in the study, with 91% of them completing the 12-week assessment.

The study found that there were no significant differences in cognitive processing speed improvements between the groups that received the different combinations of treatments. In other words, cognitive rehabilitation and exercise didn’t seem to make a clear difference in cognitive abilities for these participants.

Additionally, there were some adverse events that could be related to the treatments, such as pain, dizziness, falls, and headaches, but they were spread across the different groups, and no specific treatment appeared to be riskier than others.

What does this mean for people with MS?

The CogEx researchers found that combining cognitive rehabilitation with aerobic exercise did not provide extra benefits for improving cognitive processing speed in people with progressive MS compared to either treatment alone.

However, two-thirds of the participants found significant improvements in their processing speed after 12 weeks of therapy, and this improvement was still present in almost half of them six months later.

These improvements were observed in all the treatment groups, which suggests that both cognitive rehabilitation and exercise might be effective in addressing cognitive processing speed issues. However, confirmation will be required by comparing these results with a group that received no treatment at all.

In summary, engaging in various mental, physical, and social activities may lead to improvements in cognitive processing for people living with progressive MS.

While the CogEx study did not show additional benefits from combining cognitive rehabilitation and exercise, it does suggest that people with progressive MS do have the potential to improve their cognitive processing speed.

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Hope for Cognitive Improvements in Progressive MS: The CogEx Study