Cognitive rehabilitation in multiple sclerosis: Three digital ingredients to address current and future priorities

Abstract

Multiple sclerosis (MS) is a neurological chronic disease with autoimmune demyelinating lesions and one of the most common disability causes in young adults. People with MS (PwMS) experience cognitive impairments (CIs) and clinical evidence shows their presence during all MS stages even in the absence of other symptoms. Cognitive rehabilitation (CR) aims at reducing CI and improving PwMS’ awareness of cognitive difficulties faced in their daily living. More defined cognitive profiles, easier treatment access and the need to transfer intervention effects into everyday life activities are aims of utmost relevance for CR in MS. Currently, advanced technologies may pave the way to rethink CR in MS to address the priority of more personalized and effective, accessible and ecological interventions. For this purpose, digital twins, tele-cognitive-rehabilitation and metaverse are the main candidate digital ingredients. Based on scientific evidences, we propose digital twin technology to enhance MS cognitive phenotyping; tele-cognitive-rehabilitation to make feasible the cognitive intervention access to a larger number of PwMS; and metaverse to represent the best choice to train real-world dual- and multi-tasking deficits in virtual daily life environments. Moreover, multi-domain high-frequency big-data collected through tele-cognitive-assessment, tele-cognitive-rehabilitation, and metaverse may be merged to refine artificial intelligence algorithms and obtain increasingly detailed patient’s cognitive profile in order to enhance intervention personalization. Here, we present how these digital ingredients and their integration could be crucial to address the current and future needs of CR facilitating the early detection of subtle CI and the delivery of increasingly effective treatments.

Mobile Health App (DIGICOG-MS) for Self-Assessment of Cognitive Impairment in People With Multiple Sclerosis: Instrument Validation and Usability Study

“…This aligns results from previous studies that highlighted the potentialities of a digital tool for cognitive assessment in MS [23,58,59]. As indicated by Tacchino et al [60], digital cognitive assessments, expected to occur more frequently, at home or in an unsupervised setting, could also support the integration with electronic PROs of other dimensions significant for MS (e.g., mood). Brichetto et al…”

Enhancing the Quality of Life of Patients with Multiple Sclerosis: Promising Results on the Role of Cognitive Tele-Rehabilitation Plus Virtual Reality

“…In this context, remote rehabilitation protocols offer a promising alternative to traditional in-person rehabilitation. TR addresses mobility-related issues and has the potential to reduce healthcare costs [7,8]. Furthermore, it is worth noting that prior studies have suggested that the clinical effectiveness of TR may be comparable to or even superior to traditional rehabilitation programs [7,8].…”

“…TR addresses mobility-related issues and has the potential to reduce healthcare costs [7,8]. Furthermore, it is worth noting that prior studies have suggested that the clinical effectiveness of TR may be comparable to or even superior to traditional rehabilitation programs [7,8]. Various authors have also demonstrated that the benefits of TR are enhanced when used in conjunction with VR, which provides concrete, sustainable, and realistic experiences [6][7][8][9].…”

“…Furthermore, it is worth noting that prior studies have suggested that the clinical effectiveness of TR may be comparable to or even superior to traditional rehabilitation programs [7,8]. Various authors have also demonstrated that the benefits of TR are enhanced when used in conjunction with VR, which provides concrete, sustainable, and realistic experiences [6][7][8][9]. The simulation of real-life scenarios, through playful elements, fosters patient engagement and the potential for applying what has been learned in everyday life [6].…”