The purpose of the study is to determine the effect of an web-based intensive cognitive rehabilitation program in neuropsychological performance of a population of patients with multiple sclerosis or clinical isolated syndrome.

Objectives

Primary:

1. To determine the effect of an intensive cognitive rehabilitation program in neuropsychological performance of a population of patients with multiple sclerosis or clinical isolated syndrome.

Secondary:

1. To characterize the neuropsychological profile of a population of patients with multiple sclerosis or clinical isolated syndrome.
2. To evaluate the relation between Expended Disability Status Scale score and cognitive dysfunction.
3. To evaluate the impact of depression on neuropsychological performance.
4. To evaluate the relation between cognitive dysfunction and the 9-hole peg test.
5. To evaluate the relation between cognitive dysfunction and the 25-foot walk test.

Population and Sample Patients will be selected from an electronic database that exists in Centro Hospitalar Entre Douro e Vouga. They will be consecutively convoked and it will be proposed neuropsychological evaluation and participation in the study.

Every patient will have a baseline neuropsychological evaluation (table 1). After that, they will be randomized for training (Cogweb® program or Cogweb Monthly Notebooks®) or placebo in a 2(training):1(placebo) fashion (online program of randomization). After a 3-month period of tasks (training versus placebo), they will have another neuropsychological evaluation with the same battery used for baseline.

Patients included in intervention arm that have computer with internet access at home will perform a minimum of 3 sessions per week of Cogweb® during 3 months. Patients included in intervention arm that don't have computer with internet access at home will perform a minimum of 3 sessions per week of Cogweb Monthly Notebooks® during 3 months.

Patients included in placebo arm will have to complete a task (send an email with a copy of a journal/magazine heading) a minimum of 3 times a week.

Every patient included will have an outpatient appointment in the end of the first and second months of tasks (training versus placebo).

The placebo group is a group of patients with multiple sclerosis, selected according to inclusion and exclusion criteria, from the same database than those assigned for training.

The neuropsychological evaluation plan comprises: global efficiency (Montreal Cognitive Assessment test); processing speed (reading task of Stroop test, symbol searching from Wechsler Adult Intelligence Scale); attention (letter cut of Behavioural Inattention Test, Trail making test part B); memory (Letter and number sequence of Wechsler Memory Scale, digit memory, spatial localization of Wechsler Memory Scale, logic memory of Wechsler Memory Scale, word list from Wechsler Memory Scale); executive functions (colour naming task of Stroop test, inhibition from INECO frontal screening, verbal initiative from Lisbon Dementia Evaluating Battery, Zoo Map from Ineco, Matrix from Wechsler Adult Intelligence Scale) and anxious and depressive symptoms (Hospital Anxiety and Depression Scale).

Sample Size There will be convoked 75 patients (convenience sample).

Design Experimental, single-center study.

Clinical Practice Concomitant medication allowed Any except corticotherapy. Discontinuation criteria

1. Desire of the patient to end participation in the study.
2. Noncompliance of the intervention plan or fail the appointments predetermined.

Parameters to evaluate de study objectives

1. Neuropsychological battery: performed at baseline and at 3 months after the completion of study tasks (each test is composed of numerical, continuous variables).
2. Expended Disability Status Scale score: screening at baseline.
3. Stage of the disease: screening from the database.
4. Number of years of disease evolution.
5. 9-hole peg test: performed at baseline and at 3 months after the completion of study tasks.
6. 25-foot walk test: performed at baseline and at 3 months after the completion of study tasks.

Efficacy Endpoints Primary: To determine if an intensive cognitive rehabilitation program changes, in a statistically significant way, the performance on a neuropsychological evaluation after 3 months of training, comparing to the control group (number of tests scored more than one standard deviation from the normal value). There will be analyzed the total and partial scores for each test. The individuals with cognitive deficits at baseline will be analyzes as rehabilitation group. The others (without cognitive deficits in cognitive evaluation at baseline) will be analyzed as a separated group of cognitive stimulation.

Secondary:

1. To characterize the profile of a population of patients with multiple sclerosis, according to the performance in a neuropsychological battery, in terms of processing speed, attention, memory and executive functions.
2. To determine the percentage of patients with Cognitive Dysfunction, defined as performance >1standard deviation below the median in ≥3 tests of the battery.
3. To correlate the Expended Disability Status Scale score with the Cognitive Dysfunction.
4. To correlate the Hospital Anxiety and Depression Scale score with the Cognitive Dysfunction.
5. To correlate the 9-hole peg test with the Cognitive Dysfunction.
6. To correlate the 25-foot walk test with the Cognitive Dysfunction.

Safety Endpoints Not applicable.

Inclusion Criteria:

• Patients with MS diagnosed according to McDonald criteria from 2010 and clinical isolated syndrome patients.
• Age ≥18 years old.
• Informed consent.

Exclusion Criteria:

• Disease relapse in the last month.
• Corticotherapy in the last month.
• Expended Disability Status Scale score >6,0.