#ACTRIMS2022 – Cognitive Training Paired With tDCS Aids Patients
Electrically stimulating the brain while doing at-home cognitive training games can help to prevent a decline in cognition for people with multiple sclerosis (MS), particularly those with more advanced disability, a study indicates.
“This could lead to a therapy that can remediate cognitive impairment, we just need to optimize” the intervention protocol, said Leigh Charvet, PhD, a professor in the neurology department of New York University. Charvet presented study findings at the Americas Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS) Forum 2022, in the talk “Cognitive Functioning in MS Improves with At-Home Online Training Paired with Transcranial Direct Current Stimulation (tDCS): Results from a Sham-Controlled Randomized Clinical Trial.” Over three-quarters of MS patients experience cognitive difficulties as a symptom of the disease. These difficulties usually start off mild — like slight delays in processing speed — but worsen with progression, often leading to problems with learning, memory, and other cognitive domains.
Adaptive cognitive training is an intervention broadly aiming to boost skills by having a person play computer games specially “designed to target processing speed that then has a transfer effect to other aspects of cognitive functioning,” Charvet said. Charvet noted that the “adaptive” part of this kind of training is key: Based on how well a person is doing on the various exercises, the computer will adjust the difficulty of exercises to match.
“For instance, [the training] slows down when the user slows down or speeds up to drive the learning to maintain a level of engagement to get the most out of the training session,” she said. Charvet and colleagues previously ran a clinical trial that enrolled 135 MS patients with mild-to-moderate cognitive impairment, who were given 12 weeks of at-home adaptive cognitive training (from Brain HQ) or video games with no active component. Results showed a significant benefit in intervention group patients on measures of neuropsychiatric function after the 12 weeks.
In their new study, the researchers wanted to test whether applying transcranial direct current stimulation, or tDCS, might increase the benefits derived from adaptive cognitive training. tDCS is a non-invasive, painless procedure that involves using electrodes on the scalp to stimulate specific parts of the brain. In this case, it is used to stimulate the left dorsolateral prefrontal cortex, a brain region that is important for cognition. The overall goal is to help facilitate changes in the brain’s architecture that lead to cognitive benefits. tDCS is “a very safe and well-tolerated technique,” Charvet noted.
Researchers enrolled 120 people with MS, mostly female and white, who had clinically significant fatigue but not depression or severe cognitive impairment. All underwent 20-minute sessions of adaptive cognitive training daily for 30 days, and they were randomly divided to receive active tDCS or a sham procedure during the training sessions.
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