Cognitive dysfunction is common in patients with multiple sclerosis (MS). In fact, more than half of all MS patients will develop some sort of cognitive impairment, which can severely impact their quality of life. Furthermore, no pharmacological treatments exist to manage cognitive dysfunction. However, a 2021 review of existing research has found that undergoing cognitive rehabilitation is effective at restoring cognition in individuals with MS.
Cognitive dysfunction and rehabilitation
It’s estimated that up to two-thirds of MS sufferers experience cognitive dysfunction over the course of their disease. Cognitive dysfunction in people with MS can result in symptoms such as memory impairment, difficulty in processing information, and struggles with learning new information. The standard treatment for MS-related cognitive dysfunction is a process called “cognitive rehabilitation.”
According to the National MS Society, cognitive rehabilitation “is designed to help people [with MS] compensate for loss of memory, slowed learning ability and other cognitive changes. It is provided by neuropsychologists, occupational therapists or speech/language pathologists.”
Cognitive rehabilitation is done in several weekly sessions over a period of weeks or months, each session lasting about an hour. During a session, the patient will participate in a variety of exercises designed to improve their cognitive ability. The exercises are tailored to the patient’s specific level of impairment.
Currently, cognitive rehabilitation programs focus on helping the patient better communicate with others, carry out everyday tasks more efficiently, and improve memory and learning. There are two approaches to cognitive rehabilitation: restorative and compensatory. The former involves strengthening the patient’s cognitive abilities (often via computer programs) while the latter aims to help the patient compensate for their impaired cognitive skills, using techniques such as visualization and periodic reminders.
The review
In their summary of existing studies, Michelle Chen, Nancy Chiaravalloti, and John DeLuca of the Kessler Foundation looked at 81 existing studies on cognitive rehabilitation for MS. The researchers concluded that the results were sufficient to establish cognitive rehabilitation as an “effective approach to improving MS-related cognitive impairment.”
“Cognitive rehabilitation should be part of a comprehensive treatment plan for people with MS who experience cognitive deficits. Given the lack of approved pharmacological treatments, behavioral approaches are the best treatment options that clinicians can currently offer. Patients generally report enjoying treatment, which would be conducive to compliance,” said Dr. John DeLuca, the study’s co-author and Senior Vice President for Research and Training at the Kessler Foundation.
The therapy is cost-effective, said DeLuca, as well as convenient–computer programs allow for cognitive rehabilitation in the comfort of the patient’s own home. “[C]omputer-based treatments can be easily delivered at home, making this low-cost effective intervention more convenient and accessible to individuals in need.”
Although not a panacea, it appears that cognitive rehabilitation is today’s gold standard for treating MS-related cognitive dysfunction and should be used until the inevitable advent of more advanced therapies in the next few decades.
Written by Natan Rosenfeld