Up to 70% of people with MS can experience cognitive problems. These are persistent and debilitating to the person with MS, and can adversely affect their personal, social, and professional lives. Unsurprisingly, the MS Society with the James Lind Alliance identified finding treatments to improve cognition as a top 10 research priority. Our portfolio of research into cognition focuses on (i) understanding the cognitive and neural mechanisms that underpin the cognitive problems that people with MS face, and (ii) finding ways to treat or support people with cognitive problems, so that they can continue to participate in activities of daily life.

1. Neuropsychological Evaluation and Rehabilitation in Multiple Sclerosis (NEuRoMS)

The NEuRoMS is a 6-year programme that aims to develop a neuropsychological evaluation pathway, to routinely assess all people with MS for cognitive problems attending NHS MS clinics, and to develop and test a brief neuropsychological rehabilitation programme for people with MS with mild cognitive problems.

Funder: NIHR Programme Grant for Applied Research

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 2. Cognitive Rehabilitation of Attention and Memory in Multiple Sclerosis – II (CRAMMS-II)

CRAMMS was an NIHR/HTA-funded trial that determined the clinical and cost-effectiveness of a 10-session group rehabilitation programme. We recruited 449 people with MS and cognitive problems, 229 were randomly allocated to receive cognitive rehabilitation in addition to usual care and 240 to receive only their usual clinical care, and outcome measured at 6 and 12 months. Results can be found in Clinical Rehabilitation and the Health Technology Assessment Monograph.

In CRAMMS-II, we are determining who benefits most from cognitive rehabilitation, and based on this classification, we will conduct a new trial of the CRAMMS intervention, to prospectively test whether our new classification system yields better outcomes when compared to providing the intervention to everyone with cognitive problems.

Funder: MS Society

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 3. Digitising cognitive tests

Increasingly, tests to assess people’s cognition is being delivered online or on computerised formats. This has made administration and scoring of these tests much easier, but some of these tests have not undergone rigorous testing to establish their psychometric properties or they are expensive to purchase. This makes it difficult to use these in routine NHS clinics, where they are most needed.

Hannah’s PhD research has examined all cognitive tests used in MS research, and she has sought patient and clinician views on various tests. Based on this information, she has been working with MindTech to digitise two tests, is collecting normative data, and is determining how these new digitised tests compared to their traditional paper-pencil counterparts.

Funder: MS Society

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 4. Cochrane review: Memory rehabilitation for people with MS

Cochrane reviews bring together the best and latest evidence of effectiveness of a particular treatment. We completed this review in 2016, and now that there are a number of new studies on memory rehabilitation in MS, we felt it was time to update this review. We believe this will be the biggest update yet of this review. This update is part of Lauren’s PhD research.

Funder: MS Society

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 5. Medication adherence in people with cognitive problems

Up to 70% of people with MS can have cognitive problems. We also know that many people with MS are on a complicated regimen of medications and treatments, and many times, people forget to take these treatments on time. Working with the UK MS Register, Sarah’s doctorate project will identify strategies related to disease modifying treatment (DMT) adherence amongst people with MS with associated cognitive deficits, and whether the barriers and strategies related to DMT adherence differ between those who are adherent vs non-adherent.

Funder: Health Education England (as part of the DClinPsy degree)

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 6. SMART Rehab: Exploring the effects of Strengthening Mental Abilities with Relational Training on Executive Functioning for People with MS

There is some evidence that ‘brain training’ exercises are helpful for improving cognition, but the evidence is not robust. Strengthening Mental Abilities with Relational Training (SMART) is computerised intervention that aims to improve cognition. The program is based on theoretical developments in Relational Frame Training, an established theory of language and cognition. RFT proposes that many cognitive processes are underpinned by our ability to ‘relate’ concepts together, and that this ability is learnt (starting in infancy) and develops over time as the individual interacts increasingly with their environment. In this mixed-methods, multiple-baseline across participants Single Case Experimental Design Rupert will examine the feasibility and effectiveness of the SMART intervention for people with MS reporting cognitive problems.

Funder: Health Education England (as part of the DClinPsy degree)

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 7. Neuromodulation with Connectivity-Guided Intermittent Theta Burst Stimulation for Cognitive Impairment in MS: A Feasibility Trial

In this feasibility trial, we will test the feasibility of MRI-guided intermittent theta burst stimulation (iTBS) as a treatment for improving cognitive status in people with MS. We will test the feasibility of recruitment, participant retention and experience of the procedure. We will also collect preliminary evidence of efficacy and for different administration protocols to allow us to optimise the design of a subsequent planned fully randomised controlled trial.

Funder: MS Society

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 8. Development of a self-report measure of cognitive abilities for people with MS

There are a few self-report measures of cognitive abilities for people with MS, but these tend to be long, complex, lack validity and input from people with MS, or are expensive. Therefore, we cannot use these in routine clinical practice in NHS MS clinics. Furthermore, increasingly, there is a call to use robust patient-reported measure in clinical trials. Therefore, it is vital that we have one that is suitable for use for these purposes. In this study, Heather will develop an item pool based on qualitative research into cognitive problems faced by people with MS, from people with MS, clinicians and other stakeholders. This item pool will be used in a Delphi study to develop the scale, which will then be assessed for its psychometric properties. We will test whether respondents understand each item as it was intended to be understood, using cognitive interviews with people with MS.

Funder: Health Education England (as part of the DClinPsy degree)

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