Cognitive Deficits in Multiple Sclerosis: Recent Advances in Treatment and Neurorehabilitation
Purpose of review
This article highlights recent progress in research on treatment and neurorehabilitation of cognitive impairment in multiple sclerosis (MS) including pharmacological interventions, physical exercise, and neuropsychological rehabilitation, both in conventional and technology-assisted settings.
The most consistent evidence in terms of improvement or preservation of circumscribed cognitive scores in MS patients comes from moderately sampled randomized clinical trials on multimodal approaches that combine conventional or computerized neuropsychological training with psychoeducation or cognitive behavioral therapy. Disease-modifying treatments also appear to have beneficial effects in preventing or attenuating cognitive decline, whereas there is little evidence for agents such as donepezil or stimulants. Finally, physical exercise may yield some cognitive improvement in MS patients.
Despite substantial and often promising research efforts, there is a lack of validated and widely accepted clinical procedures for cognitive neurorehabilitation in MS. Development of such approaches will require collaborative efforts towards the design of interventions that are fundamentally inspired by cognitive neuroscience, potentially guided by neuroimaging, and composed of conventional neuropsychological training and cognitive behavioral therapy as well as physical exercise and therapeutic video games. Subsequently, large-scale validation will be needed with meaningful outcome measures reflecting transfer to everyday cognitive function and maintenance of training effects.
KeywordsMultiple sclerosis Cognition Rehabilitation Neurotechnology Magnetic resonance imaging Cerebellum Video games
This work was supported by fellowships from the Leenaards Foundation and the Baasch-Medicus Foundation, a Clinical Medicine Plus scholarship from the Dr. Max Cloëtta Foundation and the Uniscientia Foundation Vaduz, and a grant from the Helmut Horten Foundation to A.A.S.
Compliance with Ethical Standards
Conflict of interest
Riley Bove reports grants from Akili Interactive, personal fees from Roche Genentech, personal fees from Genzyme Sanofi, personal fees from Novartis, outside the submitted work. Arseny A. Sokolov reports fellowships from the Leenaards Foundation, from the Dr. Max Cloëtta Foundation and the Uniscientia Foundation Vaduz, from the Baasch-Medicus Foundation, and a grant from the Helmut Horten Foundation during the conduct of the study. Petr Grivaz declares no potential conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
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