Neuropsychological Functions and Cognitive Neurorehabilitation in Multiple Sclerosis

Although cognitive difficulties are not frequently reported by patients among the initial symptoms of Multiple Sclerosis (MS), there is sufficient evidence that cognitive impairment is present from the early stage of the disease. Today it is commonly accepted that roughly one-half of individuals with MS will experience cognitive dysfunction over the course of the disease. Though MS was originally considered a disease of white matter, more recent investigations with advanced immunohistochemistry techniques have revealed that demyelination of gray matter is a common neuropathological feature in MS contributing significantly to cognitive impairment. However, despite now been recognized as a core symptom of MS, evidence up till now is only modest regarding the efficacy of pharmacological agents on cognitive dysfunction and non-pharmacological interventions such as cognitive rehabilitation also provide incomplete evidence on whether they might improve or stabilize cognitive impairment and especially over long follow up periods. Despite this general consensus, there are studies that have reported the efficacy of cognitive neurorehabilitation in reducing MS associated cognitive deficits. In this chapter we provide a selective review of the most relevant features related to this topic