Healthy Living

Behavioral Approach Can Help Eliminate Cognitive Fatigue in Multiple Sclerosis, Study Shows

Behavioral Approach Can Help Eliminate Cognitive Fatigue in Multiple Sclerosis

There has been research regarding reducing cognitive fatigue in people with MS via a non-drug approach (Dobryakova, PhD, Angela Spirou, MS, Nancy Chiaravalloti, PhD, et al). This new research shows that activating the brain's reward system may help relieve cognitive fatigue associated with MS.

Dr. Dobryakova, a research scientist at Kessler Foundation, was a recipient of a 2016 Switzer Research Fellowship by the National Institute on Disability, Independent Living and Rehabilitation Research (NIDILRR), and a 2015 Independent Investigator Grant from the National MS Society.

Cognitive fatigue/mental exhaustion

One of the many effects MS has on the body is cognitive fatigue (also referred to as ‘mental exhaustion’). This condition centers around memory issues, and trouble maintaining attention and processing information. Short-term memory is much more affected by this than long-term memory. Also impaired are executive function and self-regulation skills.”

According to Harvard University, executive function and self-regulation skills are a systematic series of mental steps allowing a person to plan, focus, recall instructions, and to successfully multi-task. This skill set is necessary to filter out distractions, set priorities, make and reach goals, and to control impulses.

Without those skills, anyone with MS experiences a long-term disability (CogniFit).

Cognitive fatigue is a disabling symptom reported by as many as 90 percent of individuals with MS (Med India Network for Health).

Cognitive fatigue and the brain’s fronto-striatal network

“Studies show that the fronto-striatal network is involved in cognitive fatigue”, says Med India Network for Health.

A recent article by MS researchers relates the effective use of a “reward system” to control cognitive fatigue. The approach suggests the “prospect of monetary reward stimulates the fronto-striatal network and reduces cognitive fatigue in MS and controls.” The article, "Fronto-striatal Network Activation Leads to Less Fatigue in Multiple Sclerosis" was published online on June 19, 2017, in Multiple Sclerosis Journal.

Before delving into the research study, we need to first understand what the brain’s cerebral fronto-striatal network is.

The fronto-striatal network is a system of circuits that connects the frontal lobe of the brain to the different brain areas that control motor, cognitive and behavioral functions.

The frontal lobe, located at the front of the brain, is the largest of the four major lobes of the cerebral cortex.

“The frontal lobe is the part of the brain that controls important cognitive skills in humans, such as emotional expression, problem solving, memory, language, judgment, and sexual behavior. It is, in essence, the ‘control panel’ of our personality and our ability to communicate” (Healthline).

Study report and findings

This research project was supported by the National MS Society and the Kessler Foundation. The Foundation is named after its founder, Dr. Henry H. Kessler, an orthopedist. Dr. Kessler’s mission is to provide “comprehensive rehabilitation for people with physical disabilities (to) help them achieve maximum independence,” and this remains at the core of the group’s mission statement (Kessler Foundation).

The Foundation also notes that “Over the past decade, Kessler Foundation has invested almost $50 million in the work of its researchers, who develop ways to help people with disabilities overcome obstacles, and lead full and productive lives in their communities.” Their site also notes their work with people who have MS.

Unless otherwise noted, the following information on this study was obtained from that Science News Article:

For the study, measurement of the level of cognitive fatigue was obtained by the use of functional neuro-imaging. This measurement was done through the use of MRI Scans which can detect localized brain neural activity in response to performing specific sensory, motor and cognitive tasks (Farlex).

The MRI scans were performed while the study participants completed a gambling activity. There were 14 ‘healthy’ controls and 19 individuals with MS in the study.

One group of the participants were offered the opportunity to win money, while no offer of benefit was given to the other group.

For those promised a financial outcome, there were significant activations of their fronto-striatal networks. This response was tied to a significant reduction in their cognitive fatigue.

Future use of these positive findings

These responses suggested that positive reinforcement via behavioral interventions could be useful in the clinical setting, and that motivating people to reach a particular goal attached to that reinforcement could be an effective approach to reducing cognitive fatigue associated with MS.

In speaking of this study, the Kessler Foundation noted: “Behavioral approach reduces cognitive fatigue in multiple sclerosis … The study demonstrated potential for nonpharmacologic intervention for treating cognitive fatigue in individuals with multiple sclerosis."

We are told this is the first study to show this effect for people living with MS (Med India).

The study results showed that, in this particular case, the promise of a financial award for performing a task stimulated the fronto-striatal network and reduced cognitive fatigue for the participants.

The findings also provided encouragement that treatment of cognitive fatigue in persons with MS can successfully be delivered without drugs, that by providing a variety of enticing goals, their cognitive fatigue can be reduced.

From a wider perspective, “Research is the way forward for people with MS, since we do not yet have a cure for this disabling neurological disease and one is urgently needed” (SELF).