Cognitive rehabilitation interventions for multiple sclerosis (MS) patients include psychoeducational feedback, restorative, and compensatory interventions. GPs can assist their MS patients by helping them understand the benefits of cognitive rehabilitation and by facilitating access to services.
Cognitive rehabilitation refers to the alleviation of cognitive deficits associated with neurological insults. This is a person-centered approach to improve affected individuals’ quality of life and health. This article was published in the Australian Journal of General Practice.
The aims of interventions in cognitive rehabilitation can be compensatory, restorative, or both. In individuals with multiple sclerosis (MS), the interventions facilitate the protection and preservation of existing cognitive functioning via the cognitive reserve. Cognitive rehabilitation functions at the level of neurobiology as it stabilizes the physiological network of the brain and mediates neuroplasticity mechanisms. In MS, the reduction in depression and stress is associated with neurogenesis, improved serotonin precursor regulation, and changes in the neurobiology of the hypothalamic–pituitary–adrenal axis.
The initial steps include clarification of the nature of cognitive concerns along with the provision of initial psychoeducation. The hypothalamic–pituitary–adrenal axis exhibits positive neurobiological changes in MS patients along with neurogenesis and improved serotonin regulation upon reduction in the levels of depression and stress.
The initial treatment plan requires clarification about the cognitive impairment, objective cognitive screening, reports of concerns among patients and carers, and psychological screening results. The initial screening and consultation have a psychologically therapeutic effect. According to international guidelines, a more comprehensive neuropsychological assessment is required in the case of cognitive decline or cognitive impairment on screening. This assessment facilitates the development of an individually tailored treatment and care plan. There is a decreased risk for adverse outcomes when the assessment is conducted by qualified neuropsychologists having prior experience with MS. Absence of the Medicare Benefits Schedule (MBS) hinders the accessibility to assessment and feedback.
There is a wide range of cognitive rehabilitation interventions for MS, which can be adopted by healthcare providers for treatment. These interventions, broadly categorized into compensatory and restorative interventions, include practical compensatory interventions, internalized cognitive skills-based compensatory strategies, visual imagery, self-generation, modified Story Memory Technique, spaced retrieval technique, Brain HQ, RehaCom, and Attention Process Training. These interventions promote neuroplasticity, protect cognitive reserve, and increase functional connectivity. Multidisciplinary rehabilitation services, although useful for effective treatment, are not available in the majority of the states and territories in Australia. Affected individuals may use the general practitioner (GP) Mental Health Care plan for subsidized costs, private health insurance, or National Disability Insurance Scheme (NDIS) funds.
Reference
Longley, W. A. (2022). Cognitive rehabilitation in multiple sclerosis. Aust J Gen Pract, 51(4), 233-237. https://doi.org/10.31128/AJGP-08-21-6146
