Photo Credit: Naeblys
Dr. Elizabeth Gromisch discusses her study, which showed the feasibility of a telehealth intervention for teaching compensatory cognitive strategies in MS.
Studies have shown that as many as 70% of persons with MS experience cognitive impairment. This can manifest as mild to moderate impairment or, in some cases, severe. Prospective memory (PM) is one of the cognitive domains that can be diminished in these patients. PM includes event-based or time-based tasks, including remembering a doctor’s appointment, knowing to take medication at a designated time, or realizing that an alarm prompts you to take the medication.
“However, no cognitive rehabilitation intervention has specifically addressed improving [prospective memory] in [people with MS],” Elizabeth S. Gromisch, PhD, MSCS, and colleagues wrote in Multiple Sclerosis and Related Disorders.
To explore the potential of a telehealth PM intervention as a cognitive rehabilitative treatment for patients with MS, the researchers developed a feasibility study to identify acceptability, adherence, and enrollment criteria that could be adapted to initiate a future trial of this treatment protocol. Participants reported having trouble “remembering places they have to be” and “things they have to do.”
The intervention randomly assigned participants to either the active treatment group (Telehealth PM Intervention; n=17) or the active control group (Control; n=18). The telehealth PM intervention was offered through remote one-on-one sessions held twice a week over a 4-week period.
Dr. Gromisch spoke with Physician’s Weekly (PW) about the results of the feasibility study.
PW: Why did you feel this topic needed exploration?
Dr. Gromisch: Prospective memory, or “remembering to remember,” has several functional implications. This is the type of memory that we use to remember to take our medications, attend our medical appointments, and pay our bills. Persons with MS can have prospective memory issues, particularly when the tasks are time-based (eg, remembering to do something at a specific time). However, we have very few options for treating prospective memory problems in this population.
What findings are important to emphasize?
We found that a telehealth intervention that teaches compensatory cognitive strategies to persons with MS is feasible. We also found early evidence that the two strategies taught—visual imagery and implementation intentions—can improve time-based prospective memory.
How can these findings be incorporated into practice?
Although further research is needed to establish the efficacy of these strategies, both visual imagery and implementation intentions can be taught to patients as part of a cognitive rehabilitation program.
What makes this issue particularly urgent?
Cognitive impairment is a prevalent issue in MS that can negatively impact several aspects of daily functioning. We need to identify treatments that can help patients manage their cognitive difficulties and determine whether they can be delivered in a telehealth format.
What are the implications of this study?
This study is the first prospective memory-specific cognitive rehabilitation trial in MS and provides further evidence that telerehabilitation is a feasible treatment option for people with MS. This is particularly important for patients who do not have access to cognitive rehabilitation services nearby or experience barriers to attending in-person services, such as transportation issues.
What should future research focus on?
As this trial was a feasibility trial, we still need to conduct a larger clinical trial to establish the efficacy of these strategies for improving prospective memory in persons with MS.
