Cognitive Health & Functioning with MS

Overview of Cognitive Health and MS

The term “cognition” refers to all of the high-level processes carried out by the human brain. Like a computer, the human brain takes in information, stores it, processes it and generates output based on it.Multiple sclerosis can cause problems with one or more of these cognitive functions. In fact, over half of people with MS will experience some changes in cognitive functions. These changes are most commonly related to speed of information processing, memory and attention. According to one study, the most common cognitive complaint among people with MS is difficulty finding words.If you notice any changes in your cognitive health, report them to your healthcare provider so that you can get a thorough assessment and management plan. Make room in your life for mentally stimulating and challenging activities. Like exercise for the body, mental stimulation helps the mind stay active, alert and engaged even in the face of aging or changes caused by MS.

Ask an MS Expert: Cognitive Rehabilitation in MS

The Role of Cognitive Reserve in MS

The concept of cognitive reserve helps to explain why individuals with the same degree of brain changes due to aging or a neurological disease like MS may function very differently cognitively.Research has shown that a lifetime of intellectual enrichment from education, stimulating work and leisure activities helps to lessen or slow the impact of changes related to disease or aging in the brain. In other words, people with cognitive reserve have more protection from cognitive decline. Cognitive reserve is like savings in the bank.

Maintaining Cognitive Health in MS

Many factors can contribute to cognitive issues, such as low blood sugar, certain medications, depression, emotional stress and fatigue. If you or your loved ones are concerned about the changes in memory or thinking you’re experiencing, share your experiences with others and learn techniques to help you cope. To improve your cognitive function:

Eat more healthfully
Exercise your brain
Ask your healthcare provider about medications that might be affecting your cognitive function
Go to therapy
Learn stress-management techniques
Examine your sleep patterns
Increase your physical activity

Nutrition and Cognitive Decline With MS

What you eat may affect your health in several ways. For example, a healthy body weight is associated with decreased risk for disease activity and related disability, such as relapses and lesions. And dietary metabolites such as vitamins, fatty acids and amino acids that form proteins have direct effects on the immune system and the brain.Scientists have yet to establish that any particular diet helps change the course of MS. However, a Society-funded study by researchers at Mount Sinai in New York City and others showed the benefits of eating more healthy foods, specifically the Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet, which is designed to focus on brain health. Scientists found that people within 5 years of an MS diagnosis who ate foods recommended by the MIND diet had higher tissue integrity in brain areas that are key to message relaying.The MIND diet calls for more leafy vegetables, berries, nuts and fish, and less fried foods, butter, cheese, red and processed meats and sweets. Research has suggested it may help prevent Alzheimer’s disease and help older individuals retain cognitive function. Further study is needed to find out if healthy diets also are beneficial later in the course of MS.

Maintaining Cognitive Health in MS

Eat more healthfully
Exercise your brain
Ask your healthcare provider about medications that might be affecting your cognitive function
Go to therapy
Learn stress-management techniques
Examine your sleep patterns
Increase your physical activity

Nutrition and Cognitive Decline With MS

Prevent Memory Loss and Cognitive Dysfunction

Cognitive training or constantly exercising your brain can lessen or slow the impact of changes in the brain. Continue to learn new things and to engage in stimulating work and leisure activities. This mental work will build a cognitive reserve that will help protect you from decline.To engage your mind, spark creativity and stimulate thinking to support cognitive health, try:

Reading
Creative writing
Drawing
Doing crossword puzzles
Learning to speak a new language or to play an instrument

If you have trouble finding words, try:

Cuing yourself or describing the word: “It’s a type of …”
Visualizing it or trying to imagine a picture of what you are thinking of
Choosing the next best word to express what you are thinking of
Asking for help

If you manage to retrieve the word, repeat it to reinforce it.

Medication for Cognitive Changes

Although many medications have been evaluated, large-scale clinical trials have failed to prove that any particular one is effective. Studies have shown that some central nervous system stimulants help attention, information processing speed and memory problems. Disease-modifying therapies that reduce disease activity (number of relapses, lesion activity as shown on MRI and degree of tissue loss or atrophy) may slow cognitive changes.

Therapy for Cognitive Changes

Cognitive Remediation Therapy (CRT), also known as cognitive enhancement therapy or cognitive rehabilitation, is a treatment method designed to improve attention, memory and executive functions. Tools provided by this approach include restorative and compensatory activities.Restorative activities can include learning and memory exercises or strategies, such as:

Combining modes of learning. You will be more likely to remember something if you “see it, say it, hear it, write it, do it.” It’s okay to give yourself extra time.
Repeating and verifying. Say what you hear and make sure it is correct to improve your attention and memory.
Practicing at intervals. Spacing out your rehearsals over time will improve your ability to store information.
Building associations. Use memory aids. For example, to remember the name of someone you just met, associate it with a friend or family member of the same name, or with a place, color or event that sounds like it.

Compensatory activities that help make up for functions that are no longer working well include:

Consolidating and centralizing. Designate one place in your home as information “Grand Central.” Include your master calendar, mail, bills, phone messages, keys, wallet and to-do and shopping lists.
Planning. Post a calendar large enough to display everyone’s appointments, activities, social engagements and reminders. Keep pens or markers right beside it. Or use a computer program set up with reminders for routine tasks. Synchronize it with your mobile devices so you have your appointments with you while on the go.
Recording. Dictate your to-do list, notes or other reminders on a digital voice recorder (available on many phones).
Reminding. Use checklists, the alarm on your watch or phone, your kitchen timer and more.
Eliminating or removing yourself from distractions. Turn off the TV, music and whatever else is “on” when speaking with someone in person or on the phone. Background visual and noise distractions can hinder learning or remembering. If you can’t eliminate the distraction (for example, people talking at a party) then ask, “Can we talk in a quieter place?”
Taking a break. If you are having difficulty concentrating, take a breath and refresh.
Doing one thing at a time. Avoid switching back and forth from one topic or task to another. Finish what you’re working on or find an appropriate stopping place before switching to something else.

Reduce Stress to Improve Cognition

Reducing stress is essential for your emotional balance, as well as your mental and physical health. Just as cognitive impairment can stress you out, stress can affect your cognitive skills. Plus, life with MS can be stressful, and many people with the disease say that in times of stress, they experience more or worse symptoms.Stress management techniques can help you:

Reduce the number or severity of stressful life events by identifying possible sources and avoiding them, or making changes in your life to eliminate them
Learn to reexamine stressful situations that cannot be avoided in order to interpret them in a less distressing way and avoid catastrophic thinking
Control triggers through relaxation, yoga, meditation and other techniques

For techniques, see “26 Stress-Reducing Strategies You Can Practice Today.”

Sleep and Cognition

Sleep problems may be a factor in the development of cognitive issues. If you have trouble sleeping, which is common with MS, it can affect your memory and information processing speed. The good news is that sleep disorders can be addressed. Among possible treatments:

Cognitive Behavioral Therapy for depression, anxiety and insomnia
Symptom-management medications to control urinary and bowel issues, restless legs and other sleep disturbances
Medical equipment, such as continuous positive airway pressure (CPAP) for sleep apnea and bright-light therapy for persons with disrupted sleep-wake cycles
Sedative medications for short-term treatment of insomnia

Discuss your sleeping difficulties with your healthcare provider, who may ask you to participate in a sleep study.

Physical Activity for Better Brain Function

Weakness, fatigue and thinking challenges are all possible symptoms of MS —and are all related.In addition to building muscle strength and improving cardiovascular function, regular aerobic exercise and weight training can help reduce fatigue and improve strength. They can also rebuild critical connections and generate nerve growth in the brain and nervous system.With MS, you may be tempted to avoid physical activity. Fatigue may keep you from getting to the gym or disability may lead you to think you cannot work out. But with modifications, people at all levels of ability can enjoy the benefits of exercise.Experts recommend that you:

Find an activity you enjoy and fits your agenda
Schedule exercise at times when your energy level is high
Tell instructors about your MS
Watch your symptoms and needs
Manage your body temperature
Monitor your pulse to find the right target range
Pace yourself to avoid overdoing it
Adapt routines to balance issues, strength and differences between one side of the body and the other

Recommended Resources

A Closer Look at Cognition: Momentum article
Multiple Sclerosis Journal: Recommendations for Cognitive Screening and Management in MS Care
To find a clinical neuropsychologist, visit the American Academy of Clinical Neuropsychology or our Find Doctors and Resources Tool. For additional support, contact an MS Navigator.
In-person and virtual self-help groups: Opportunities in your community to share, learn, interact with others

Reading
Creative writing
Drawing
Doing crossword puzzles
Learning to speak a new language or to play an instrument

If you have trouble finding words, try:

Cuing yourself or describing the word: “It’s a type of …”
Visualizing it or trying to imagine a picture of what you are thinking of
Choosing the next best word to express what you are thinking of
Asking for help

If you manage to retrieve the word, repeat it to reinforce it.

Medication for Cognitive Changes

Therapy for Cognitive Changes

Combining modes of learning. You will be more likely to remember something if you “see it, say it, hear it, write it, do it.” It’s okay to give yourself extra time.
Repeating and verifying. Say what you hear and make sure it is correct to improve your attention and memory.
Practicing at intervals. Spacing out your rehearsals over time will improve your ability to store information.
Building associations. Use memory aids. For example, to remember the name of someone you just met, associate it with a friend or family member of the same name, or with a place, color or event that sounds like it.

Compensatory activities that help make up for functions that are no longer working well include:

Consolidating and centralizing. Designate one place in your home as information “Grand Central.” Include your master calendar, mail, bills, phone messages, keys, wallet and to-do and shopping lists.
Planning. Post a calendar large enough to display everyone’s appointments, activities, social engagements and reminders. Keep pens or markers right beside it. Or use a computer program set up with reminders for routine tasks. Synchronize it with your mobile devices so you have your appointments with you while on the go.
Recording. Dictate your to-do list, notes or other reminders on a digital voice recorder (available on many phones).
Reminding. Use checklists, the alarm on your watch or phone, your kitchen timer and more.
Eliminating or removing yourself from distractions. Turn off the TV, music and whatever else is “on” when speaking with someone in person or on the phone. Background visual and noise distractions can hinder learning or remembering. If you can’t eliminate the distraction (for example, people talking at a party) then ask, “Can we talk in a quieter place?”
Taking a break. If you are having difficulty concentrating, take a breath and refresh.
Doing one thing at a time. Avoid switching back and forth from one topic or task to another. Finish what you’re working on or find an appropriate stopping place before switching to something else.

Reduce Stress to Improve Cognition

Reduce the number or severity of stressful life events by identifying possible sources and avoiding them, or making changes in your life to eliminate them
Learn to reexamine stressful situations that cannot be avoided in order to interpret them in a less distressing way and avoid catastrophic thinking
Control triggers through relaxation, yoga, meditation and other techniques

For techniques, see “26 Stress-Reducing Strategies You Can Practice Today.”

Sleep and Cognition

Cognitive Behavioral Therapy for depression, anxiety and insomnia
Symptom-management medications to control urinary and bowel issues, restless legs and other sleep disturbances
Medical equipment, such as continuous positive airway pressure (CPAP) for sleep apnea and bright-light therapy for persons with disrupted sleep-wake cycles
Sedative medications for short-term treatment of insomnia

Discuss your sleeping difficulties with your healthcare provider, who may ask you to participate in a sleep study.

Physical Activity for Better Brain Function

Find an activity you enjoy and fits your agenda
Schedule exercise at times when your energy level is high
Tell instructors about your MS
Watch your symptoms and needs
Manage your body temperature
Monitor your pulse to find the right target range
Pace yourself to avoid overdoing it
Adapt routines to balance issues, strength and differences between one side of the body and the other

Recommended Resources

A Closer Look at Cognition: Momentum article
Multiple Sclerosis Journal: Recommendations for Cognitive Screening and Management in MS Care
To find a clinical neuropsychologist, visit the American Academy of Clinical Neuropsychology or our Find Doctors and Resources Tool. For additional support, contact an MS Navigator.
In-person and virtual self-help groups: Opportunities in your community to share, learn, interact with others

Cognitive Health in Multiple Sclerosis

Overview of Cognitive Health and MS

The Role of Cognitive Reserve in MS

Prevent Memory Loss and Cognitive Dysfunction