Neuropsychological rehabilitation in adult multiple sclerosis F. Mattioli • C. Stampatori • F. Bellomi • R. Capra • M. Rocca • M. Filippi Published online: 17 July 2010 Ó Springer-Verlag 2010 Abstract Neuropsychological impairment affects 40–65% of multiple sclerosis patients, mainly involving speed in information processing, attention, executive functions and memory. Deterioration occurs over time independently from disability and seems to correlate particularly with magnetic resonance imaging (MRI) atrophy measures. Studies on therapies effective in controlling cognitive impairment are scanty. We found that intensive and specific training of attention, information processing and executive functions is significantly effective in ameliorating both neuropsycho- logical treated functions and in reducing depression. Pre- liminary functional MRI data suggest that possible neural correlates of this neuropsychological training could be an exercise-induced activation of prefrontal and cingulate cortices. Keywords Neuropsychological rehabilitation Á Multiple sclerosis Introduction Cognitive impairment is reported in 40–65% of multiple sclerosis (MS) patients [1] and has profound implications on their social integration and employability [2]. It is related to both demyelinization process and axonal loss [3], but MRI detectable gray matter atrophy measures mainly correlate with clinical deficits’ progression [4, 5] also in the benign cases [6]. Speed in information processing, executive functions, attention and memory are the cognitive areas mainly affected in patients and their deficits are detectable early in the disease course and worsen over time [7]. Multiple cognitive function impairments often coexist, enhancing the global impairment severity and sometimes leading to overt dementia. Different disease-modifying drugs have been suggested to partially improve cognitive deterioration in MS [8], although most of them have been reported to be effective on one or two single neuropsychological tests only. Fur- thermore, the majority of the studies were non-placebo controlled and a possible learning effect could not be ruled out. Cognitive–behavioral interventions in MS A review of cognitive rehabilitation studies investigating the effectiveness of neurobehavioral rehabilitative proce- dures on neuropsychological and psychological outcomes reported that cognitive–behavioral approaches are benefi- cial, although the diversity of psychological intervention and the multiple outcome measures prevented definite conclusions from being drawn [9]. In particular, 16 ran- domized studies were reviewed, with a total of 1,006 cases, F. Mattioli (&) Á C. Stampatori Á F. Bellomi Neuropsychology Unit, Spedali Civili of Brescia, Via Nikolajewka, 13, 25123 Brescia, Italy e-mail: flaviacaterina.mattioli@gmail.com R. Capra Multiple Sclerosis Center, Spedali Civili of Brescia, Brescia, Italy M. Rocca Á M. Filippi Neuroimaging Research Unit, San Raffaele Hospital, Milan, Italy 123 Neurol Sci (2010) 31 (Suppl 2):S271–S274 DOI 10.1007/s10072-010-0373-7