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December 10, 2013; 81 (24) Article

An RCT to treat learning impairment in multiple sclerosis

The MEMREHAB trial

Nancy D. Chiaravalloti, Nancy B. Moore, Olga M. Nikelshpur, John DeLuca
First published November 8, 2013, DOI: https://doi.org/10.1212/01.wnl.0000437295.97946.a8
Nancy D. Chiaravalloti
From the Kessler Foundation Neuropsychology and Neuroscience Laboratory (N.D.C., N.B.M., O.M.N., J.D.), West Orange; and Departments of Physical Medicine and Rehabilitation (N.D.C., O.M.N., J.D.) and Neurology & Neurosciences (J.D.), Rutgers, New Jersey Medical School, Newark, NJ.
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Nancy B. Moore
From the Kessler Foundation Neuropsychology and Neuroscience Laboratory (N.D.C., N.B.M., O.M.N., J.D.), West Orange; and Departments of Physical Medicine and Rehabilitation (N.D.C., O.M.N., J.D.) and Neurology & Neurosciences (J.D.), Rutgers, New Jersey Medical School, Newark, NJ.
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Olga M. Nikelshpur
From the Kessler Foundation Neuropsychology and Neuroscience Laboratory (N.D.C., N.B.M., O.M.N., J.D.), West Orange; and Departments of Physical Medicine and Rehabilitation (N.D.C., O.M.N., J.D.) and Neurology & Neurosciences (J.D.), Rutgers, New Jersey Medical School, Newark, NJ.
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John DeLuca
From the Kessler Foundation Neuropsychology and Neuroscience Laboratory (N.D.C., N.B.M., O.M.N., J.D.), West Orange; and Departments of Physical Medicine and Rehabilitation (N.D.C., O.M.N., J.D.) and Neurology & Neurosciences (J.D.), Rutgers, New Jersey Medical School, Newark, NJ.
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Citation
An RCT to treat learning impairment in multiple sclerosis
The MEMREHAB trial
Nancy D. Chiaravalloti, Nancy B. Moore, Olga M. Nikelshpur, John DeLuca
Neurology Dec 2013, 81 (24) 2066-2072; DOI: 10.1212/01.wnl.0000437295.97946.a8

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Abstract

Objective: To examine the efficacy of the modified Story Memory Technique (mSMT), a 10-session behavioral intervention teaching context and imagery to facilitate learning, to improve learning and memory abilities in persons with multiple sclerosis (MS).

Methods: This double-blind, placebo-controlled, randomized clinical trial included 86 participants with clinically definite MS, 41 in the treatment group and 45 in the placebo control group. Participants completed a baseline neuropsychological assessment, including questionnaires assessing everyday memory, a repeat assessment immediately posttreatment, and a long-term follow-up assessment 6 months after treatment. After completion of the treatment phase, persons in the treatment group were assigned to a booster session or a non–booster session group to examine the efficacy of monthly booster sessions in facilitating the treatment effect over time.

Results: The treatment group showed a significantly improved learning slope relative to the placebo group posttreatment. Similar results were noted on objective measures of everyday memory, general contentment, and family report of apathy and executive dysfunction. Long-term follow-up data showed that posttreatment improvement in the treatment group continued to be noted on the list learning and self-report measures. The provision of booster sessions demonstrated little benefit.

Conclusion: The mSMT is effective for improving learning and memory in MS.

Classification of evidence: This study provides Class I evidence that the mSMT behavioral intervention improves both objective memory and everyday memory in patients with MS over 5 weeks, with treatment effects lasting over a 6-month period.

GLOSSARY

CI=
confidence interval;
CVLT=
California Verbal Learning Test;
FAMS=
Functional Assessment of Multiple Sclerosis;
FrSBe=
Frontal Systems Behavior Scale;
MS=
multiple sclerosis;
mSMT=
modified Story Memory Technique;
RA=
research assistant;
RBMT=
Rivermead Behavioural Memory Test;
RCT=
randomized clinical trial;
RM-ANOVA=
repeated-measures analysis of variance

Footnotes

  • Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Editorial, page 2060

  • Supplemental data at www.neurology.org

  • Received January 22, 2013.
  • Accepted in final form August 12, 2013.
  • © 2013 American Academy of Neurology
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