A Feasibility Study of Working Memory Training for Individuals With Pediatric-Onset Multiple Sclerosis

Cognitive impairment occurs in up to half of children and adolescents with multiple sclerosis (MS), and may be severe enough to compromise intellectual functioning, academic performance, and daily life function. Working memory (WM), which refers to the cognitive system that temporarily stores information long enough to use while manipulating the information for some purpose, is one of the major executive functions found to be compromised in pediatric-onset MS patients. The current dissertation sought to introduce a computerized cognitive training program (Cogmed) that is novel to the MS population in order to investigate feasibility, subjective experiences, and individual characteristics related to training outcomes, as well as examine preliminary efficacy of Cogmed in pediatric-onset MS patients. This dissertation employed mixed methods comprising Cogmed-specific training outcomes, performance on pre- and post-training neuropsychological assessment measures, and patient exit interviews. Pediatric-onset MS individuals who were identified as having cognitive difficulties (n = 9) underwent 5-6 weeks of intensive, home-based computerized training on verbal and visual-spatial WM exercises. Patients demonstrated general adherence and tolerance to Cogmed training, and completed training within the recommended 5-6 week timeframe. Almost all patients acknowledged changes in their WM performance as a result of training (n =8), and all patients (n = 9) described the training program as not intruding on their social lives. Age, disease onset, disease duration, and degree of brain atrophy emerged as potential predictors of individual training outcomes, as did intrinsic motivation. All individuals demonstrated improved performance on trained measures of WM and three individuals demonstrated improved performance on select non-trained measures of WM. The findings of this study demonstrate feasibility of implementing Cogmed in pediatric-onset MS patients, warranting subsequent large-scale randomized controlled studies that employ a multimodal approach to data analysis and that pay attention to individual differences that may predict variable training outcomes.