Effects of Neurocognitive Rehabilitation on the Levels of Neurotransmitters and Memory Proteins in Patients with Multiple SclerosisÖzlem Totuk, Erdil Arsoy, Recai Türkoğlu
Objective: This study aimed to investigate the role of neurotrophic factors and neurotransmitters in the neurocognitive impairments observed in Multiple Sclerosis (MS) patients, explore potential biomarkers, and evaluate the impact of computer-assisted cognitive rehabilitation (CCR) on these biomarkers.
Materials and Methods: The study included 20 healthy volunteers and 23 relapsing-remitting MS patients with a beck depression inventory score below 17, who could use computers and had no attack in the last 6 months. Serum levels of brain-derived neurotrophic factor (BDNF), cAMP response element-binding protein (CREB), melatonin, and orexin-A were measured using enzyme-linked immunosorbent assay (ELISA) and compared between patients and controls. MS patients underwent assessment using the brief repeatable battery of neuropsychological tests (BRB-N) before (baseline) and after (sixth month) CCR their biomarker levels were measured again, along with administering neuropsychological tests.
Results: Results showed lower levels of BDNF, CREB, melatonin, and orexin-A in MS patients compared to healthy controls before neurorehabilitation. Among the measured cognition-related proteins in the MS group, only BDNF was insignificantly decreased after neurorehabilitation. No significant differences were found in orexin-A, melatonin, and CREB levels before and after neurorehabilitation. Although, correlation analysis revealed no significant correlation between biomarkers and clinical parameters, paced auditory serial addition test and stroop tests which pointed to sustaining attention, information processing speed, verbal fluency, and categorical reasoning were found meaningful after CCR.
Conclusions: CCR may have beneficial effects on cognitive functions, particularly executive functions. However, the four examined molecules did not reflect cognitive changes in MS and cannot be used as biomarkers. Further investigation of other molecules related to CREB and BDNF pathways may shed light on cognitive impairment in MS.