Sex Differences in Elderly Multiple Sclerosis Patients Undergoing Neurorehabilitation: How Many Things are Taken for Granted? A Retrospective Study

Background: Our aim is to evaluate the intricate dynamics of gender differences in cognitive rehabilitation outcomes among older adults with MS undergoing cognitive rehabilitation using robotics plus virtual reality. Methods: This retrospective study included 80 RRMS patients aged >60 years, matched for demographic and clinical variables and divided into two groups. The experimental group (EG, n = 40) received Lokomat Free-D training with VR integration, while the control group (CG, n = 40) underwent traditional rehabilitation. Cognitive, functional, and emotional outcomes were assessed before and after treatment. Results: Intergroup analysis revealed significantly greater improvements in the EG compared to the CG in MoCA (P < 0.001 in males, P = 0.001 in females), FIM (P = 0.02 in females), and HRS-A (P = 0.01 in males, P = 0.005 in females). Within-group analyses showed that both males and females in the EG experienced significant improvements across all domains (P < 0.001), but in the CG, improvements were more limited, particularly in mood scores. Notably, a positive correlation between MoCA and gender was found in EG (r = 0.47; P = 0.002), suggesting stronger cognitive gains among women. Conclusion: Our results provide preliminary data on the influence of gender differences on neurological rehabilitation outcomes, which should be evaluated and taken into due consideration to personalize and improve rehabilitation treatment.