Treatment and management of cognitive dysfunction in patients with multiple sclerosis

Cognitive impairment is a common and devastating manifestation of multiple sclerosis (MS). Although disease-modifying therapies have been efficacious for reducing relapse rates in MS, such treatments are ineffective for treating cognitive dysfunction. Alternative treatment approaches for mitigating cognitive problems are greatly needed in this population. To date, cognitive rehabilitation and exercise training have been identified as possible candidates for treating MS-related cognitive impairment; however, cognitive dysfunction is still often considered to be poorly managed in patients with MS. This Review provides a comprehensive overview of recent developments in the treatment and management of cognitive impairment in people with MS. We describe the theoretical rationales, current states of the science, field-wide challenges and recent advances in cognitive rehabilitation and exercise training for treating MS-related cognitive impairment. We also discuss future directions for research into the treatment of cognitive impairment in MS that should set the stage for the inclusion of cognitive rehabilitation and exercise training into clinical practice within the next decade. In this Review, the authors discuss the treatment and management of cognitive impairment in people with multiple sclerosis. They describe the theoretical rationales, challenges and advances in cognitive rehabilitation and exercise training for treating multiple sclerosis-related cognitive impairment, and discuss future directions for research in this field. Key points Cognitive deficits are common in people with multiple sclerosis (MS) and have a substantial impact on daily life functioning; effective treatment of such deficits is essential. Studies examining the efficacy of cognitive rehabilitation in MS have become more frequent in recent years and a few effective cognitive rehabilitation programmes for individuals with MS have been identified. Research on exercise training as a promising approach for improving cognition in MS has been growing, but more research is necessary. Insufficient evidence is currently available to support pharmacological approaches for treating cognitive impairment in patients with MS. Research is needed on factors such as the treatment timing, dosage and duration, and the impact of treatment on everyday life in patients with MS.