Cognitive dysfunction in multiple sclerosis: current approaches to clinical management

In the last two decades clinicians have become increasingly aware of the frequency, importance and functional impact of cognitive dysfunction in multiple sclerosis. There is, however, a dearth of research in this area. In order to further progress in the field of neuropsychological diagnosis it is essential to validate sensitive, cost-effective and reliable screening instruments that can be used in clinical settings to identify patients appropriate for extensive neuropsychological assessment. As for the therapeutic approach, there is preliminary evidence that treatment with both disease-modifying and symptomatic agents may influence positively also the cognitive outcome of the patient. Few studies have assessed the efficacy of cognitive rehabilitation programs using an experimental design. Therefore, further research is clearly needed in this field: in particular, there is a need for tailor-made rehabilitation techniques for multiple sclerosis subjects, which take into account the course and stage of the disease, as well as the psychosocial problems of the individual patient.