Between 40 percent and 65 percent of people with multiple sclerosis (MS) experience cognitive symptoms. Sometimes referred to as brain fog or “cog fog,” cognitive problems 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.
Cognitive rehabilitation is a type of therapy that helps keep cognitive abilities sharp. Some studies have shown that cognitive rehabilitation can improve problems with attention, information processing, new learning, and memory function in people with MS. If you or a loved one is experiencing cognitive deficits from MS, cognitive rehabilitation may be able to help in several ways.
Cognitive rehabilitation therapy may be administered by an occupational therapist, a physical therapist, a speech specialist, a neuropsychologist, or a physician, depending on the needs of the individual.
Cognitive rehabilitation activities can be classified as either restorative or compensatory. Restorative cognitive rehabilitation is designed to restore cognitive abilities 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 symptoms.
Examples of restorative cognitive rehabilitation include having a person perform increasingly difficult memory tests to improve their memory or undergo training to improve their attention span. These tasks are meant to actually 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.
Although cognitive rehabilitation for MS has been gaining a lot of traction, it’s a complex topic to study. Making direct comparisons between studies can be difficult due to differences in how they’ve been conducted.
However, more recent reviews have indicated that cognitive rehabilitation therapy may help with cognitive dysfunction in several ways. While some of the studies discussed here focused on improving specific types of cognitive difficulties, cognitive rehab may also target more than one type of dysfunction at a time.
Two separate small-scale studies (in 2012 and 2014) tested the effectiveness of computer-based attention-training programs for people living with MS. In both studies, the participants who used the program showed improvements in maintaining attention. In the 2012 study, MRI scans showed greater brain activity in the participants who completed the training compared to the control group, who used a sham program.
A third study from 2013, published in Journal of the Neurological Sciences, looked at the potential long-term cognitive benefits of neuropsychological rehabilitation. This type of therapy involves a blend of cognitive rehabilitation, psychotherapy, and psychoeducation — teaching a person about condition-related changes they’re experiencing. After 13 weeks of rehabilitation, participants with moderate to severe difficulties maintaining attention showed significant improvement. A follow-up nine months later showed they’d maintained those improvements.
Though the outcomes of these studies show promise, not all research supports that cognitive rehabilitation therapy can impact attention.
Executive functioning refers to higher thinking, planning, and decision-making. One 2004 research study, published in the Journal of Cognitive Rehabilitation, 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.
In a more recent 2018 study — published in Acta Neurologica Scandinavica — 34 people with relapsing-remitting MS underwent intensive group cognitive rehabilitation over four weeks. In the end, they showed significantly higher scores on executive function tests compared to a control group that hadn’t undergone the therapy. They also showed improvements in memory — but not in attention.
Other research has observed no effect of cognitive training on executive functioning. More studies are needed to confirm this benefit.
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.
Learn more about how cognition in MS is measured.
A small pilot study including 21 people with MS cognitive issues examined whether processing speed training could improve information processing, and results were encouraging. A subsequent study was launched in 2020 to further explore the effects of cognitive rehabilitation — along with aerobic exercise — on processing speed. Its results will shed more light on this potential benefit.
Cognitive rehabilitation for MS is one way to work on cognition problems. Here are a few other tips and tricks for improving cognitive skills:
Consider seeking professional help. A neuropsychologist or therapist can perform an evaluation — a series of cognitive tests — to help you find out which areas of cognitive functioning you need the most help with and tailor your therapy accordingly.
Read more about strategies for managing cognitive problems.
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