Cognitive training for multiple sclerosis: what the trials show
- Cognitive impairment is reported in an estimated 43% to 65% of people with multiple sclerosis (MS), most often affecting memory, attention and processing speed (Rao et al., 1991)[4].
- In a 12-week home-based controlled study of 107 adults with relapsing MS, the trained group improved significantly over controls on three memory-based abilities, with large reported effect sizes (partial η² ≈ 0.19–0.21; p ≤ 0.003) (Shatil et al., 2010)[1].
- An updated review fully appraised 40 cognitive-rehabilitation studies in MS and found one verbal learning-and-memory technique strong enough for a "Practice Guideline", but rated most evidence Class II or III (Goverover et al., 2017)[2].
- What the evidence does not show: no study reviewed here establishes that cognitive training treats, slows or prevents MS itself; reviewers repeatedly call for larger randomized trials (Goverover et al., 2017; O'Brien et al., 2008)[2][3].
- How common is cognitive impairment in MS?
- Can people with MS train cognition at home, on their own?
- Which cognitive abilities improved, and by how much?
- What does the wider rehabilitation literature conclude?
- How much training did the studies use?
- What the evidence does NOT show
- What this means in practice
How common is cognitive impairment in MS?
Cognitive impairment is one of the most common consequences of MS. Estimates of its prevalence range from 43% to 65% of patients, with episodic memory, attention/concentration and processing speed among the most affected domains (Rao et al., 1991)[4]. It has been associated with poorer quality of life: patients who are cognitively impaired were reported to participate in fewer social activities and to be less likely to be employed (Shatil et al., 2010)[1].
At the time these studies were conducted, no established pharmacological therapy existed for MS-associated cognitive impairment, which is why non-pharmacological cognitive rehabilitation has been studied as a candidate part of the treatment strategy (O'Brien et al., 2008)[3].
Can people with MS train cognition at home, on their own?
Most earlier computer-assisted rehabilitation in MS had been clinic-based and prompted (O'Brien et al., 2008)[3]. A 2010 study in NeuroRehabilitation instead tested whether people with MS, left entirely unprompted, would keep up a home-based, personalized computerized training regimen, and whether their cognitive performance would change over 12 weeks against an untrained control group (Shatil et al., 2010)[1].
The single-center study at the Multiple Sclerosis & Brain Research Centre, Carmel Medical Centre, Haifa, enrolled 107 adults with relapsing-remitting or relapsing-progressive MS and assigned them to a training group (n = 59) or a control group (n = 48). Participants trained through 24 sessions of 20 to 30 minutes, three times a week for 12 weeks, with no training-related contact from their doctors during the study to preserve the test of unprompted adherence[1].
Adherence was the primary question, and it was substantial: 42 of the 59 trained participants (71.2%) used the program at home unprompted, with no reminders, and 22 (37.3%) completed the entire 24-session regimen on their own (Shatil et al., 2010)[1]. Among trained participants, non-completers were significantly younger than completers (40.1 vs 49.9 years; p = 0.001)[1].
Which cognitive abilities improved, and by how much?
Of the 107 enrolled, 46 completed the full study (22 training, 24 control). By analysis of covariance, the training group improved significantly more than controls on three memory-based abilities, general memory, visual working memory and verbal-auditory working memory, with large reported effect sizes (partial η² of 0.207, 0.196 and 0.191; all p ≤ 0.003 adjusted for baseline and age) (Shatil et al., 2010)[1].
| Cognitive ability | ANCOVA p (adjusted) | Effect size (partial η²) |
|---|---|---|
| General memory | 0.002 | 0.207 |
| Visual working memory | 0.003 | 0.196 |
| Verbal-auditory working memory | 0.003 | 0.191 |
Post-hoc exploration also pointed to gains in naming speed, information-recall speed, focused attention and visuo-motor vigilance, while no significant change appeared in depression or disability in either group[1]. The authors framed the result cautiously, as support for larger studies rather than proof.
What does the wider rehabilitation literature conclude?
A single trial is only one data point. An updated review in Archives of Physical Medicine and Rehabilitation appraised MS cognitive-rehabilitation research published from 2007 to 2016, fully reviewing 40 studies and classifying them by methodological rigor: 6 Class I, 10 Class II and 24 Class III studies (Goverover et al., 2017)[2].
One intervention in verbal learning and memory received support for a "Practice Guideline", its strongest recommendation tier short of a Practice Standard, and two computer programs received support as practice guidelines in attention and multi-cognitive training, with further studies supporting practice "options"[2]. The reviewers nonetheless concluded that more rigorous research was needed to provide Class I evidence for most techniques[2]. An earlier review by the same group had found few high-quality studies in MS, most clinic-based rather than home-based (O'Brien et al., 2008)[3].
How much training did the studies use?
The home-based MS study used 24 sessions of 20–30 minutes, three times a week over 12 weeks, roughly 60 to 90 minutes per week (Shatil et al., 2010)[1]. Nearly 60% of the training group persevered through at least half of the sessions on their own, which the authors offered as evidence of feasibility, not clinical benefit[1]. Across the broader MS literature, protocols and outcome batteries varied widely, a barrier to firm cross-study conclusions that the 2017 review cited for its lean toward Class II and III evidence (Goverover et al., 2017)[2].
What the evidence does NOT show
Several limits are stated plainly by the authors. First, the home-based MS study was not randomized and had no active control: participants were not randomly assigned and controls received no comparison activity, so practice and placebo effects cannot be ruled out (Shatil et al., 2010)[1]. The authors note that "true subject randomization and the intention-to-treat principle were not adopted in this study," and call for trials with an active comparator[1].
Second, the completer sample was small, only 46 of 107 enrolled finished, and fatigue rose in the trained group while staying stable in controls, which the authors report did not appear to compromise cognitive performance[1]. Third, the measured outcomes were cognitive-performance scores, not disease activity, disability, function or quality of life; whether gains persist after training ends was untested[1].
Most importantly, none of the studies reviewed here establishes that cognitive training treats, slows or prevents multiple sclerosis or its underlying course. The 2017 review concluded that much of the literature remained Class II or III, and a Cochrane review it cited called for "robust random clinical trials… with rigorous methodological standards" (Goverover et al., 2017)[2]. The honest reading is feasibility and improvement on trained cognitive measures in specific samples, not a cure.
What this means in practice
For people living with MS and clinicians weighing options, the literature supports a measured view: home-based, personalized cognitive training was feasible and was associated with improvement on several memory measures in a controlled study (Shatil et al., 2010)[1], and parts of the broader field reached a Practice-Guideline level for verbal learning and memory (Goverover et al., 2017)[2], but the evidence base is uneven, and decisions about MS care belong with a qualified clinician.
For deeper reading, see the full breakdown of the home-based MS study in our study summary, the related evidence reviews on brain training in healthy older adults, cognitive training for insomnia, cognitive rehabilitation after stroke, long-COVID brain fog and stress and cognition, and the full research index.
References
- (2010). Home-based personalized cognitive training in MS patients: A study of adherence and cognitive performance. NeuroRehabilitation, 26(2), 143–153. https://doi.org/10.3233/NRE-2010-0546 107 adults with relapsing MS; 12-week home training; gains on 3 memory abilities; 71.2% trained unprompted. Full study breakdown
- (2017). Evidenced-based cognitive rehabilitation for persons with multiple sclerosis: an updated review of the literature from 2007 to 2016. Archives of Physical Medicine and Rehabilitation, 99(2), 390–407. https://doi.org/10.1016/j.apmr.2017.07.021 Updated review; 40 studies appraised (6 Class I, 10 Class II, 24 Class III); a verbal learning-and-memory technique reached a Practice Guideline.
- (2008). Evidence-based cognitive rehabilitation for persons with multiple sclerosis: a review of the literature. Archives of Physical Medicine and Rehabilitation, 89(4), 761–769. https://doi.org/10.1016/j.apmr.2007.10.019 Earlier review; few high-quality cognitive-rehabilitation studies in MS, most clinic-based rather than home-based.
- (1991). Cognitive dysfunction in multiple sclerosis. I. Frequency, patterns, and prediction. Neurology, 41(5), 685–691. https://doi.org/10.1212/wnl.41.5.685 Cognitive impairment reported in 43–65% of people with MS; memory, attention and processing speed most affected.