For a study, the researchers sought to compare the cognitive effects of active vs sham tDCS combined with adaptive cognitive training (aCT) administered as an at-home intervention in adults with MS in a randomized sham-controlled clinical trial (RCT). People with MS and fatigue (Fatigue Severity Scale, FSS) but no depression (Beck Depression Inventory, BDI) or severe cognitive impairment were enrolled in the study (Symbol Digit Modalities Test, SDMT). Over the course of 6 weeks, participants were randomly assigned to either active (2.0 mA), or sham left anodal dorsolateral prefrontal cortex (DLPFC) tDCS paired with aCT (Posit Science’s BrainHQ). At the start of the trial, participants were divided into 2 groups based on their level of neurologic disability (EDSS Low: 0.0-3.0 and High: 3.5-6.5). All daily intervention sessions were conducted at home under the supervision of a remote monitor. Using various formats, the Brief International Cognitive Assessment in MS (BICAMS) was performed at baseline and the end of the session. BICAMS test scores were translated to demographics-adjusted z scores and averaged for the composite score. At both timepoints, cognitive assessments were completed by n=106 of the overall study sample of n=116 participants. Participants ranged in age from 20 to 72 years old, with 81% of them being female and 63% having the relapsing subtype. Treatment fidelity was great, with n=103 (99%) of participants completing more than 25/30 tDCS+aCT sessions. The active (n=55) vs sham (n=51) group had a bigger and better pre- to post-intervention change in BICAMS (mean change in BICAMS z score=0.05±0.54 vs. -0.17±0.46, respectively, p=0.027). While the active tDCS advantage was detected in both high and low EDSS strata, individuals with higher EDSS (n=23: 0.03±0.56 vs n=21: -0.41± 034, p=0.004) compared to those with lower EDSS (n=32: 0.07± 0.53 vs n=30: 0.00±0.47, p=0.595) had a bigger and significant change in BICAMS in the active vs sham. In MS, an at-home intervention was possible to combine online adaptive cognitive training and tDCS. Active tDCS had significantly superior cognitive effects than sham tDCS. The cognitive benefit was greater in those with higher degrees of baseline neurological disability (EDSS) than those with lower levels.


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