Please select the eligibility criteria that correspond to the clinical trial below.
Title: Plasticity-based, Adaptive, Computerized Cognitive Remediation Treatment (PACR) for Adults With Multiple Sclerosis (MS)
Brief Summary: Cognitive impairment remains a major disability for individuals with multiple sclerosis (MS). The primary objective of this study is to evaluate the efficacy for treating MS-associated cognitive deficits using a unique computer-based plasticity-based and adaptive cognitive remediation treatment (PACR) compared to a computer-based control. This novel cognitive remediation approach has led to striking improvements in cognitive functioning in other disorders (schizophrenia, traumatic brain injury, aging, and dementia) but has never been applied to individuals with MS. The investigators will enroll 136 MS participants who will be randomized in a 2:1 pattern to complete either the treatment or control condition for 60 hours across a 12-week treatment period. Both the treatment and control conditions will be accessed remotely by the subjects from a study-provided laptop computer. Study outcomes will include program compliance, performance on study tasks and neuropsychological measures, quality of life and functional status. Given the success of this program with other disorders and strong preliminary data from our feasibility study, the investigators believe PACR is an exciting untapped opportunity to improve cognition in individuals with MS.


Options:
A: Inclusion Criteria:

Key inclusion criteria for the participants' eligibility are a definite MS diagnosis (McDonald criteria). Participants fulfilling the key inclusion and the following criteria are eligible for this study

* EDSS 1.0 - 6.0
* Age 19 - 75 years

The presence of any one of the following exclusion criteria will lead to exclusion of the participant:

* Persistent infections
* Severe cardiovascular and pulmonal diseases (renal failure, hepatic dysfunction, cardiovascular disease)
* Severe cardiovascular exacerbations (RR \> 240/120, HR above the age predicted maximum of 220-Age) during training
* Immunosuppressive therapy the day of CPET
* Life style factors and / or persistent addictions (drug or alcohol abuse)
* Inability to follow the study procedures (due to psychological disorders or dementia)
* Insufficient knowledge of the project language (German)
* Women who are pregnant or breast feeding,
* Intention to become pregnant during the course of the study,
* Lack of safe contraception, defined as: Female participants of childbearing potential, not using and not willing to continue using a medically reliable method of contraception for the entire study duration, such as oral, injectable, or implantable contraceptives, or intrauterine contraceptive devices, or who are not using any other method considered sufficiently reliable by the investigator in individual cases.
* Participation in another study with investigational drug within the 30 days preceding and during the present study,
* Previous enrolment into the current study,
* Enrolment of the investigator, his / her family members, employees and other dependent persons,
* Specific exclusions for the disease under study,
* Specific concomitant therapy washout requirements prior to and/or during study participation,
* Dietary restrictions

Exclusion Criteria: Criteria in which the participant withdraws from this study may be the following:

* Inability to comply with the daily schedule
* Strong symptom exacerbations
* Withdrawal of informed consent
* Non-compliance
* Disease progression or relapse
B: Inclusion Criteria:

* MS defined according to the McDonald criteria revised in 2010
* Men and women aged between 18 and 65 years
* RR and SP forms
* Duration of progression ≤ 25 years
* EDSS ≤ 5.5
* Lack of disease activity as defined by the new Lublin criteria (2013)
* Cognitive complaint and/or cognitive disorders according to the investigator's judgement
* Impaired cognitive performance at least 1.65 SD below normative data at one test of the BCcogSEP battery
* French native language
* Owner of a laptop computer with Internet access
* Signing of the informed consent

Exclusion Criteria:

* - Other neurological, psychiatric or developmental diseases prior to the MS diagnosis
* Cranial trauma sequelae
* Chronic alcohol and/or drug consumption
* EDSS \> 6
* Relapse and/or treatment with corticosteroids within the past month
* Persons deprived of liberty, minors, adults under wardship
* Cognitive examination within the past 6 months (including in particular all or some of the tests proposed by this project)
* Presence of dementia according to DSM V criteria, or of cognitive disorders preventing the patient from undergoing cognitive tests or performing cognitive rehabilitation exercises
* Any visual or motor deficit preventing the patient from undergoing cognitive tests or performing cognitive rehabilitation exercises
C: Inclusion Criteria:

* Diagnosis of Multiple sclerosis

Exclusion Criteria:

* Diagnosis of other neurological conditions
D: Inclusion Criteria:

* Ages 18-70
* Definite MS Diagnosis, any subtype \[83\]
* Probable cognitive impairment as defined by a score ≤ 1 SD below the mean of normative data on the SDMT
* Concurrent medications to be kept constant over three months (as possible)
* No relapse or steroids in previous month
* Reading score on WRAT-3 of 37 or greater
* Visual, auditory and motor capacity to operate computer software, as judged by treating neurologist or study staff
* Willing to sign Agreement to Borrow Laptop

Exclusion Criteria:

* History of mental retardation, pervasive developmental disorder or other neurological condition associated with cognitive impairment
* Primary psychiatric disorder that would influence ability to participate
* Other serious uncontrolled medical condition (e.g., cancer or acute myocardial infarction)
* Alcohol or other substance use disorder
* History of computer-based training manufactured by Posit Science
* Learned English language after 12 years of age

Answer: D