Computerized Cognition Testing and Cognitive Motor Interference in MS

Walking and cognitive impairments are common in persons with multiple sclerosis (MS).
Approximately 85% of persons with MS report walking as a major limitation, whereas 65%
experience cognitive dysfunction. Traditionally, walking and cognition have been viewed as
unrelated, but there is evidence of cognitive-motor interference (CMI). CMI is believed to
stem from damage to common neural substances responsible for cognitive and motor functions.
Recent evidence supports cognitive-motor interference in persons with MS. For example, there
is evidence that walking performance declines when performed in conjunction with a
simultaneous cognitive task (i.e., dual task cost [DTC] of walking). This decline in walking
performance is greater in persons with MS compared to healthy control and is associated with
walking impairment. The degree of CMI during walking is associated with walking performance
and cognitive function in people with MS. For instance, CMI has been found to be related to
general cognitive function and self-reported everyday cognitive errors in people with MS
with minimal disability.

Cognitive-motor interference during mobility tasks is of practical and clinical importance
because it has been linked to decreased community mobility and a greater risk of falls in
other clinical populations such as stoke, Parkinson's disease and the elderly. We have
recently demonstrated that the degree of CMI during walking was associated with
physiological fall risk in MS, whereas gait velocity in and of itself was not.

Evidence gathered from other special populations suggests that CMI can be minimized with
interventions. However, there is no research on rehabilitation strategies on CMI in people
with MS. One possible approach for improving cognitive function and reducing CMI involves
computerized cognitive testing. This approach capitalizes on neural plasticity and has been
found to improve cognitive function, walking and balance in healthy older adults. Although
there is limited preliminary data suggesting this type of training may improve cognitive
function in people with MS, there is no extant data indicating computerized cognitive
training will impact mobility. Based on association between cognitive and motor function in
people with MS, it is possible that cognitive training may lead to improvements in walking
performance as seen in other clinical populations. One major advantage of computerized
cognitive training is that it can be completed without direct supervision and in one's home
to minimize various barriers to clinic-based rehabilitation.

Inclusion Criteria:

- medically confirmed MS diagnosis, relapse free in the last 30 days, willingness to
complete 12 week intervention, a computer with Internet access and capacity to run
the cognitive training software, and a willingness to travel twice to our research
lab.

Exclusion Criteria:

- Non-ambulatory, inability to see/read computer screen