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.

Keywords: cognitive deficit; cognitive disorder; cognitive impairment; digital twin; dual-task; metaverse; multiple sclerosis; telerehabilitation.

FIGURE 1

The three digital ingredients. Digital twin, tele-cognitive-rehabilitation, and metaverse are digital ingredients that can improve per se cognitive rehabilitation outcomes in MS. In the beginning, data from tele-cognitive-assessment with dedicated apps implementing validated cognitive tests would allow the cognitive phenotyping of PwMS at group-level; over time, based on an increasing amount of data the AI algorithms would provide a rough cognitive virtual patient’s copy. Asynchronous and, especially, synchronous remote interventions can be delivered through tele-cognitive-rehabilitation; the availability of digital tools for remote communication allowed overcoming barriers that limit the CR access to many PwMS and, consequently, starting the treatments as soon as possible and continuing them during the different disease phases. Metaverse makes available virtual scenarios in which PwMS can actually train in ecological environments a plethora of dual- and multi-tasks and everyday life activities. This figure has been designed using modified free images from Flaticon.com.

FIGURE 2

Integration and development of the three digital ingredients. The three digital ingredients represent different sources of data that can be integrated. Over time, the increasing exchange of the data between the different data sources (gray arrows) will feed the AI algorithms that, in turn, will enhance the cognitive phenotyping and provide increasingly defined digital twins. At the same time, the rehabilitative protocols delivered through the tele-cognitive-rehabilitation platform will be increasingly tailored, eventually in a (semi-)automatic way, with a corresponding improvement of the treatment effects (e.g., firstly IPS improved and, then, also other cognitive domains). In the metaverse, the complexity of the tasks increases toward training cognitive functions in more ecological environments and improve the performances transfer into everyday life activities. This figure has been designed using modified free images from Flaticon.com.