Experts analyze options for treating multiple sclerosis-related cognitive impairment
Next decade will see inclusion of cognitive rehabilitation and exercise training in treatment protocols for multiple sclerosis
Credit: Kessler Foundation
East Hanover, NJ. June 16, 2020. Experts in cognitive research evaluated the status of available treatments as well as promising strategies for treating cognitive deficits in multiple sclerosis. The article, “Treatment and management of cognitive dysfunction in patients with multiple sclerosis”, was published in Nature Reviews 2020 May 05. (doi: 10.1038/s41582-020-0355-1) The authors are John DeLuca, PhD, and Nancy Chiaravalloti, PhD, of Kessler Foundation, and Brian Sandroff, PhD, of the University of Alabama at Birmingham.
Cognitive dysfunction is a common, disabling symptom of multiple sclerosis, affecting two-thirds of patients. These individuals can have difficulties managing finances, performing household tasks, and functioning in the community and the workplace. Although the impact on daily life may be profound, the diagnosis and management of cognitive dysfunction in this population remains inadequate. 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. “Evidence suggests that cognitive rehabilitation is effective in MS-related cognitive dysfunction, and may confer long-lasting effects,” said John DeLuca, PhD, senior VP of Research and Training at Kessler Foundation, and a co-author of the article. “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. With improvements in methodology, this line of research will support consideration of exercise as the standard of care for individuals with MS. “It is critical that larger scale studies include participants with MS, including progressive MS, and target select cognitive outcomes,” Dr. DeLuca noted. To develop treatment protocols, the timing, dosage and duration of exercise need to be determined. “As studies continue to evolve, clinical applications of exercise recommendations are likely to be implemented within the next ten years,” he predicted.
The authors found that 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. Dr. DeLuca addressed the fundamental challenge to trials of pharmaceutical agents: “To determine the efficacy of a pharmacologic intervention for cognitive dysfunction, randomized controlled trials need to include cognition among their primary outcomes.”
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About John DeLuca, PhD
Dr. DeLuca has been involved in neuropsychology and rehabilitation research for over 30 years, and has received more than 35 million dollars in grant support for his research. Recent projects include the cerebral mapping of human cognitive processes using functional neuroimaging and the development of research-based techniques to improve cognitive impairment. He is the author of more than 350 articles, books and chapters, has edited six texts in neuropsychology, neuroimaging and rehabilitation, and is a co-editor of the “Encyclopedia of Clinical Neuropsychology.” Dr. DeLuca serves on the editorial boards of several journals and has received numerous awards for his research, including early career awards from the American Psychological Association and the National Academy of Neuropsychology, and a mid-career award from the International Neuropsychological Society. He is a professor in the departments of physical medicine & rehabilitation and neurology at Rutgers New Jersey Medical School, where he directs the postdoctoral fellowship program in neuropsychology. Dr. DeLuca serves on numerous committees for both national and international societies, and is a neuropsychology consultant to the New Jersey Devils of the National Hockey League and the New York Red Bulls Major League Soccer team.
About Kessler Foundation
Kessler Foundation, a major nonprofit organization in the field of disability, is a global leader in rehabilitation research that seeks to improve cognition, mobility and long-term outcomes, including employment, for people with neurological disabilities caused by diseases and injuries of the brain and spinal cord. Kessler Foundation leads the nation in funding innovative programs that expand opportunities for employment for people with disabilities. For more information, visit KesslerFoundation.org.
For more information, or to interview an expert, contact: Carolann Murphy, 973.324.8382, [email protected]
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