Efficacy of an executive function intervention programme in MS: a placebo-controlled and pseudo-randomized trial Computer-Assisted Cognitive Rehabilitation of Attention Deficits for Multiple Sclerosis Effects of donepezil on memory and cognition in multiple sclerosis Randomised multicentre trial on safety and efficacy of rivastigmine in cognitively impaired multiple sclerosis patients A randomized controlled trial of a cognitive rehabilitation intervention for persons with multiple sclerosis Neuropsychological rehabilitation does not improve cognitive performance but reduces perceived cognitive deficits in patients with multiple sclerosis: a randomised, controlled, multi-centre trial Integrative group-based cognitive rehabilitation efficacy in multiple sclerosis: a randomized clinical trial Treating learning impairments improves memory performance in multiple sclerosis: a randomized clinical trial The Economic Benefits of Acetylcholinesterase Inhibitors for Patients with Alzheimer Disease and Associated Dementias Impact of Armodafinil on Cognition in Multiple Sclerosis: A Randomized, Double-blind Crossover Pilot Study Neuropsychological rehabilitation has beneficial effects on perceived cognitive deficits in multiple sclerosis during nine-month follow-up A pilot randomised controlled trial of an Internet-based cognitive behavioural therapy self-management programme (MS Invigor8) for multiple sclerosis fatigue. Cognitive effects of atypical antipsychotic medications in patients with Alzheimer's disease: outcomes from CATIE-AD. Computer-aided retraining of memory and attention in people with multiple sclerosis: a randomized, double-blind controlled trial Correlates of dropout, efficacy, and adverse events in treatment with acetylcholinesterase inhibitors in Korean patients with Alzheimer's disease. Cognitive improvement after treatment with second-generation antipsychotic medications in first-episode schizophrenia: is it a practice effect? An RCT to treat learning impairment in multiple sclerosis
We evaluated a rehabilitation programme for executive deficits in multiple sclerosis patients by comparing outcome scores of a  cognitive intervention group ( CIG ; n = 11 ) with those of a  placebo group ( n = 14 ) and an  untreated group ( n = 15 ) .  Executive functioning and verbal learning improved significantly more in the CIG . The treatment effect on verbal learning was still present at 1-year follow-up . Baseline brain atrophy , quantified by the brain parenchymal fraction , was associated with treatment effects for one aspect of executive functioning . Consequently , cognitive intervention may be beneficial and baseline brain atrophy has some predictive value in determining treatment outcome for executive functioning 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 Acetylcholinesterase inhibitors are used to treat dementia associated with Alzheimer 's disease , but their cognitive benefits may extend to additional disorders such as multiple sclerosis ( MS ) . A single-center double-blind placebo-controlled r and omized clinical trial evaluated the effectiveness of donepezil in a sample of 69 MS persons selected for initial memory difficulties . Subjects received neuropsychological assessment at baseline and after 24 weeks of treatment . The primary outcome was change in total recall on the Selective Reminding Test , a measure of verbal learning and memory . Secondary outcomes included other neuropsychological tests from the Brief Repeatable Battery , patient-reported change in memory , and physician-reported impression of cognitive change .  Donepezil improved memory performance on the SRT compared to placebo . This benefit remained significant after controlling for various covariates including Exp and ed Disability Status Scale ( EDSS ) , MS subtype , interferon beta use , treatment group beliefs , gender , baseline selected reminding test ( SRT ) score , and reading ability . Subjects on donepezil were more likely to report memory improvement ( 65.7 % ) than those on placebo ( 32.4 % ) . The clinician also reported cognitive improvement in more donepezil ( 54.3 % ) than placebo ( 29.4 % ) subjects . No serious adverse events related to study medication occurred . However , more donepezil ( 34.3 % ) than placebo ( 8.8 % ) subjects reported unusual/abnormal dreams .  Donepezil improved learning and memory in MS patients with initial cognitive difficulties in a single-center clinical trial . Replication of results in a larger multi-center investigation is warranted in order to more definitively assess the efficacy of this intervention Background : Cognitive decline has been recognised as a frequent symptom in multiple sclerosis ( MS ) .  Cholinesterase inhibitors ( ChEIs ) are employed for the treatment of Alzheimer ’s disease , but there is some evidence that ChEIs might also be effective in MS patients with cognitive deficits , particularly deficits of memory function . Objective : The aim of this study was to evaluate efficacy on memory function and safety of the ChEI rivastigmine in MS patients with cognitive deficits as measured by the change from baseline of the total recall score of the selective reminding test ( SRT ) after 16 weeks of treatment . Methods : Efficacy and safety of rivastigmine were analysed in a 16-week , multicentre , double-blind , r and omised , placebo-controlled study , followed by an optional one-year open-label treatment phase . Effects of rivastigmine and placebo were compared by an analysis of covariance . Results : In total , 86 patients were enrolled . Patients who received rivastigmine ( n = 43 ) showed a non-significant increase in total recall score ( sum of all words immediately recalled over all six trials ) over placebo ( n = 38 ) after 16 weeks of treatment ( p = 0.2576 ) . Other outcome measures provided no evidence supporting benefits of rivastigmine . Treatment with rivastigmine was well tolerated . Conclusions : With the results of this study , the need for an effective therapy in cognitively impaired MS patients is still required . Thus , intensive and continued clinical research is required to explore therapeutic options for cognitive deficits in MS patients Objective : To explore the feasibility and effects of a computer-assisted cognitive rehabilitation intervention –  Memory , Attention , and Problem Solving Skills for Persons with Multiple Sclerosis ( MAPSS-MS ) – for persons with multiple sclerosis on cognitive performance , memory strategy use , self-efficacy for control of symptoms and neuropsychological competence in activities of daily living ( ADL ) . Design : A r and omized controlled single-blinded trial with treatment and wait list control groups . Setting : Southwestern United States . Subjects : Convenience sample of 61 persons ( 34 treatment , 27 wait list control ) with multiple sclerosis ( mean age 47.9 years , SD 8.8 ) . Intervention : The eight-week MAPSS-MS intervention program included two components : ( a ) eight weekly group sessions focused on building efficacy for use of cognitive compensatory strategies and ( b ) a computer-assisted cognitive rehabilitation program with home-based training . Outcome measures : A neuropsychological battery of performance tests comprising the Minimal Assessment of Cognitive Function in Multiple Sclerosis ( MACFIMS ) and self-report instruments ( use of memory strategies , self-efficacy for control of multiple sclerosis and neuropsychological competence in ADL ) were completed at baseline , two months ( after classes ) , and at five months . Results : Both groups improved significantly ( P < 0.05 ) over time on most measures in the MACFIMS battery as well as the measures of strategy use and neuropsychological competence in ADL . There was a significant group-by-time interaction for scores on the measures of verbal memory and the use of compensatory strategies . Conclusions : The MAPSS-MS intervention was feasible and well-accepted by participants . Given the large relative increase in use of compensatory strategies by the intervention group , it holds promise for enhancing cognitive function in persons with multiple sclerosis 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 Abstract Purpose : This study aim ed to determine the efficacy of the integrative group-based cognitive rehabilitation programme , REHACOP , on improving cognitive functions in multiple sclerosis ( MS ) . Methods : Fourty-two MS patients were r and omized to the treatment programme REHACOP  ( n = 21 ) or waiting list control condition ( n = 21 ) . The REHACOP group received cognitive rehabilitation in group format for three months focused on attention , processing speed , learning and memory , language , executive functioning , and social cognition . Patients completed a neuropsychological assessment at baseline and follow-up , which included tests of attention , processing speed , working memory , verbal memory , verbal fluency , and executive functioning . Repeated measures multivariate analysis of covariance ( MANCOVA ) was used to determine the efficacy of the cognitive rehabilitation programme . Results : Group × Time interactions revealed significant improvements in the REHACOP group as compared with the control group for processing speed ( p = 0.011 , np2 = 0.16 ) , working memory ( p = 0.014 , np2 = 0.15 ) , verbal memory ( p = 0.025 , np2 = 0.13 ) , and executive functioning ( p = 0.024 , np2 = 0.13 ) , showing medium – large effect sizes . Conclusions : Patients receiving REHACOP  showed improvements in several cognitive domains . This preliminary study thus provides evidence supporting the efficacy of this integrative group-based cognitive rehabilitation intervention in MS . Future research should confirm these findings , examine the impact of the treatment on everyday life functioning and explore the presence of brain changes associated with cognitive rehabilitation . Implication s for rehabilitation This study provides initial evidence for integrative group-based cognitive rehabilitation efficacy in MS patients through the implementation of the REHACOP cognitive rehabilitation programme . Patients received cognitive rehabilitation for three months ( 3 one-hour-sessions per week ) focused on training attention , learning and memory , language , executive functioning , and social cognition . Patients attending REHACOP sessions showed medium to large and statistically significant improvements in processing speed , working memory , verbal memory , and executive functioning This r and omized clinincal trial utilized established techniques to improve new learning and memory performance in multiple sclerosis ( MS ) participants with learning impairment . Participants were 29 individuals with clinincally definite MS with documented learning deficits , r and omly assigned to the experimental or control group . The experimental group underwent eight sessions of the Story Memory Technique ( SMT ) , while the control group participated in eight sessions of memory exercises .  Neuropsychological assessment was conducted at baseline , immediately following treatment and 5 weeks later to assess outcome . When stratifying participants by degree of learning deficits , a significant treatment effect was noted . MS participants with moderate-severe impairment in learning  showed a significant improvement in learning abilities when compared to controls , ( t(19)-3.32 , P<0.01 ) evident in 88 % of participants in the experimental group . Little improvement was noted in MS participants with mild learning impairments . Significant self-reported improvements in memory were noted in MS participants that underwent treatment , but not those that did not undergo treatment ( t(26)-2.55 , P<0.01 ) . Results indicate that learning and memory deficits in MS can be effectively treated through a memory rehabilitation program utilizing context and imagery to improve new learning . Appropriate patient selection is important , with moderately-severely impaired individuals showing significantly greater benefit from treatment Most cost-effectiveness studies using simulation modeling have demonstrated that donepezil , rivastigmine , and galantamine are cost effective for the treatment of mild-to-moderate Alzheimer disease ( AD ) . These conclusions are in large part based on the assumption that improvement in cognitive status , or prevention of cognitive and functional decline , reduces the amount of time patients spend institutionalized or receiving other full-time care . However , as discussed in this article , outcomes besides delay to institutionalization affect the costs of AD . In review s of utilization data from Medicare and managed care organizations , it was noted that hospitalization and post acute care in skilled nursing facilities accounted for the largest amount of excess direct costs , even among patients with mild or moderate AD . These utilization review s also suggest that many patients with AD and related dementias require inpatient care because they are not able to self-manage comorbid conditions . The improvements in cognitive status and daily functioning associated with acetylcholinesterase inhibitor ( AChEI ) therapy are expected to translate into improved management of comorbidities and reduced caregiver burden , thus reducing the total cost of care . To confirm these and other economic benefits of AChEIs , pharmacoeconomic outcomes should be evaluated routinely as part of r and omized , controlled trials and through well-controlled observational studies of AD patients in community and institutional setting Objective : Examine the efficacy of armodafinil in improving cognition in patients with multiple sclerosis ( MS ) . Background : Many patients with MS experience cognitive difficulties .  Armodafinil has shown promise as a cognitive enhancer in other patient population s. No studies have examined whether armodafinil improves cognition in patients with MS . Methods : We conducted a double-blind , placebo-controlled , crossover study testing the efficacy of armodafinil in reducing cognitive problems in patients with MS . We r and omized 17 patients to receive a dose of  lactose placebo  about 2 hours before they underwent a neuropsychological testing session . After a week-long washout period , we gave them a single 250-mg dose of armodafinil about 2 hours before testing them a second time . We r and omized another 16 patients to receive the active drug first , then the placebo .  We excluded 3 of the participants before analyzing the data . Results : After correcting for multiple comparisons of the 8 neuropsychological dependent measures , we found that the patients had significantly improved delayed memory on a list-learning task after they took armodafinil ( P=0.0005 ) , but no improvement on measures of executive function , visual memory , processing speed , or self-reported fatigue . Conclusions : Results provide preliminary evidence that armodafinil may improve delayed verbal recall in patients with MS . A larger trial showing enhanced memory among patients taking long-term armodafinil  could serve as a foundation for its possible clinical use as a memory enhancer in patients with 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 majority of people affected by Multiple Sclerosis ( paMS ) experience severe and disabling fatigue . A recent r and omised controlled trial ( RCT ) showed that cognitive behaviour therapy with a clinical psychologist was an effective treatment for MS fatigue . An Internet-based version of this intervention , MS Invigor8 , was developed for the current study using agile design and input from paMS . MS Invigor8 includes eight tailored , interactive sessions . The aim was to test the feasibility and potential efficacy and cost-effectiveness of the programme in a pilot RCT . 40 patients were r and omised to MS Invigor8 ( n=23 ) or st and ard care ( n=17 ) . The MS Invigor8 group accessed sessions over 8 - 10 weeks and received up to three 30 - 60min telephone support sessions . Participants completed online st and ardised question naires assessing fatigue , mood , quality of life and service use at baseline and 10 weeks follow-up . Large between group treatment effects were found for the primary outcomes of fatigue severity ( d=1.19 ) and impact ( d=1.02 ) . The MS Invigor8 group also reported significantly greater improvements in anxiety , depression and quality -adjusted life years . These data suggest that Internet-based CBT may be a clinical ly and cost-effective treatment for MS fatigue . A larger RCT with longer term follow-up is warranted OBJECTIVE The impact of the atypical antipsychotics olanzapine , quetiapine , and risperidone on cognition in patients with Alzheimer 's disease is unclear . The authors assessed the effects of time and treatment on neuropsychological functioning during the Clinical Antipsychotic Trials of Intervention Effectiveness-Alzheimer 's Disease study ( CATIE-AD ) . METHOD CATIE-AD included 421 out patients with Alzheimer 's disease and psychosis or agitated/aggressive behavior who were r and omly assigned to receive masked , flexible-dose olanzapine , quetiapine , risperidone , or placebo . Based on their clinicians ' judgment , patients could discontinue the originally assigned medication and receive another r and omly assigned medication . Patients were followed for 36 weeks , and cognitive assessment s were obtained at baseline and at 12 , 24 , and 36 weeks . Outcomes were compared for 357 patients for whom data were available for at least one cognitive measure at baseline and one follow-up assessment that took place after they had been on their prescribed medication or placebo for at least 2 weeks . RESULTS Overall , patients showed steady , significant declines over time in most cognitive areas , including in scores on the Mini-Mental State Examination ( MMSE ; -2.4 points over 36 weeks ) and the cognitive subscale of the Alzheimer 's Disease Assessment Scale ( -4.4 points ) . Cognitive function declined more in patients receiving antipsychotics than in those given placebo on multiple cognitive measures , including the MMSE , the cognitive subscale of the Brief Psychiatric Rating Scale , and a cognitive summary score summarizing change on 18 cognitive tests . CONCLUSIONS In CATIE-AD , atypical antipsychotics were associated with worsening cognitive function at a magnitude consistent with 1 year 's deterioration compared with placebo . Further cognitive impairment is an additional risk of treatment with atypical antipsychotics that should be considered when treating patients with Alzheimer 's disease CONTEXT Cognitive compromise is one of the main contributing factors to activity and participation restrictions in people with multiple sclerosis ( MS ) .  Computer-aided programs are used for retraining memory and attention , but data on the efficacy of these interventions are scarce . OBJECTIVE To assess the efficacy of computer-aided retraining of memory and attention in people with MS impaired in these abilities . DESIGN AND SETTING R and omized , double-blind , controlled trial . PARTICIPANTS Out patients ( n=82 ) with subjective complaints of poor attention or memory , confirmed by a score < 80th percentile in at least two tests of the Brief Repeatable Battery of Neuropsychological Tests ( BRBNT ) . INTERVENTIONS Participants were r and omized to two computer-assisted retraining interventions  : memory and attention ( study arm ) , and visuo-constructional and visuo-motor coordination ( control arm ) . Both groups received 16 training sessions over 8 weeks . OUTCOME MEASURES Improvement of 20 % or more in at least two BRBNT test scores at 8 weeks compared to baseline ( primary end point ) . Changes in depression and health-related quality of life . RESULTS An improvement occurred in 45 % of study patients vs. 43 % of control patients ( odds ratio 1.07 , 95 % confidence interval 0.44 - 2.64 ) . The study treatment was better than the control treatment only on the word list generation test ( p=0.016 ) . CONCLUSIONS This trial does not support the efficacy of specific memory and attention retraining in MS The correlates of dropout , efficacy , and adverse events in the treatment of Alzheimer 's disease ( AD ) with acetylcholinesterase inhibitors ( ChEI ) are unclear . To investigate these issues , a 26-week prospect i ve , r and omized , open-labeled trial with donepezil or rivastigmine was undertaken . Sixty-four Korean patients with AD were recruited , and data on sociodemographic and clinical characteristics and several assessment scales were collected . Characteristics of available caregivers were also gathered . Information on adverse events and dropout was recorded . Thirty-five ( 55 % ) patients dropped out during treatment with ChEI , for reasons mainly related to financial burden of caregivers . Of the 29 patients who completed the 26-week trial , 16 ( 55 % ) were responsive to ChEI . Lower scores on the Clinical Dementia Rating and Blessed Dementia Scale at baseline were associated with the efficacy of ChEI . Of the total participants , 26 ( 41 % ) experienced adverse events , although these seemed to be mild and appeared to be associated with the psychological state of patients or coadministration of psychotropic drugs . In conclusion , ChEI seemed to be effective and well tolerated in the treatment of Korean patients with AD , but the use of this drug was limited mainly by the financial burden of caregivers CONTEXT Cognitive impairment in schizophrenia is frequent , involves multiple domains , and is enduring . Numerous recent clinical trials have suggested that second-generation antipsychotic medications significantly enhance cognition in schizophrenia . However , none of these studies included healthy controls undergoing repeated testing to assess the possibility that improvements might reflect simple practice effects . OBJECTIVE To report the results on cognition of a r and omized comparison of 2 widely prescribed second-generation antipsychotic medications , olanzapine and risperidone , in patients with first-episode schizophrenia and a healthy control group . DESIGN R and omized clinical trial . SETTING Hospital-based research units . Patients A total of 104 participants with first-episode schizophrenia and 84 healthy controls . MAIN OUTCOME MEASURES Cognitive assessment of all study participants occurred at baseline , 6 weeks later , and 16 weeks later . Neurocognitive tests included measures of working memory and attention , speed , motor function , episodic memory , and executive function . RESULTS No differential drug effects were observed . Of 16 cognitive measures , 9 demonstrated improvement over time and only 2 demonstrated greater rates of change than those observed in the healthy control group undergoing repeated assessment . The composite effect size for cognitive change was 0.33 in the healthy control group ( attributed to practice ) and 0.36 in the patients with first-episode schizophrenia . Improvements in cognition in the first-episode schizophrenia group could not be accounted for by medication dose , demographic variables , or intellectual level . CONCLUSIONS The cognitive improvements observed in the trial were consistent in magnitude with practice effects observed in healthy controls , suggesting that some of the improvements in cognition in the first-episode schizophrenia group may have been due to practice effects ( ie , exposure , familiarity , and /or procedural learning ) . Our results also indicated that differential medication effects on cognition were small . We believe that these findings have important implication s for drug discovery and the design of registration trials that attempt to demonstrate cognitive enhancement Objective : To examine the efficacy of the modified Story Memory Technique ( mSMT ) , a 10-session behavioral intervention teaching context and imagery to facilitate learning , to improve learning and memory abilities in persons with multiple sclerosis ( MS ) . Methods : This double-blind , placebo-controlled , r and omized clinical trial included 86 participants with clinical ly definite MS , 41 in the treatment group and 45 in the placebo control group . Participants completed a baseline neuropsychological assessment , including question naires assessing everyday memory , a repeat assessment immediately posttreatment , and a long-term follow-up assessment 6 months after treatment . After completion of the treatment phase , persons in the treatment group were assigned to a booster session or a non – booster session group to examine the efficacy of monthly booster sessions in facilitating the treatment effect over time . Results : The treatment group showed a significantly improved learning slope relative to the placebo group posttreatment . Similar results were noted on objective measures of everyday memory , general contentment , and family report of apathy and executive dysfunction . Long-term follow-up data showed that posttreatment improvement in the treatment group continued to be noted on the list learning and self-report measures . The provision of booster sessions demonstrated little benefit . Conclusion : The mSMT is effective for improving learning and memory in MS . Classification of evidence : This study provides Class I evidence that the mSMT behavioral intervention improves both objective memory and everyday memory in patients with MS over 5 weeks , with treatment effects lasting over a 6-month period
Whilst there was only a limited pool of relatively small trials and a number of different compounds , we found that collectively , both AChEIs ( donepezil and rivastigmine ) and stimulants ( methylpheni date , modafinil , l‐amphetamine sulfate and lisdexamfetamine dimesylate ) offered no significant benefits over placebo on measures of processing speed , working memory , verbal fluency , verbal memory , visuospatial memory or executive functioning
HighlightsCognitive deficits are present in up to 70 % of people with multiple sclerosis (MS).There are no approved treatments for these difficulties .
We examined whether adjunctive pharmacotherapies can improve cognition in MS.Acetylcholinesterase inhibitors offered no significant benefits over placebo .
Stimulant‐based medications offered no significant benefits over placebo .
& NA ; We sought to examine the effectiveness of acetylcholinesterase inhibitors ( AChEIs ) and stimulant‐based medications for improving cognitive performance in patients with multiple sclerosis ( MS ) .