Overview

The neuropsychological aspects of multiple sclerosis (MS), including cognitive dysfunction, are some of the most disabling symptoms of the disease, and they negatively impact quality of life for patients. During the course of MS, approximately 50% of patients experience cognitive deficits that may affect short-term memory, concentration, visuospatial function, executive function, and sensory function. Cognitive decline can become apparent early in the course of MS. A recent study that used neuropsychological assessment showed that approximately 50% of the patients with MS and very mild physical disability had cognitive impairment with a primary involvement of the prefrontal cognitive functions. However, cognitive impairment is more prevalent among patients with the progressive forms of the MS than patients with relapsing-remitting MS. Patients with pediatric-onset MS may also be at risk for cognitive dysfunction, and for this population of patients there are long-term implications for social adjustment, employment, and well-being. It is now recognized that MS produces pathological lesions of gray matter that have consequences for cognitive functions in patients with MS.

Rehabilitation early in the disease course has been shown to improve cognitive abilities. Results of another recent study showed that patients with clinically stable relapsing-remitting MS and mild to moderate cognitive impairment who received computer-assisted functional cognitive training, compared with standard clinical care, demonstrated significant improvements in verbal and visuospatial episodic memory, processing speed/attention, and executive functioning from pre-assessment to post-assessment. Early detection of cognitive dysfunction followed by cognitive rehabilitation may reduce or delay cognitive decline in patients with MS.