Working memory training in pediatric-onset Multiple Sclerosis patients

Institution: York University

Investigator(s): Christine Till, Brenda Banwell, Gary Turner, Sridar Narayanan, Bravina Bala

Program: Cogmed RM

Background & Aim: Multiple sclerosis (MS) is a chronic inflammatory degenerative disease of the central nervous system that typically affects young adults, but can also begin in childhood. Canada has a prevalence rate of MS that is among the highest worldwide, affecting 250 per 100,000, with 5-15% of these individuals diagnosed prior to age 18. Pediatric MS affects 1.4 to 2.5 per 100,000 Canadian children, an incidence rate that compares to other pediatric neurologic diseases, such as ischemic stroke (2-8/100,000) and brain tumors (4-5/100,000).

Cognitive impairment occurs in 30-50% of childhood-onset MS patients with prominent deficits in processing speed, attention, visual-perception, language, and executive functioning. These deficits can have a potentially devastating impact on intellectual and academic abilities, and can be of sufficient severity as to interfere with occupational and daily life function. Cognitive deterioration may occur over time, particularly in younger-onset MS patients and mainly on complex attention tasks. Compared with adult MS, the cognitive profile in pediatric MS has noticeable differences – reflecting the unique vulnerabilities of the developing brain.

This research proposes that working memory be targeted in pediatric-onset MS patients given: (1) consistent reports of working memory dysfunction in this population, (2) the proclivity of the disease for diffuse networks and brain regions associated with working memory, and (3) increasing evidence that working memory capacity can be improved by adaptive and extended training. The overall aim of this study is to investigate whether intensive computerized cognitive training can bring about sustainable behavioral and neuroanatomic change in pediatric-onset MS patients. The immature brain is thought to possess a high capacity for neuroplasticity and recovery following insult. The discovery that pediatric patients with MS have a more favorable clinical course than do those with the more common adult-onset of the disease is one example of how the developing brain shows an enormous capacity to adapt to neurologic disease.

Population & Sample Size: N= 32 adolescents with pediatric onset MS, ages 14 – 20 years
• n = 16 adolescents in the adaptive Cogmed training group
• n = 16 adolescents in the non-adaptive (placebo) Cogmed training group

Design: Randomized, double-blinded, placebo controlled, test-retest, 6 month follow up, MRI