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Cognitive Rehabilitation for Multiple Sclerosis: How Can It Help?

Posted on December 27, 2021
Medically reviewed by
Evelyn O. Berman, M.D.
Article written by
Brooke Dulka, Ph.D.

  • Approximately 40 percent to 65 percent of individuals with multiple sclerosis (MS) live with symptoms of cognitive impairment.
  • Evidence supports that cognitive rehabilitation training can be used to improve cognitive deficits, but more research is needed.
  • There are activities you can do at home to help your own cognitive abilities.

Multiple sclerosis is a disease of the nervous system that can cause progressive disability and sometimes cognition changes. A process called demyelination strips the fatty, insulating sheath off of brain cells. This fatty sheath, called myelin, helps speed up cell-to-cell communication processes.

Demyelination results in symptoms such as muscle weakness, fatigue, pain, and walking difficulties. In addition to these physical symptoms, many people with MS (between 40 percent and 65 percent) also experience cognitive symptoms.

Cognitive symptoms — sometimes referred to as cog fog or brain fog — may include difficulty remembering things, paying attention, or making decisions. These symptoms affect not only cognition, but all areas of a person’s daily life.

For instance, research shows people with MS who have cognitive impairments (compared to those who had only physical impairments) were less likely to be employed, participated in fewer social and vocational activities, had greater difficulties in carrying out routine tasks, and were more vulnerable to psychological difficulties.

Learn about signs of cognitive symptoms in MS to watch.

Cognitive Rehabilitation for Multiple Sclerosis

One promising therapeutic strategy for those with MS who are experiencing cognitive impairment is cognitive rehabilitation therapy — essentially training that helps keep cognitive abilities sharp. Cognitive rehabilitation is important for people with MS because they often face difficulties with attention, information processing abilities, new learning, and memory functioning. Training that improves cognitive function can significantly impact the life of a person with MS.

Cognitive rehabilitation therapy may be performed by an occupational therapist, physical therapist, speech specialist, neuropsychologist, or a physician, depending on the needs of the individual.

This training encompasses two types of rehabilitation: restorative and compensatory. Restorative cognitive rehabilitation works to restore cognitive faculties that have been lost. Compensatory cognitive rehabilitation can teach people strategies to compensate for cognitive impairment. Usually, therapists will employ both strategies to help people with MS.

Examples of restorative cognitive rehabilitation include having a person perform increasingly difficult memory tests to improve their memory. They may also undergo training to improve their attention span. These tasks are meant to increase the function of the brain through processes known as plasticity. Here, “plasticity” refers to the ability of the brain to recover from damage, which may occur by shifting certain functions to undamaged areas.

Examples of compensatory cognitive rehabilitation include using calendars to help keep track of tasks and events or using alarms to get a person’s attention in certain situations.

Cognitive rehabilitation therapy typically involves one or more sessions per week over several weeks or months. Each session lasts about an hour and includes a variety of activities, depending on the needs of the individual and the areas of cognitive function they struggle with most. Some people may have more problems with spatial memory. Others may have more difficulty with other aspects of cognition such as attention.

Have you tried cognitive rehabilitation therapy before?
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Benefits: What Does the Research Say?

Although cognitive rehabilitation for MS has been gaining a lot of traction, it has been a complex topic to study. It is difficult to make direct comparisons between studies, due to differences in how they have been conducted.

However, more recent reviews have made progress in describing the science behind cognitive rehabilitation therapy in the limited studies that are available. Overall, cognitive rehabilitation therapy seems to largely be an effective strategy.

Attention

In one study, 22 individuals with MS experienced significant improvements to their cognition using specific computer-based training strategies for attention impairment. Improvements in both alertness and divided attention were noted for people who received training specific to attention during experimental testing.

These participants also reported improvements in cognitive functioning in everyday life and quality of life. However, not all research supports that cognitive rehabilitation therapy can impact attention.

Executive Functioning

Executive functioning refers to higher thinking, planning, and decision-making. One research study examined 10 people who participated in cognitive rehabilitation for 24 one-hour weekly sessions over six months. The cognitive rehabilitation therapy in this study involved computer-based strategy games and pen-and-paper exercises.

Study participants with relapsing-remitting MS showed a 36 percent improvement on a strategy test. Individuals with secondary progressive MS realized a 16 percent improvement. Other research has observed no effect of cognitive training on executive functioning.

Learning and Memory

Memory processes including learning can be affected by MS. It is also the area of cognitive impairment that has received the most attention.

For instance, in a study of 29 individuals with MS, participants who had moderate to severe learning impairments showed a significant improvement in learning abilities after the cognitive rehabilitation intervention. This intervention consisted of a story memory technique, which focused on using memory recall and imagery, over eight total sessions (twice a week for four weeks).

Long-term follow-up on memory was also significantly better in those individuals who underwent cognitive rehabilitation. However, other similar research has observed no such effect.

Overall, across all domains of cognitive functioning, more research is needed to understand the relationship between cognitive rehabilitation and MS.

Learn more about how cognition in MS is measured.

Tips for Cognitive Improvement

Cognitive rehabilitation does help some people with MS. Here are a few tips and tricks for improving cognitive skills:

  • Use mental pictures to aid memory.
  • Write down people’s names when you meet them.
  • When learning something new, give yourself extra time to practice.
  • Set up a family calendar to track activities.
  • Plan your most challenging cognitive tasks for the time of day you function best.
  • Make sure you are getting adequate sleep.
  • Exercise.

Consider seeking professional help. A neuropsychologist or therapist can perform an evaluation to help you find out which areas of cognitive functioning you need the most help with and tailor your therapy accordingly.

Building a Community

MyMSTeam is the social network for people with multiple sclerosis and their loved ones. On MyMSTeam, more than 178,000 members come together to ask questions, give advice, and share their stories with others who understand life with multiple sclerosis.

Are you living with multiple sclerosis? Share your experience in the comments below, or start a conversation by posting on your Activities page.

Evelyn O. Berman, M.D. is a neurology and pediatric specialist and treats disorders of the brain in children. Review provided by VeriMed Healthcare Network. Learn more about her here.
Brooke Dulka, Ph.D. is a freelance science writer and editor. She received her doctoral training in biological psychology at the University of Tennessee. Learn more about her here.

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