OBJECTIVE: Cognitive impairment (CI) in people with multiple sclerosis (pwMS) may be present from the onset, is common, and has a profound impact on those affected. This study compared the effectiveness of three different therapeutic approaches (computerized cognitive training, BrainStim (BS); treadmill walking (TW); combined training (BS + TW)) on subjective and objective cognitive functioning in pwMS and CI. METHODS: 61 pwMS were recruited from the Department of Neurology outpatient clinic of the University Hospital Düsseldorf and neurologists in private practice. After screening for eligibility, pwMS were randomized into three treatment arms: 1) BS, 2) TW, 3) BS + TW. Subjective and objective cognitive functioning were evaluated before and after intervention, including the Perceived Deficits Questionnaire (PDQ-20) and Symbol Digit Modalities Test (SDMT) as primary end points, respectively. RESULTS: 46 pwMS entered the final analysis (n = 15 excluded). Change scores revealed significant effects on PDQ20 total score for all three treatment groups. These effects were stable over 6 months in the BS + TW group only. Moreover, change scores revealed significant effects on the SDMT for the TW group and BS + TW group, lasting 6 months. Between-group differences were not significant. CONCLUSION: Comparing three different behavioral treatments, we found that exercise training (TW), computer-based cognitive training (BS), and their combination (BS + TW) significantly improved subjective cognitive performance, with the combined group showing the most long-lasting effect. Objective cognitive performance improved significantly in the TW and BS + TW group, while cognitive training alone showed no effect. Results suggest that combining exercise with cognitive training may provide additional cognitive benefits than either intervention alone.

Brain and Mind Centre University of Sydney Sydney NSW Australia

COGITO Center for Applied Neurocognition and Neuropsychological Research Düsseldorf Germany

Comprehensive Center for Clinical Neurosciences and Mental Health Medical University of Vienna Vienna Austria

Department of Experimental Psychology Heinrich Heine University Düsseldorf Germany

Department of Neurology Inselspital Bern University Hospital University of Bern Freiburgstrasse 37 3010 Bern Switzerland

Department of Neurology Maria Hilf Clinics Mönchengladbach Germany

Department of Neurology Medical Faculty University Clinic and Heinrich Heine University of Düsseldorf Düsseldorf Germany

Department of Neurology Medical University of Vienna Vienna Austria

Department of Neurology Palacky University Olomouc Olomouc Czechia

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