Experts in cognitive research evaluated the status of available treatments as well as promising strategies for treating cognitive deficits in multiple sclerosis. The authors provided detailed analyses of different approaches to treatment, including cognitive rehabilitation, exercise training, and pharmacotherapy, and the important contributions of brain neuroimaging to advances in this field.

Over the past decade, research activity in cognitive rehabilitation has increased in the population with MS. There is greater emphasis on cognitive screening and assessment, and some standardized treatment protocols are available. Researchers at the Kessler Foundation said evidence suggests cognitive rehabilitation is effective in MS-related cognitive dysfunction, and may confer long-lasting effects. Access to cognitive rehabilitation therapy is likely to increase as remote options for delivery become more widely accepted, such as programs for home computers and telerehabilitation services.

Exercise training is an active area of MS research that shows promise for enhancing cognitive function and effecting positive change in the everyday lives of people living with MS. The authors said with improvements in methodology, this line of research will support consideration of exercise as the standard of care for individuals with MS. To develop treatment protocols, the timing, dosage, and duration of exercise need to be determined.

The authors found current pharmacotherapeutic approaches were of limited benefit for the cognitive symptoms of MS. To date, none of the available medications or disease-modifying therapies for MS are indicated for the treatment of cognitive deficits. The authors said that to determine the efficacy of a pharmacologic intervention for cognitive dysfunction, randomized controlled trials need to include cognition among their primary outcomes.

The article was published in Nature Reviews.