NEUROPSYCHOLOGY AND MULTIPLE-SCLEROSIS - DIAGNOSTIC AND REHABILITATIVE APPROACHES

The frequency of cognitive deficits in multiple sclerosis (MS) patient s is rather high and the estimates vary between 43% and 72% depending on the patient samples studied as well as on the methods of cognitive assessment. Despite the great impact of cognitive dysfunction on sever al aspects of the quality of life, the importance of accurate assessme nt and rehabilitation of neuropsychological deficits in MS patients ha s long been ignored. In this article, we first describe tests for the assessment of impairments, disabilities and handicaps. We emphasize th at after screening with brief assessment instruments, detailed testing of the basic target deficits is mandatory for the planning of special cognitive training programs. Second, the correlation of certain cogni tive deficit patterns with important magnetic resonance imaging (MRI) variables such as total lesion area, size of the corpus callosum and s pecific lesion location is outlined in detail. Third, some recommendat ions are made with regard to general rehabilitation principles such as restitution, compensation and adaptation as well as for special rehab ilitation techniques including cognitive retraining of basic deficits and/or training of activities of daily living. Finally, we emphasize t hat there is a need for the development of tailor-made neuropsychologi cal rehabilitation techniques for MS patients, which take into account the course and stage of the disease as well as the specific psychosoc ial problems of the individual patient.