Effect of non-pharmacological interventions on cognitive function in multiple sclerosis patients: A systematic review...

This study aims to systematically assess the impact of non-pharmacological interventions on cognitive function in patients with multiple sclerosis (MS).

Utilizing the PICO framework, a comprehensive search was conducted across several databases including PubMed, Web of Science, EMbase, The Cochrane Library, CNKI, China Biomedical, Wanfang, and VIP. Short repeatable neuropsychological tests and simple cognitive assessments for MS were employed. Randomized controlled trials were selected to evaluate the influence of non-drug interventions on cognitive function in MS patients, with data collection extending until April 2024. The PEDro scale was used to evaluate the quality of included studies, while CINeMA was utilized for grading the quality of evidence. Meta-analysis was performed using Stata17.0 software.

A total of 67 RCTs involving 3222 MS patients across 11 interventions were included, predominantly from Europe, North America, and the Middle East, with most studies published in the last five years. The average PEDro scale score was 7.17, indicating intermediate quality of evidence. The cumulative rankings of the best probabilities for each cognitive function sub-dimension revealed that for information processing speed, the ranking was as follows: exercise (89.7%) > mindfulness (88.8%) > virtual reality + exercise (64.4%); for memory improvement: virtual reality + exercise (93.4%) > non-invasive brain stimulation (68.1%) > non-invasive brain stimulation + cognitive rehabilitation (60.2%); for attention: mindfulness (87.8%) > computer cognitive training (81.3%) > virtual reality (58.4%); and for executive function: mindfulness (93.2%) > exercise (73.0%) > multiple cognitive rehabilitation (60.5%).

Exercise exhibits the most significant benefits in enhancing information processing speed among MS patients, while the combination of virtual reality and exercise shows the best improvement for memory. Mindfulness practices are particularly advantageous for enhancing attention and executive functions in this patient population.