How cognitive rehabilitation can affect motor cognition, fatigue perception and fatigability. Hypothesis of early assessment and intervention.

Background: Cognitive impairment is common in Multiple Sclerosis (MS), occurring in up to 65% of patients. The cognitive domains affected most commonly in MS include information processing speed (often first target of progressive cognitive decline), learning and episodic and working memory. The management of cognitive impairment still relies on rehabilitative strategies, which have been reported to be effective in ameliorating cognitive domains but, even if strongly recommended for MS management and standard care, multidisciplinary treatment, including physiotherapy, occupational therapy, speech and swallow therapy, neuropsychology, built on cognitive rehabilitation principles, has scarce scientific evidence. Aim: to incorporate the cognitive assessment into MS clinics and clinical trials, to utilize state-of-the-art neuroimaging to explicate neural bases of deficits, and to develop effective symptomatic cognitive treatments. Methods and analysis: A total of 16 people with Multiple Sclerosis (MS) has been randomly assigned to ReBrain group and standard care group. They both consist in multidisciplinary rehabilitation protocol with two hours twice a week for 12 weeks sessions including physiotherapy, occupational therapy, neuropsychological therapy and speech and swallow therapy. ReBrain treatments follow principle of cognitive rehabilitation, combining restorative and compensatory strategies, specific exercises of executive attention stimulation and holistic approach. Evaluation scales will be assessed immediately before (baseline visit, T0), after the booster session (T1, 12 weeks after baseline visit), at three months (T2, 24 weeks after baseline visit). Discussion: According to the preliminary data collected, the newly introduced ReBrain protocol allows a reliable management of PwMS showing cognitive impairment. An increased number of participant is needed to obtain more significant results.