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Multiple Sclerosis Centers of Excellence

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Cognitive Rehabilitation

Adam Nelson, PhD, ABPP

Approximately 40-65% of people with MS experience noticeable changes in cognitive functioning related to their MS. For some, these changes are fairly minor, while for others, the cognitive changes significantly disrupt their daily lives. Declining cognitive functioning is among the top concerns for those with MS because this can affect employment, relationships, driving, health management, and other important areas of daily life.

Cognition refers to a wide range of brain functions involved in thinking, including learning and memory, concentration, problem solving, planning and organization, multi-tasking, language skills, and reasoning. Forgetfulness and taking a little longer to process information and respond are some of the most commonly reported cognitive complaints of people with MS. Because MS is unpredictable it is difficult to predict in what areas, if any, a particular individual may have cognitive difficulties. For some, an assessment of cognitive functioning by a trained professional can be a helpful part of a treatment plan, allowing them to better understand their cognitive strengths and weaknesses.

Cognitive rehabilitation refers to clinical interventions to improve cognition and, or, help a person develop strategies to help compensate for cognitive difficulties in daily life. While many of the activities included in cognitive rehabilitation can be practiced without the help of a clinician, some individuals may benefit from cognitive rehabilitation with a professional. Cognitive rehabilitation is often done by speech and occupational therapists, neuropsychologists, and others with appropriate training.

An important part of cognitive rehabilitation is providing information about why a person with MS experiences cognitive changes and the factors that might make cognition better or worse. This can help the person feel more in control of their life and their experience. Some examples of helpful questions that may be addressed in cognitive rehabilitation include:

  • Why do I remember some things well, but not others?
  • How does energy level impact my cognitive functioning?
  • Why does it take me twice as long to complete some tasks?
  • How does depression impact my cognitive functioning?
  • What cognitive changes can I expect in the future?

Cognitive rehabilitation can also be compensatory; that is, they help an individual compensate, or develop tools and strategies, to help cope with a cognitive problem. Examples of compensatory strategies include:

  • Using a notebook to write down important information during the day.
  • Using an appointment calendar for scheduling and setting alarms to prompt.
  • Allowing an extra 15 minutes to get to appointments.
  • Following a structured daily schedule.
  • Using imagery, grouping, or other internal memory strategies.
  • Making "to do" lists for task completion and crossing off when complete.
  • Breaking down large goals into smaller tasks, prioritizing the tasks, and scheduling the tasks into an appointment calendar.
  • Following a structured daily schedule.
  • Using imagery, grouping, or other internal memory strategies.

Other approaches to cognitive rehabilitation are restorative; that is, they aim to restore lost functioning in a particular cognitive skill, and, or, lead to a more general improvement in daily cognitive skills. Restorative cognitive rehabilitation is conducted in a treatment setting with a provider and usually involves a schedule of cognitive exercises administered by the clinician and or a computer.

Research Support

So far, the strongest scientific evidence for the effectiveness of cognitive rehabilitation comes from studies with individuals with traumatic brain injury (TBI) or stroke. To best understand what works and what doesn’t work with people with MS, more research needs to be done with people with MS. Even though research on cognitive rehabilitation in MS is in its infancy and is far from conclusive, there are some promising findings suggesting that physical activities, such as walking, Pilates, and yoga, some of which are already frequently used by people with MS, may also help cognition. Relaxation and mindfulness exercises also show promise for improving attention, in addition to their known benefits for stress reduction.

Brain Training Computer Programs

Many people have heard about computer-based “brain training” software, some of which is available for free, but much of which costs money. While some of these training programs have shown promise for improving certain cognitive skills, it is still unclear whether they lead to lasting and generalized improvement in cognitive abilities. The research in this area is far from conclusive. Individuals who are already mentally and physically active should not necessarily change their routines to engage in computer-based exercises; however, for some individuals who aren’t as active, these activities may be a way to get them engaged in some mental stimulation.

In summary, people with MS who have memory or other cognitive difficulties may benefit from cognitive rehabilitation; however, more research is needed to better understand how and why it works. A cognitive evaluation is often a first step, to assess a person’s strengths and weaknesses, in order to best guide treatment. For some, cognitive rehabilitation activities may be done in the home, while for others, office visits may be more appropriate. If you have further questions about cognition or cognitive rehabilitation, ask your health care provider!