Cognitive rehabilitation programmes can effectively restore cognitive dysfunction in multiple sclerosis patients, a recent review has found.
By analysing data from a large number of studies, a team of researchers from the Kessler Foundation have concluded that cognitive rehabilitation programmes should be recommended by clinicians as a low-cost, low-risk, and effective approach for treating multiple sclerosis-related cognitive impairment.
The study has been published in the Journal of Neurology.
Cognitive impairment is a common and debilitating symptom of multiple sclerosis (MS), affecting around 40 to 65% of patients. It typically involves complex attention, information processing speed, memory, and executive functions. Such deficits can be extremely disruptive to everyday life, affecting a person’s ability to manage their disease, complete day-to-day errands, and maintain employment. There is currently no gold-standard treatment for MS-related cognitive impairment, and medications approved to treat MS have shown limited efficacy in treating cognitive dysfunction.
One treatment approach that holds significant potential is cognitive rehabilitation. This treatment uses behavioural interventions to improve cognition. There are two general approaches to cognitive rehabilitation: restorative and compensatory.
Restorative cognitive rehabilitation
Restorative cognitive rehabilitation, also known as cognitive remediation, aims to reinforce, strengthen, and recover cognitive skills, typically through repetitive cognitive exercises using computer-assisted paradigms. Healthcare professionals use restorative cognitive rehabilitation to improve cognitive function by reinstating or strengthening the functions a person has either lost or continues to find challenging. Restorative cognitive rehabilitation treatment helps a person to practice skills so that they can improve. For example, they may be required to perform increasingly difficult memory tests to improve their memory or undergo training to improve their attention span. The approach builds on the idea of neuroplasticity, which suggests that the brain can change with practice.
Compensatory cognitive rehabilitation
In contrast, compensatory cognitive rehabilitation does not aim to restore lost cognitive skills, but instead helps patients compensate for their cognitive difficulties using various strategies such as visualisation and reminders. This can be a temporary strategy, where a person uses assistive devices as they build up new skills. Compensatory cognitive rehabilitation can also be a long-term strategy when it is not possible to restore a person’s functioning fully. Some examples of compensatory treatment include using assistive speech devices for a person with a speech impairment, using calendars and memory tools for people who struggle with executive functioning, and setting alarms to regain a person’s attention in certain contexts.
In the review, the Kessler research team looked at research into cognitive rehabilitation to give an overview of the efficacy of the treatment, both restorative and compensatory approaches, for treating MS-related cognitive impairment. From their findings, the researchers concluded that cognitive rehabilitation is an effective approach to improving cognitive impairment in MS patients, as demonstrated by 81 published studies.
The study authors argue that the evidence found in the review provides solid grounding for cognitive rehabilitation to be used as a standard treatment plan to improve cognitive functioning in MS patients.
Co-author Dr John DeLuca, Senior Vice President for Research and Training at Kessler Foundation, said: “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, behavioural approaches are the best treatment options that clinicians can currently offer.
“Patients generally report enjoying treatment, which would be conducive to compliance. Furthermore, computer-based treatments can be easily delivered at home, making this low-cost, effective intervention more convenient and accessible to individuals in need.”