Study protocol: Improving cognition in people with progressive multiple sclerosis: A multi-arm, randomized, blinded, sham-controlled trial of cognitive rehabilitation and aerobic exercise (COGEx): BMC Neurology

A. Feinstein, M.P. Amato, G. Brichetto, J. Chataway, N. Chiaravalloti, U. Dalgas, J. Deluca, P. Feys, M. Filippi, J. Freeman, C. Meza, M. Inglese, R.W. Motl, M.A. Rocca, B.M. Sandroff, A. Salter, G. Cutter

Research output: Contribution to journalArticlepeer-review


Background: Cognitive dysfunction affects up to 70% of people with progressive MS (PMS). It can exert a deleterious effect on activities of daily living, employment and relationships. Preliminary evidence suggests that performance can improve with cognitive rehabilitation (CR) and aerobic exercise (EX), but existing data are predominantly from people with relapsing-remitting MS without cognitive impairment. There is therefore a need to investigate whether this is also the case in people with progressive forms of the disease who have objectively identified cognitive impairment. It is hypothesized that CR and EX are effective treatments for people with PMS who have cognitive impairment, in particular processing speed (PS) deficits, and that a combination of these two treatments is more effective than each individual treatment given alone. We further hypothesize that improvements in PS will be associated with modifications of functional and/or structural plasticity within specific brain networks/regions involved in PS measured with advanced MRI techniques. Methods: This study is a multisite, randomized, double-blinded, sham controlled clinical trial of CR and aerobic exercise. Three hundred and sixty subjects from 11 sites will be randomly assigned into one of four groups: CR plus aerobic exercise; CR plus sham exercise; CR sham plus aerobic exercise and CR sham plus sham exercise. Subjects will participate in the assigned treatments for 12 weeks, twice a week. All subjects will have a cognitive and physical assessment at baseline, 12 weeks and 24 weeks. In an embedded sub-study, approximately 30% of subjects will undergo structural and functional MRI to investigate the neural mechanisms underlying the behavioral response. The primary outcome is the Symbol Digit Modalities Test (SDMT) measuring PS. Secondary outcome measures include: indices of verbal and non-verbal memory, depression, walking speed and a dual cognitive-motor task and MRI. Discussion: The study is being undertaken in 6 countries (11 centres) in multiple languages (English, Italian, Danish, Dutch); with testing material validated and standardized in these languages. The rationale for this approach is to obtain a robustly powered sample size and to demonstrate that these two interventions can be given effectively in multiple countries and in different languages. Trial registration: The trial was registered on September 20th 2018 at having identifier NCT03679468. Registration was performed before recruitment was initiated. © 2020 The Author(s).
Original languageEnglish
Article number204
JournalBMC Neurol.
Issue number1
Publication statusPublished - 2020


  • Aerobic exercise
  • Cognitive training
  • Progressive multiple sclerosis
  • aerobic exercise
  • Article
  • brain function
  • clinical protocol
  • cognition
  • cognition assessment
  • cognitive defect
  • cognitive rehabilitation
  • controlled study
  • daily life activity
  • depression
  • double blind procedure
  • employment status
  • follow up
  • functional assessment
  • functional connectivity
  • human
  • human relation
  • major clinical study
  • motor performance
  • multiple sclerosis
  • nerve cell network
  • nerve cell plasticity
  • neuropsychological test
  • nuclear magnetic resonance imaging
  • outcome assessment
  • physical capacity
  • randomized controlled trial
  • symbol digit modalities test
  • verbal memory
  • walking speed
  • complication
  • exercise
  • kinesiotherapy
  • physiology
  • Cognitive Dysfunction
  • Exercise
  • Exercise Therapy
  • Humans
  • Multiple Sclerosis, Chronic Progressive
  • Neuropsychological Tests


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