Health & Wellness

If you are experiencing cognitive challenges due to MS, there is good news: research shows that proper exercise (both cognitive and physical aerobic exercise) can help improve some of the changes that you may be experiencing.
 
What is Cognitive Exercise?
 
You can think about a “cognitive workout” similar to a physical workout at the gym. When working out, it is essential to challenge yourself in order to see benefits. For example, if you go to the gym and consistently lift a one pound weight, you may not see your strength improve. However, if you lift weights that are challenging to you, and slowly you increase the challenge, you should notice improved strength.
 
Furthermore, it is important to workout consistently to maintain or increase the improvements you make. If you go to the gym consistently for months or even years and then completely stop attending, the physical improvements you gained will slowly decline over time.
 
Similar to the gym analogy, therefore, it is recommended that you consistently work out your cognitive skills with proper, challenging exercises. There are many different ways you can engage in cognitive exercises. There are many types of “brain game” exercises that are available online, in bookstores, or applications on your phone, to help work on cognitive exercises. Ask your doctor for a referral to an occupational therapist or neuropsychologist for an assessment of your specific cognitive impairments and recommendations for appropriate cognitive rehabilitation exercises that can improve those changes you may be experiencing. There are also sometimes medications available to help with these changes.

In the meantime, employing cognitive strategies and techniques can prevent or minimize how the cognitive changes you may be experiencing affect your everyday activities. Here is a list of practical steps and coping suggestions to help with some of the changes.
 
Practical Steps
 
There are many ways to compensate for some cognitive challenges including the following tips:
 

• For important events, use organized reminders such as smartphone applications, a calendar, Post-it notes, checklists, alarm clocks/timers, etc.
• Try to leave commonly used items in the same location (i.e. keys in a bowl or on a hook by the door).
• Engage in one task at a time to avoid unnecessary distractions (i.e. turning off the ringer on your phone when trying to pay your bills or refrain from leaving the kitchen while cooking something on the stove).
• Tackle the more difficult tasks in the morning or at a time of day when you are not feeling fatigued.
• Repeat things to yourself out loud to help you remember them.
• Create associations between something you are trying to remember and something familiar to you (i.e. associating George, your new neighbor, with the first U.S. president).
• Staying organized (though difficult at times) can help minimize confusion and allow you to easily locate objects you may need.
• Having a routine (such as always paying bills the same day each month or attempting to schedule appointments on a particular day of the week) can help to reduce tasks you have to remember. 
• Try to complete difficult or cognitively demanding tasks in a quiet environment.
• Concentrate on the task at hand. This may sound obvious, but oftentimes, our minds are constantly thinking about many other things aside from the current task. Attempt to refocus yourself so your undivided attention is on the task you are attempting to complete.
• Take your time when engaging in a task.
• Get a good night’s sleep. Poor sleep or fatigue can worsen cognitive changes.
• Rest when fatigued or incorporate rest breaks throughout the day to avoid reaching the point of exhaustion.
• Remain socially and intellectually active.
• Eat well-balanced meals throughout the day.
• Manage stress as well as possible.

Coping Strategies
 

• Don’t be hard on yourself: These cognitive changes that you may be experiencing are not your fault. Take the necessary steps to improve your abilities as much as possible and be proud of the progress you make!
• Speak to others who understand what you are experiencing. There are many educational and support programs (in-person, call-in, and online) offered in various regions. There are also many clinicians specializing in MS, who may have a better understanding of what you are experiencing.
• Explain to those around you how they can help: Oftentimes, loved ones want to help, but do not know exactly how and may not understand how your cognitive changes are affecting you. Unwanted or inappropriate help, however, can be frustrating for the individual experiencing the challenge. Explaining to someone how she or he could be of assistance could benefit both of you. For example, a mother calling to remind her daughter with cognitive challenges to take her medication, three times a day, when the daughter rarely forgets to take her medication, can be perceived as an annoyance instead of being helpful. However, the daughter may significantly benefit from her mother helping her with a specific task or errand.

 
Cognitive changes can be extremely frustrating. Taking some of these practical steps or implementing some of these coping strategies may help minimize the way cognitive changes interfere with your life. Stay strong and positive in this battle because your endurance should yield positive results!
 
Dr. J. Tamar Kalina has been working in the field of multiple sclerosis for more than 12 years. She specializes is developing and implementing research and rehabilitation programs. Her research focuses on improving the functional independence and quality of life for people with MS. Dr. Kalina has personally designed more than 18 specialized rehabilitation programs and has experience running more than 100 MS clinical research trials. Dr. Kalina is an assistant professor at the NYU Langone Medical Center and adjunct faculty at Columbia University and NYU Steinhardt.