title: Cognitive rehabilitation in multiple sclerosis: A systematic review.
abstract: BACKGROUND
  Cognitive impairment is a common clinical feature of multiple sclerosis (MS) at both the earlier and later stages of the disease, and has a significant impact on patients' functional status and quality of life. The need to address this deficit should be taken into account in clinical practice and research studies.
  
  
  OBJECTIVE
  To conduct an updated systematic review of all published studies of cognitive rehabilitation interventions in people with MS, including studies with methodological shortcomings, to highlight major strengths and weaknesses in the field and to provide directions for future research.
  
  
  METHODS
  We searched electronic databases (PubMed and Web of Science) for articles published in English up until January 2014. The reference lists of all identified articles were also searched to complete the initial list of references.
  
  
  METHODS
  Articles were categorized into outcome measures: cognition, imaging, mood, fatigue, quality of life and self-perceived cognitive deficits. All articles were reviewed independently and assessed according to predetermined criteria.
  
  
  RESULTS
  A total of 33 studies met the inclusion criteria of which 4 were of Level II-1 and none was Level I. Although the majority of these studies reported some improvements in cognitive abilities (N=31), the evidence which has been reported in the literature remains inconclusive and no definite conclusions can be drawn about the effect of different types of interventions on cognitive rehabilitation outcomes (recommendation C).
  
  
  CONCLUSIONS
  This review identified conflicting findings in the published literature about the effectiveness of various forms of cognitive rehabilitation techniques used in patients with MS. Studies with more rigorous methodology are therefore needed to clarify which form of cognitive rehabilitation may lead to greater clinical improvement.
authors.affiliation: IRCCS Fondazione Ospedale San Camillo, Venice, Italy. Electronic address: micaela.mitolo@ospedalesancamillo.net.
authors.forename: Micaela
authors.initials: M
authors.lastname: Mitolo
authors.affiliation: IRCCS Fondazione Ospedale San Camillo, Venice, Italy; Department of Neuroscience, University of Sheffield, Sheffield, UK.
authors.forename: Annalena
authors.initials: A
authors.lastname: Venneri
authors.affiliation: Academic Unit of Radiology, University of Sheffield, Sheffield, UK.
authors.forename: Iain D
authors.initials: ID
authors.lastname: Wilkinson
authors.affiliation: Department of Neuroscience, University of Sheffield, Sheffield, UK; Academic Department of Neurology, Sheffield Teaching Hospital NHS Foundation Trust, Sheffield, UK.
authors.forename: Basil
authors.initials: B
authors.lastname: Sharrack
mesh_terms: D003072:Cognition Disorders / Q000453:epidemiology / Q000523:psychology / Q000534:rehabilitation*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D006801:Humans; D009103:Multiple Sclerosis / Q000453:epidemiology / Q000523:psychology / Q000534:rehabilitation*; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D016896:Treatment Outcome
keywords: Attention; Cognitive rehabilitation; Multiple sclerosis; Quality of life; Working memory; fMRI