Long Term Conditions

Cognitive Rehabilitation for Attention and Memory in Multiple Sclerosis (CRAMMS) trial

Living with MS

Many people with multiple sclerosis (MS) experience difficulties with attention, concentration and memory. Cognitive rehabilitation is one form of treatment which could be offered to help people with MS manage these problems. 

The CRAMMS Trial was designed to determine the clinical and cost-effectiveness of a 10-session group rehabilitation programme. We recruited 449 people with MS and cognitive problems, 229 were randomly allocated to receive cognitive rehabilitation in addition to usual care and 240 to receive only their usual clinical care.

Cognitive rehabilitation showed no long-term effect on quality of life but the results suggested a small gain in quality of life at 6 months.  There was also a reduction in everyday memory problems and an improvement in mood at both 6 and 12 months after random allocation.  There were no differences between the groups in costs or quality adjusted life years.

These results suggest that this cognitive rehabilitation programme may have modest benefits for people with MS, but future research needs to establish how short-term gains can be maintained over time.

Video: Trial summary and main findings


About multiple sclerosis (MS)

About multiple sclerosis

Multiple Sclerosis or MS is a condition of the central nervous system which affects the nerves in the brain and spinal cord. The damage appears to be caused by the immune system mistakenly attacking a coating around the nerve called myelin.

MS is a lifelong condition and is the most common condition of the central nervous system affecting young adults. Although it can be diagnosed at any age, the majority of people are diagnosed in their 20s and 30s. It can cause serious disability, but it is possible to control symptoms and life expectancy is very good.

According to the MS Trust over 100,000 people in the UK have MS and it is nearly three times more common to present in women than in men. Symptoms in MS are very wide ranging and are particular to each individual. Not everyone will experience the same symptoms and they may even vary day to day for each person.

If you are worried you may be experiencing the early signs of MS please see your GP.


What is cognitive rehabilitation?

Cognition describes the way we:

  • Concentrate and focus attention
  • Do more than one thing at a time (multitask)
  • Learn and remember new things
  • Reason and solve problems
  • Plan, carry out and monitor our own activities
  • Understand and use language
  • Recognise objects, compile things together and judge distances

Cognitive rehabilitation programmes used to treat other illnesses are provided by occupational therapists and psychologists in either a group setting or on a one to one basis.

In the CRAMMS trial, the cognitive rehabilitation will take place in groups of 4 to 6 people.


Why is cognitive rehabilitation important?

About 50% of all people with Multiple Sclerosis (MS) will have some form of difficulty at some time with elements of thinking, memory, attention span or concentration.

Problems with memory and thinking can really affect people with MS. The kind of problems that are more common in MS include difficulties with concentrating, being unable to find the right word (it's on the tip of my tongue) and short term memory problems. At present, people who have MS might not routinely receive any further therapy after they leave hospital to help with their memory problems. 

Cognitive rehabilitation is a way of relearning the cognitive skills that may have been lost over time, and also helping people cope better with their cognitive problems. There is some evidence that memory rehabilitation may help lessen everyday forgetting, but this has not yet been proven conclusively by large-scale randomised controlled trials.



1. Who was running the CRAMMS study?

The trial was sponsored by The University of Nottingham and was led by Professor Nadina Lincoln and Professor Roshan das Nair from The University of Nottingham School of Medicine.

The study was coordinated by the Nottingham Clinical Trials Unit (NCTU).

2. What was involved in the CRAMMS trial? 

The CRAMMS trial compared a cognitive rehabilitation programme for attention and memory with current clinical care to find out which is more effective.The cognitive rehabilitation programme included teaching in the use of using mnemonics - that is using patterns, words and images to remember details - and memory aids, such as diaries and, mobile phones and cameras.

3. What was the purpose of the CRAMMS trial? 

The purpose of this research is to help people with MS increase their ability to cope with their everyday memory problems so that they can get on with their lives and do the things that people take for granted, for example remembering to attend an appointment, locking the door, or recalling where they have put things.

4. How was CRAMMS funded? 

The CRAMMS trial was funded by the National Institute for Health Research Health Technology Assessment Programme. The Nottingham Research Ethics Committee has given ethical approval to conduct this study in line with the NHS Health Research Authority.

5. When will the results be available?

A full report of the trial findings will be published as a monograph in Health Technology Assessment later in 2019.

The results are summarised for participants in the video below.


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Long Term Conditions Research Group

School of Medicine
Division of Rehabilitation and Ageing
telephone: +44 (0)115 823 0226