How to Manage Thinking and Memory Problems in MS
Cognitive deficits — problems with processing information, learning, and remembering — are common in MS, but some practical solutions can help.
“The hardest thing is that Ellen often can’t remember what she’s doing,” Richard Friedman, 42, told his wife’s multiple sclerosis (MS) support group in San Francisco recently. “She’ll leave a pot cooking and never think about it until the smoke alarm goes off. She’ll be talking with you and completely forget what she was saying. It’s hard for both of us.”
Ellen, 45, is a former school teacher.
Ellen’s attention loss is called a “cognitive deficit.” Other cognitive (thinking) deficits include difficulty learning new information and remembering it, slowed processing of information, and problems with planning and organization.
According to a paper published in the October 2018 issue of the Multiple Sclerosis Journal and endorsed by the National Medical Advisory Board of the National Multiple Sclerosis Society (NMSS) as well as the International Multiple Sclerosis Cognition Society, cognitive deficits affect up to 65 percent of people with MS.
As with other symptoms of MS, cognitive deficits can range from very mild to severe. Early and ongoing screening for cognitive changes can help identify problems and the strategies to manage them at home and at work.
Just like physical symptoms of MS, cognitive symptoms result from damage to the myelin covering of nerve fibers in the brain and the nerve fibers themselves. Since the areas of damage are different in different people, the effects on cognition vary from person to person.
Depending on the cognitive symptoms you’re experiencing and their severity, the following suggestions may help you manage your symptoms, minimize their impact on your life, and prevent new symptoms.
To Stay Focused, Avoid Multitasking
Nicholas LaRocca, PhD, a psychologist and a consultant for the NMSS, says, “In MS, divided attention tasks, or paying attention to more than one thing at a time, are frequently affected.”
To improve your ability to focus on any one task, don’t multitask!
Ellen has learned to apply this rule to avoid burning things. “I stay in the kitchen until everything is finished and turned off,” she says. “Or if I can’t do that, I set a timer to remind me to check in, even if I’m just boiling water.”
When Ellen drives, she says, “I leave the radio off and don’t talk to people. If there are passengers, I ask them to keep quiet. I set my GPS for every trip to remind me where I’m going. I have to keep things simple, but it works.”
Conversations usually go better if the participants are focused on what’s being said. Rosalind Kalb, PhD, a psychologist and a consultant for the NMSS in New York City, recommends “taking conversations into a quiet place, keeping eye contact with people you are talking to, turning off the television, and removing other distracting stimuli.”
Even when you’re not trying to do two or more things at once, noises or activities around you can distract you from your task, and distraction is an attention-killer.
When you need to concentrate on something, consider wearing earplugs to cut out background noise. If possible, take “mind breaks” in a dark, quiet environment when you need to.
Write It Down to Remember It
Louise Fletcher, 61, a librarian from Vallejo, California, has had progressive MS for 20 years. She says her memory is “not good, but I’m very organized.” She keeps little notebooks for different parts of her life. She has books for each child and grandchild, and for shopping, home repair, cleaning, and her art projects. She consults her notebooks regularly and writes everything she needs to remember in the appropriate book.
Fletcher applies her “write it down” practice to cooking, too. She forgets recipes and forgets what she has already done to a dish, so she’s made many copies of her favorite recipes. As she cooks, she crosses off each step in the instructions until she gets everything done.
Other Tips for Managing Cognitive Symptoms
A number of other self-help measures, as well as a couple to discuss with your healthcare provider, can help with other mental tasks if you’re having trouble, the NMSS recommends:
Organizing Your Environment We’re not all natural organizers like Fletcher. But having a place for everything and being consistent in where you put things will make it easier to find what you want.
Paying Attention to Your Mood Depression, which is one of the most common symptoms of MS, can impact your cognition. The National MS Society recommends early and ongoing screening for depression to identify and address significant mood changes.
Relaxing The less stressed you are, the better your focus will be. Try meditating, praying, practicing yoga, petting an animal, or doing relaxation exercises to lower your stress levels. According to the Mayo Clinic, relaxation techniques can reduce fatigue and improve concentration and mood.
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Getting Enough Sleep Getting adequate sleep protects your store of energy. Fatigue brings on cognitive problems, so save your hard thinking for more rested times. Take frequent breaks from mental tasks.
Training Your Brain Exercising your mind is an important part of staying healthy with MS, and there’s some evidence, per a study published in July 2018 in the journal Disability and Health Journal, that computer-assisted cognitive training programs may help.
But these programs are not the same as commercially available “brain training” games sold online, some of which may help, and some of which likely do not. The creators of Lumosity, for example, agreed in January 2016 to pay $2 million to settle Federal Trade Commission charges alleging they deceived customers with unfounded claims of reducing or delaying cognitive decline.
On the other hand, a study published in June 2015 in the journal Neurorehabilitation and Neural Repair that focused on the Nintendo game Brain Age suggested it might improve cognitive function and cognitive fatigue.
Engaging in a variety of noncomputer mental activities, such as reading, playing Scrabble, or doing arithmetic in your head can also help keep your mind healthy.
Seeking Cognitive Rehabilitation Talk to your doctor about seeing a rehabilitation specialist for an evaluation. Depending on the results, you may be referred for treatment to a neuropsychologist, occupational therapist, or speech language pathologist.
Additional reporting by Brian P. Dunleavy.