***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background . Although a growing body of evidence has highlighted the role of cognitive rehabilitation ( CR ) in the management of cognitive dysfunctions in multiple sclerosis ( MS ) , there is still no evidence for a vali date d therapeutic approach . Objective . We propose a new therapeutic strategy characterized by a computer-based intensive attention training program in MS patients with predominant attention deficits . We aim to investigate the effectiveness of our rehabilitation procedure , tailored for those with impaired abilities , using functional magnetic resonance imaging ( fMRI ) . Methods . Using a double-blind r and omized controlled study , we enrolled 12 MS patients , who underwent a CR program ( experimental group ) , and 11 age-gender – matched MS patients , who underwent a placebo intervention ( control group ) . fMRI was recorded during the execution of a cognitive task broadly used for assessing attention abilities in MS patients ( paced visual serial addition test ) . Results . Significant effects were detected both at a phenotypic and at an intermediate phenotypic level . After CR , the experimental group , in comparison with the control group , showed a specific enhanced performance in attention abilities as assessed by the Stroop task with an effect size of 0.88 , which was associated with increased activity in the posterior cerebellar lobule and in the superior parietal lobule . Conclusions . Our study demonstrates that intensive CR tailored for those with impaired abilities affects neural plasticity and improves some aspects of cognitive deficits in MS patients . The reported neurophysiological and behavioral effects corroborate the benefits of our therapeutic approach , which might have a reliable application in the clinical management of cognitive deficits in MS BACKGROUND Systematic review s have indicated a low level of evidence for the positive effects of neuropsychological and cognitive rehabilitation in multiple sclerosis ( MS ) . How permanent the positive effects are , is unknown . OBJECTIVE The aim of the present study was to evaluate whether short-term neuropsychological rehabilitation has long-term beneficial effects in a nine-month follow-up . METHODS 102 relapsing-remitting MS patients with subjective and objective attentional deficits were r and omized into intervention and control groups . Altogether 78 out of 102 patients ( 76 % ) completed the longitudinal follow-up ( intervention group 83 % , control group 67 % ) . Intervention group received strategy -oriented neuropsychological rehabilitation conducted once a week in 60-minute sessions during thirteen consecutive weeks . The control group received no intervention .  Cognitive deficits , mood , fatigue , impact of disease , and quality of life were evaluated with self-reports at baseline , six months , and one year from baseline . RESULTS The positive effects of neuropsychological  rehabilitation  on perceived cognitive deficits were maintained for nine months . Among a subgroup of patients with moderate to severe attentional deficits , positive rehabilitation outcome was even more evident . CONCLUSION The beneficial effects of strategy -oriented neuropsychological rehabilitation on perceived cognitive deficits in MS may be maintained for at least one year after the beginning of the intervention The testing effect is a robust cognitive phenomenon by which memory retrieval on a test improves subsequent recall more than re study ing . Also known as retrieval practice , the testing effect has been studied almost exclusively in healthy undergraduates . The current study investigated whether retrieval practice during testing leads to better delayed recall than re study among persons with multiple sclerosis ( MS ) , a neurologic disease associated with memory dysfunction . In a within-subjects design , 32 persons with MS and 16 demographically matched healthy controls ( HC ) studied 48 verbal paired associates ( VPA ) divided across 3 learning conditions : massed re study ( MR ) , spaced re study ( SR ) , and spaced testing ( ST ) .  Delayed VPA cued recall was measured after 45 min . There was a large main effect of learning condition ( etap2 = .54 , p < .001 ) such that both MS and HC participants produced better delayed recall for VPAs learned through ST relative to MR and SR ; and SR relative to MR . This same pattern was observed for MS participants with objective memory impairment ( n = 16 ) , thereby providing the first evidence that retrieval  practice  improves memory more than re study among persons with neurologically based memory impairment Summary BACKGROUND : One aim of this project was to investigate the efficacy of a specific training programme for MS patients which also contained compensation strategies and relaxation exercises relevant to everyday life . The other aim was to check the programme 's relevance to everyday life . METHOD : 19 patients , r and omised into two groups , took part in the study . The participants in the treated group completed a specific neurological training programme which began immediately after the basic testing ( visit 1 ) and lasted 4 weeks , with a total of 12 sessions . The monitoring test was done immediately after the training programme ( at visit 2 ) and the follow-up was 3 months later ( visit 3 ) . Both study groups were fully comparable as regards clinical and socio-demographic data and baseline intelligence level . RESULTS : The results of the cognitive training programme were especially evident in the significant improvements in executive functions ( CKV ) and spatial-constructional abilities ( HAWIE-R ) . Comparison between the treated and the control group showed no significant difference in the fatigue values ( MFIS ) . However , when the treated group was examined over the three times of measurements , the symptoms of fatigue had diminished significantly . Regarding memory , comparison of the groups showed no changes ; within the treated group ; however , the verbal ( VLT ) and nonverbal learning and memory ( NVLT ) improved significantly . The results for sustained attention improved in both groups over time . It must be assumed that a learning effect had occurred here . The depression values ( BDI ) also improved in both study groups . The follow-up question naire showed that 60 % ( 6 ) attributed an average to above-average benefit to the training . CONCLUSION : To summarise , it is apparent that MS patients with mild to moderate cognitive impairment are able to profit from even a fairly brief neuropsychological training programme and to integrate much of it into their everyday lives . In view of this , it would seem appropriate to offer such a programme as st and ard , associated with medication . ZusammenfassungHINTERGRUND : Das Ziel dieses Projekts war es einerseits die Effizienz eines spezifischen Trainings , das auch alltagsrelevante Kompensationsstrategien und Entspannungsübungen beinhaltet , bei MS-Patienten zu untersuchen und and ererseits auch dessen Alltagsrelevanz zu überprüfen . METHOD E : 19 PatientInnen , r and omisiert in zwei Gruppen , nahmen an der Untersuchung teil . Die Teilnehmer der Versuchsgruppe absolvierten ein spezifisches neuropsychologisches Trainingsprogramm , das unmittelbar nach der Basistestung ( visit 1 ) begann und 4 Wochen dauerte , wobei insgesamt 12 Sitzungen stattf and en . Unmittelbar nach dem Training erfolgte die Kontrolltestung ( visit 2 ) und nach den darauf folgenden 3 Monaten das Follow-up ( visit 3 ) . Beide Untersuchungsgruppen waren bezüglich ihrer klinischen und soziodemografischen Date n und bezüglich des intellektuellen Ausgangsniveaus gut mitein and er vergleichbar . ERGEBNISSE : Die Erfolge des kognitiven Trainingsprogramms zeigten sich vor allem in den signifikanten Verbesserungen der Exekutivfunktionen ( CKV ) und der räumlich-konstruktiven Fähigkeiten ( HAWIE-R ) . I m Vergleich zwischen Versuchsgruppe und Kontrollgruppe zeigte sich kein signifikanter Unterschied in den Fatigue-Werten ( Ermüdungswerten ) ( MFIS ) . Bei Betrachtung der Therapiegruppe über die Dauer der drei Messzeitpunkte , nahmen die Ermüdungserscheinungen jedoch signifikant ab . Die Änderungen i m Gedächtnisbereich konnten i m Gruppenvergleich nicht nachgewiesen werden , innerhalb der Trainingsgruppe verbesserten sich die verbalen ( VLT ) und nonverbalen Lern- und Gedächtnisleistungen ( NVLT ) jedoch signifikant . Die Daueraufmerksamkeitsleistungen ( Daueraufmerksamkeit ) besserten sich in beiden Gruppen über die Zeit hinweg . Es ist anzunehmen , dass es dabei zu einem Lerneffekt gekommen ist . Die Depressionswerte ( BDI ) verbesserten sich ebenfalls in beiden Untersuchungsgruppen . Der Nachbefragungsbogen ergab , dass 60 % ( 6 ) dem Training einen durchschnittlich bis überdurchschnittlich hohen Gewinn beimaßen . SCHLUSSFOLGERUNG : Zusammenfassend zeigt sich , dass MS-Patienten mit einer leichten bis mittelgradigen kognitiven Störung auch von einem relativ kurzen neuropsychologischen Trainingsprogramms profitieren und vieles davon in ihren Alltag integrieren können . Insofern wäre es sinnvoll , ein derartiges Programm in Kombination mit einer medikamentösen Beh and lung st and ardmäßig anzubieten The present study examined the utility of using spaced learning trials ( when trials are distributed over time ) versus massed learning trials ( consecutive learning trials ) in the acquisition of everyday functional tasks . In a within-subjects design , 20 participants with multiple sclerosis ( MS ) and 18 healthy controls ( HC ) completed two route learning tasks and two paragraph reading tasks . One task in each area was presented in the “ spaced ” condition , in which the task was presented to the participants three times with 5-minutes break between each trial , and the second task in each area was presented in the “ massed ” condition , in which the task was presented three consecutive times to the participants . The dependent variables consisted of recall and recognition of the paragraphs and routes both immediately and 30 minutes following initial learning . Results showed that for paragraph learning , the spaced condition significantly enhanced memory performance for this task relative to the massed condition . However , this effect was not demonstrated in the route learning task . Thus , the spacing effect can be beneficial to enhance recall and performance of activities of daily living for individuals with MS ; however , this effect was significant for verbal tasks stimuli , but not for visual tasks stimuli . It will be important during future investigations to better characterize the factors that maximize the spacing effect Background : There is preliminary evidence on the positive effects of neuropsychological rehabilitation on cognition in multiple sclerosis ( MS ) , but the generalisability of the findings is limited by method ological problems . Objective : The aim of the present study was to determine the effects of strategy -oriented neuropsychological rehabilitation on MS . Methods : A total of 102 relapsing – remitting MS patients with subjective and objective attentional deficits were r and omised into an intervention and a control group .  Neuropsychological assessment  s were performed at baseline , at three months immediately after the intervention , and at six months . Patients in the intervention group received neuropsychological rehabilitation once a week in 60-minute sessions for 13 consecutive weeks . The control group received no intervention . Results : Neuropsychological rehabilitation including computer-based attention and working memory retraining , psychoeducation , strategy learning and psychological support did not improve cognitive performance but had a positive effect on perceived cognitive deficits . The intervention group perceived significantly fewer deficits than the control group both immediately after the intervention and at six months . The personal rehabilitation goals were also well achieved . Conclusions : Strategy -oriented neuropsychological rehabilitation did not improve cognitive performance but reduced perceived cognitive deficits in MS OBJECTIVE To examine the generation effect , the observation that items generated by subjects are better remembered than items provided , as a means of maximizing new learning in multiple sclerosis ( MS ) . DESIGN Prospect i ve between-group design . SETTING Private , nonprofit research facility . PARTICIPANTS Population -based sample of 31 subjects with MS ( MS group ) and 17 healthy controls ( control group ) , matched for age and education . INTERVENTION Immediate , thirty-minute and 1-week assessment s. MAIN OUTCOME MEASURES Neuropsychologic tests assessing language , executive functioning , working memory , long-term memory , and the generation effect were administered . Recall and recognition of generation effect stimuli was tested immediately , 30 minutes , and 1-week after presentation . RESULTS Recall and recognition of generated stimuli were significantly higher than provided stimuli across testing sessions . This effect was observed equally across the control and MS groups . Recall performance for generated stimuli correlated significantly with indices of episodic memory , information processing , and language but not executive control . Memory for the source of the information was deficient for generated words compared with provided words . CONCLUSIONS The generation effect was present in MS and control subjects and may be a viable way of maximizing new learning in MS We investigated how resting state ( RS ) functional connectivity ( FC ) of the anterior cingulate cortex ( ACC ) correlates with cognitive rehabilitation in relapsing remitting multiple sclerosis ( RRMS ) patients . A neuropsychological assessment and RS fMRI at baseline and after 12 weeks were obtained from 20 RRMS patients , who were assigned r and omly to undergo treatment ( n = 10 ) ( treatment group-TG ) , which entailed computer-assisted cognitive rehabilitation of attention/information processing and executive functions for 3 days/week , or not to receive any cognitive rehabilitation ( n = 10 ) ( control group-CG ) . Voxel-wise changes of ACC RS FC were assessed using SPM8 . In both groups , at the two study time points , ACC activity was correlated with the bilateral middle and inferior frontal gyrus , basal ganglia , posterior cingulate cortex , cerebellum , precuneus , middle temporal gyrus , and inferior parietal lobule ( IPL ) . At follow up , compared to baseline , the TG showed an increased FC of the ACC with the right middle frontal gyrus ( MFG ) and right IPL , while the CG showed a decreased FC of the ACC with the right cerebellum and right inferior 
    Output:
    
This review identified conflicting findings in the published literature about the effectiveness of various forms of cognitive rehabilitation techniques used in patients with MS .
Studies with more rigorous methodology are therefore needed to clarify which form of cognitive rehabilitation may lead to greater clinical improvement