A recent clinical trial published in The Lancet Neurology challenged the conventional belief in the synergistic benefits of cognitive rehabilitation and exercise for patients with progressive multiple sclerosis (MS). The CogEx trial (NCT03679468) investigated the effects of combining cognitive rehabilitation and exercise on processing speed in 311 patients with progressive MS. Surprisingly, the trial found no significant improvement in processing speed when compared to a nonintervention group.
While previous studies have suggested that a combination of cognitive rehabilitation and exercise could have a synergistically beneficial effect, the CogEx trial results suggest otherwise. The primary outcome measure, the Symbol Digit Modalities Test (SDMT), showed no differences in processing speed between the intervention and nonintervention groups at the 12-week mark.
Lead author Anthony Feinstein, MPhil, PhD, FRCP, noted that the unexpected positive outcomes in the sham exercise group highlight the complexity of addressing cognitive decline in MS. This underscores the importance of tailored interventions that consider individual needs and characteristics.
The CogEx trial was conducted across multiple sites in different countries, including Belgium, Canada, Denmark, Italy, the UK, and the USA. Participants were enrolled between December 2018 and April 2022 and underwent their respective interventions twice a week for 12 weeks.
The cognitive rehabilitation intervention focused on an individualized, computer-based approach to improve processing speed, while the sham cognitive rehabilitation involved internet training. The exercise intervention consisted of individualized aerobic training using a recumbent arm-leg stepper, while the sham exercise comprised stretching and balance tasks.
Although the trial did not yield the expected results, Feinstein believes that the data from the CogEx trial can contribute to a better understanding of cognitive improvement in people with advanced MS. He suggests that individually tailored interventions based on specific characteristics such as demographics, symptom profiles, and biomarkers of disease activity could hold the key to positive changes.
While further analysis of the trial’s imaging data is still ongoing, it is clear that a one-size-fits-all approach to improving cognition in MS is not sufficient. The CogEx trial highlights the necessity for personalized interventions that consider the unique needs of each patient.
Frequently Asked Questions (FAQ)
What was the primary outcome measure in the CogEx trial?
The primary outcome measure in the CogEx trial was processing speed, assessed using the Symbol Digit Modalities Test (SDMT).
Did the combination of cognitive rehabilitation and exercise improve processing speed in patients with progressive MS?
No, the CogEx trial did not show any significant improvement in processing speed among patients with progressive MS who received the combination of cognitive rehabilitation and exercise.
What were the unexpected positive outcomes observed in the sham exercise group?
The sham exercise group in the trial showed unexpected improvement in the 6-minute walk test, a secondary outcome measure. This highlights the complexity of addressing cognitive decline in MS and the need for tailored interventions.
What are the implications of the CogEx trial findings?
The CogEx trial challenges the conventional belief in the synergistic benefits of cognitive rehabilitation and exercise for patients with progressive MS. The results emphasize the need for reevaluating treatment approaches and developing more nuanced and personalized interventions for individuals with this condition.