Intervention to Reduce Perceived Cognitive Impairment in Multiple Sclerosis

Concern over worsening cognitive functioning has been shown to significantly impact patients'
lives. More than half of all MS patients demonstrate clinically significant cognitive
dysfunction, making it one of the leading causes of disability in MS. Cognitive deficits
often manifest in areas associated with information processing speed, memory, and executive
functioning. Resulting sequela can have profound implications on employment, interpersonal
relationships, and activities of daily living. Despite the prevalence of cognitive
dysfunction in MS, most studies find little to no relationship between perceived and
objective cognition in MS. Research shows that some patients overestimate the extent of their
cognitive deficits. PCI is associated with poor self-efficacy, social, and occupational
difficulties. Evidence suggests that negative emotional states may contribute to
overestimated PCI in MS. Exaggerated perceptions of impaired cognition may be intensified by
the presence of other MS symptoms, which can affect the way patients report disease activity
to healthcare providers and complicate detection of relevant disease symptomatology.

Overestimating cognitive impairment has been observed in other patient populations, but it is
especially problematic in MS and can provide an opportunity to inform patients about
discrepancies between perceived and objective cognitive functioning. Since physicians spend
significant amounts of time negating unsubstantiated healthcare concerns, an intervention
aimed at decreasing PCI in MS may improve long-term healthcare outcomes as well as the
quality of time that physicians spend with patients. Neuropsychological test results can be
used as objective evidence against perceived cognitive impairment to change patients
perceptions, if conveyed in an appropriate and nonthreatening manner.

Educating patients about the influence of emotional dysfunction and misattribution as it
relates to PCI may also decrease concern regarding cognitive decline and MS. Specifically,
internal processes such as emotional dysfunction, including a globally negative world view
can increase dissociative experiences that cause patients to misattribute normal cognitive
errors as MS-related cognitive decline. This model may inform patients understanding of
medically unsubstantiated PCI, allowing them to consider alternative factors associated with
common cognitive errors aside from MS.

Although many studies have aimed to improve cognition in MS through pharmacological
treatments, cognitive rehabilitation, and psychotherapy, to the investigators knowledge, this
is the first study to examine a psychoeducational intervention to decrease exaggerated
perceptions of cognitive impairment in MS. For the present study, the investigators will
develop a brief computer-based intervention for MS patients who perceive cognitive decline
incongruent with objective measures of cognition. The proposed intervention will incorporate
feedback from neuropsychological tests, including comparisons of perceived and objective
performance. The intervention will also introduce psychoeducation about causes of PCI, such
as emotional distress, attention, and misattribution. It is hoped that by combining
neuropsychological test feedback and psychoeducation, patients may better understand
differences between perceived and objective cognition, which in turn, may reduce concern and
offer alternative explanations for PCI.

Goals and Hypotheses

For the current study, the investigators will develop a brief computer-based intervention for
MS patients who perceive cognitive decline that is incongruent with objective measures of
cognitive functioning. The project will accomplish the following specific aims:

1. Develop and assess the feasibility and acceptability of a brief, single-session,
computerized intervention (cognitive feedback and psychoeducation; CFP) as part of a
randomized controlled pilot trial to reduce perceived cognitive impairment and distress
associated with perceived cognitive impairment that is incongruent with objective
measures of cognition in MS patients.

2. Examine whether the intervention reduces distress related to perceived cognitive
deficits. The investigators hypothesize that patients in the CFP group will report less
distress over perceived cognitive impairment compared to the control group immediately
after and one week following the intervention.

3. Examine patients understanding of factors that contribute to perceived and objective
cognitive impairment in MS. The investigators hypothesize that patients in the CFP group
will have an increased understanding of the role that negative emotion, misattribution,
and other secondary factors play in the formation of perceived cognitive deficits when
compared to patients assigned to the HEH group.

Inclusion Criteria:

- diagnosis of MS by a board-certified neurologist

- a total score > 40 on the Perceived Deficits Questionnaire (PDQ) based on previous
research that identifies this cutoff score as clinically significant in the MS
population and two standard deviations below average in the general population (Ruth
Ann Marrie, Gordon J. Chelune, Deborah M. Miller, & Jeffrey A. Cohen, 2005)

- score in the low average or better range on the Wechsler Test of Adult Reading (WTAR)

- average score equal to or greater than the 16th percentile on the Hopkins Verbal
Learning Test (HVLT), Symbol Digit Modalities Test (SDMT), Controlled Oral Word
Association Test (COWAT), and Wisconsin Card Sorting Task (WCST)

- average T score on the HVLT, SDMT, COWAT, and WCST no more than one standard deviation
below the WTAR T score

- access to a computer and a personal email account

- English-speaking

Exclusion Criteria:

- no severe sensory, motor, physical, or neurological impairment that would make
participation in the study insurmountable

- no history of nervous system disorder other than MS