Improving cognition in people with Progressive Multiple Sclerosis
Research type
Research Study
Full title
Improving cognition in people with Progressive Multiple Sclerosis: a Multi-Arm, Randomized, Blinded, Sham-Controlled Trial of Cognitive Rehabilitation and Aerobic Exercise (COGEx).
IRAS ID
250252
Contact name
Jennifer Freeman
Contact email
Sponsor organisation
University of Plymouth
Duration of Study in the UK
4 years, 0 months, 0 days
Research summary
Summary of Research:
Cognitive dysfunction affects up to 70% of people with progressive Multiple Sclerosis (MS). It can exert a deleterious effect on activities of daily living, employment and relationships, and people living with the disease consider the search for effective treatments a priority. Preliminary evidence suggests that impairments can improve with cognitive rehabilitation (CR) and aerobic exercise, but data come predominantly from people with relapsing-remitting and not progressive MS. This randomized, placebo controlled study will examine the effectiveness of cognitive rehabilitation and exercise training, either alone, or in combination on cognitive status in people with progressive MS. A team of MS researchers has been assembled from the UK, USA, Canada, Italy, Denmark, Germany and Belgium for this. A total of 360 people with progressive MS will make up the sample. Patient and reported and clinician rated measures will be undertaken before and after the 12 weeks of treatment to document the changes in cognitive and physical status that are expected to occur. Brain Magnetic Resonance Imaging will be undertaken in a sub-sample of participants (not within the UK sites) to document the structural changes that are expected to occur with symptom improvement.Summary of Findings:
CogEX: Improving cognition in people with progressive multiple sclerosisWhat was the purpose of the study?
Many people with progressive MS experience cognitive difficulties, such as trouble with memory, focus, or processing information. Until now, it was not clear whether these cognitive problems could improve with therapy in people with progressive MS.
CogEx explored whether combining computer-based cognitive rehabilitation with aerobic exercise on a recumbent stepper could improve thinking and memory more effectively than either approach on its own-or compared to non-active "sham" treatments used for comparison.
What did the study involve?
Over 300 people with progressive MS from six countries participated.
Participants were randomly assigned to one of four groups:
Cognitive rehabilitation + aerobic exercise
Cognitive rehabilitation + sham exercise
Aerobic exercise + sham cognitive rehabilitation
Sham exercise + sham cognitive rehabilitation
Everyone attended 24 in-person sessions over 12 weeks.
The main goal was to see whether participants improved on a test of thinking speed called the Symbol Digit Modalities Test (SDMT).
What did we find?
Nearly two-thirds of participants improved their cognitive scores by at least 4 points on the SDMT. This is considered a meaningful improvement in daily life.
This level of improvement was seen across all groups, including the sham groups.
The combined therapy (exercise + cognitive training) did not show added benefit over the other groups.
One possible reason: even the sham exercise (stretching and balance) turned out to help physical function, which may have boosted thinking ability indirectly.
Many participants reported that being part of the study-increased movement, mental engagement, and social interaction-offered a level of stimulation they hadn't experienced in years.
Why is this important?
The CogEx study is the largest and most rigorous trial ever conducted on cognitive treatment in progressive MS. Here's what it revealed:
People with progressive MS can improve their thinking abilities. This was not known before and is a major advance.
Cognitive and physical training are feasible and well tolerated, even in people with more advanced disease.
Cognitive decline may not be permanent-and with the right tools, some aspects may improve.
An "enriched lifestyle" that includes physical activity, mental engagement, and social interaction may play an important role in supporting brain health.
Future treatments may need to be more personalized-such as offering less vigorous but still targeted aerobic exercise suitable for people with MS, and cognitive rehabilitation that is adapted to each person's unique cognitive profile based on their assessment results-rather than using a one-size-fits-all approach.
What's next?
Future research will focus on building a profile of individuals who are most likely to benefit from these interventions and on determining the ideal timing to maximize cognitive improvements.
REC name
Wales REC 6
REC reference
18/WA/0309
Date of REC Opinion
17 Oct 2018
REC opinion
Further Information Favourable Opinion