Multiple sclerosis (MS) is a progressive disease. One of the lesser known symptoms of MS is cognitive decline. Cognitive decline includes challenges with attention span, processing of information, memory, verbal fluency or decision making.¹ This decline may be slowed down by taking action and the sooner action is taken, the better.

1. Discuss Early Comprehensive Intervention with Your Neurologist
Many studies indicate the importance of early intervention. This can include changes to your diet and exercise as well as doing puzzles or brain games to keep your mind active. It can also mean getting on treatment as soon as possible as it may help reduce brain lesions on MRI. Disease modifying therapies (DMTs) are not proven to impact or treat cognition. There is currently ongoing research to better understand the potential impact of DMTs on cognitive function.

Action to Consider: Ask your neurologist which treatment and activities may be appropriate for you to create a comprehensive intervention plan. Based on your test results (e.g., MRIs), overall health and health insurance plan, you and your doctor should come up with a plan of action together.

Common Mistake: Don't wait until you experience memory loss or other effects of MS to start a conversation with your health care team about taking action. With MS, your brain can start shrinking (losing brain volume) before you experience symptoms. Your actions today could impact your brain health in 10, 20, even 30 years.

2. Add Physical Exercise to Your Routine
Exercise may help to preserve brain health.² In fact, research has shown that exercise has been associated with reduced relapse rate, lower lesion volume and slower disease progression, all of which may help slow cognitive decline.

Action to Consider: Work with your doctor or a physical therapist to develop an exercise plan that's right for you based on your overall health, level of mobility, and other factors. Try being as active as you can, as regularly as you can. Walking, yoga, stationary biking and swimming are all good options.

Common Mistake: Don't assume that if you can't exercise as rigorously as you once did, you should stop altogether. You don't have to run a marathon. Any physical activity you can do is good. If you can't walk, you could try using your arms. If you can't exercise every day, consider exercising every other day. Exercise is one of the best gifts you can give yourself.

3. Exercise Your Brain and Keep It Active
Anything that helps keep your brain engaged is important and can help protect against cognitive problems in MS when pursued over a lifetime. This could include reading, online games, crossword puzzles, Sudoku puzzles, art, playing an instrument and other creative activities.

Brain games may be another way to exercise your brain. One such game, BrainHQ, has been shown to help people with MS improve their information processing speed.³

Action to Consider: Find one or more activities that work for you and make them a part of your daily routine. Consider using a brain game like BrainHQ. Neither Biogen nor MyMSTeam has a partnership with BrainHQ.

Additional ways to exercise your brain can be found here: Ways to Exercise Your Brain on AboveMS.com, which is sponsored by Biogen.

Common Mistake: Don't assume that you should only start exercising your brain when you start to notice signs of cognitive impairment. With MS, your brain can start shrinking (losing brain volume) before you experience symptoms.

4. Work with Your Healthcare Specialist to Take Steps Towards Healthy Living
Maintaining a healthy diet is important for anyone seeking to live a healthy life, but it may be particularly important for people living with MS. Obesity has been shown to be associated with reduced brain size and cognitive functioning.⁵ Other health issues like diabetes or hypertension may also be associated with disease progression, which can impact brain health.⁶ The effects of smoking on the response to a DMT are not known at this time, but smoking may be associated with brain tissue damage and increased disease progression and can potentially interfere with effectiveness of certain DMTs.⁴ Alcohol consumption may also worsen cognitive challenges and interfere with some treatments.⁴ The sum total impact of an unhealthy lifestyle is decreased brain health and cognitive functioning.

Action to Consider: Stop smoking and reduce alcohol consumption. Eat regular meals and follow a diet that focuses on vegetables, fruits, lean proteins and whole grains. Make sure you get enough vitamin D in your diet. Talk to your doctor or a registered dietician about how to improve your diet and whether there are certain foods you should avoid. The website ChooseMyPlate.gov provides good information about nutritious foods.

You can find some easy, healthy recipes at AboveMS, as well as more information on healthy eating in general from the National MS Society.

Common Mistake: Don't assume it's too late to start making changes or that diet and living a healthy lifestyle have nothing to do with brain health.

References:

1. Courtney SW. Cover Story: Cognitive Issues with Multiple Sclerosis: Research, Strategies and Support. Multiple Sclerosis Association of America. https://mymsaa.org/publications/motivator/winter-spring15/cover-story/. Published Spring 2015. Accessed March 2018.
2. Motl RW, Pilutti LA. Is physical exercise a multiple sclerosis disease modifying treatment? Expert Rev Neurother. 2016;16(8):951-960. https://www.tandfonline.com/doi/full/10.1080/14737175.2016.1193008. Accessed March 2018.
3. BrainHQ: Processing Speed Published Research on BrainHQ and Processing Speed. https://www.brainhq.com/world-class-science/published-research/processing-speed. Accessed March 2018.
4. Brain Health: A Guide for People With MS. MS Brain Health. http://www.msbrainhealth.org/resources/for-people-with-ms/article/brain-health-a-guide-for-people-with-ms. Published August 15, 2016. Accessed March 2018.
5. Fotuhi M, Lubinski B. The Effects of Obesity on Brain Structure and Size: An examination of both the pathophysiology of the link between obesity and brain injury, and available strategies that may reverse it. Pract Neurol. 2013;9(4)20-29;34. http://practicalneurology.com/2013/08/the-effects-of-obesity-on-brain-structure-and-size/. Accessed March 2018.
6. Dagan, A, Gringouz, I; Kliers, I and Segal, G Disability Progression in Multiple Sclerosis is Affected by the Emergence of Comorbid Arterial Hypertension; Journal of Clinical Neurology, 2016: 12(3):345-350. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4960220/pdf/jcn-12-345.pdf. Accessed May 2018.