Multiple Sclerosis Journal 1–9 DOI: 10.1177/ 1352458515587597 © The Author(s), 2015. Reprints and permissions: http://www.sagepub.co.uk/ journalsPermissions.nav MULTIPLE SCLEROSIS MSJ JOURNAL http://msj.sagepub.com 1 Introduction Cognitive impairment, which affects 60% of multiple sclerosis (MS) patients, is one of the most disabling symptoms of the disease, pervading daily living activ- ities and severely compromising their quality of life. Declines involving attention, information processing speed, and executive function both undermine the ability of the patient to cope with several aspects of pathology management and limit personal independ- ence (e.g. driving, working, and shopping). These dis- abilities promote withdrawal from social interaction, interfering with the meaning of life on the part of the patient. Unfortunately, the various immunomodula- tory treatment strategies designed for MS are reported to be only partially effective in reducing cognitive decline in patients. 1 The limited efficacy of drug therapies is one of the main reasons for the growing interest in neurorehabilitation. Recently, intensive cognitive rehabilitation approaches targeting attention/information processing speed, memory and executive function 2–5 have been shown to have positive effects on cognitive deficits and quality of life in patients. Rehabilitation-induced functional changes at the brain level have been demonstrated using functional magnetic resonance imaging (fMRI). Improvements in attention, information processing and executive function in treated patients have been positively cor- related with greater activation of the left dorsolateral prefrontal cortex (DLPFC), cingulate cortices 6 and Neuroenhancement through cognitive training and anodal tDCS in multiple sclerosis Flavia Mattioli, Fabio Bellomi, Chiara Stampatori, Ruggero Capra and Carlo Miniussi Abstract Background: Cognitive training has been shown to improve cognitive function and quality of life in multiple sclerosis (MS) patients and is correlated with increased activity in the left dorsolateral prefrontal cortex (DLPFC). Objective: This study aims to test whether combining attention training with anodal transcranial direct current stimulation (a-tDCS) over the left DLPFC can improve training efficacy. Methods: Twenty patients impaired in attention/speed of information processing were randomly assigned to cognitive training during a-tDCS over the left DLPFC or cognitive training during sham tDCS for 10 daily sessions. Neuropsychological evaluations were conducted at baseline, after treatment and six months later. Results: When a-tDCS, rather than sham, was applied during the cognitive training, patients showed a significantly greater improvement in the Symbol Digit Modality Test (SDMT) and Wisconsin Card Sort- ing Test (WCST) after treatment (p < 0.05) and in the Paced Auditory Serial Addition Test (PASAT) 2” and WCST six months later (p < 0.05). They also had significantly shorter time to reach the most difficult exercise level, compared to sham treatment (6.3 vs. 7.4 sessions; p < 0.05). Conclusions: These results indicate that a-tDCS on the DLPFC during cognitive training fosters improve- ments in attention and executive function in MS patients and shortens treatment duration. Keywords: Multiple sclerosis, transcranial direct current stimulation, rehabilitation, attention, executive functions Date received: 25 November 2014; revised: 24 April 2015; accepted: 26 April 2015 Correspondence to: Flavia Mattioli Neuropsychology Unit, Spedali Civili of Brescia, Via Nikolajewka, 13 25123 Brescia, Italy. flaviacaterina.mattioli@ gmail.com Flavia Mattioli Fabio Bellomi Chiara Stampatori Neuropsychology Unit, Spedali Civili of Brescia, Italy Ruggero Capra Multiple Sclerosis Center, Spedali Civili of Brescia, Italy Carlo Miniussi Neuroscience Section, Department of Clinical and Experimental Sciences, University of Brescia, Italy/Cognitive Neuroscience Section, IRCCS Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy 587597MSJ 0 0 10.1177/1352458515587597Multiple Sclerosis JournalF Mattioli, F Bellomi research-article 2015 Original Research Paper by guest on May 26, 2015 msj.sagepub.com Downloaded from