Treating the Underlying Cause of Cognitive Dysfunction
Many people living with MS face cognitive challenges at some point. These may be temporary, such as during a relapse or illness, or long-term problems. In the first part of this series, we discussed what cognition means, and how MS can affect our short-term memory, attention, multi-tasking, word finding, and “executive functions” including planning, prioritizing, and organizing. We also talked about what testing can be done to identify what areas of cognition you are having difficulty with. This article will focus on what can be done to keep our minds at their best, improve cognition, and different strategies that can lessen the impact of symptoms on our daily lives.
Treating the underlying cause of symptoms
Cognition is complicated, and there are many things that can affect it, including indirect causes such as medication side effects, physical disability, mood (depression and anxiety), illness, overheating, and fatigue. Lesions and atrophy (or shrinkage of brain tissue) caused by MS can also directly cause cognitive symptoms. In all likelihood, cognitive symptoms are caused by several indirect and direct factors, which make it one of the most difficult MS symptoms to treat.
One of the first steps in treating cognitive symptoms is to address the underlying causes. Several of the medications that are used to treat pain, spasticity, depression, and even bladder dysfunction, can cause drowsiness and “cog fog”. Talk to your healthcare provider about your medications, and see if adjusting the dose and timing of medications, such as only giving them at night or lowering the daytime doses, could help.
The relationship between fatigue and cognition
In the first part of this series, we also discussed the relationship between fatigue and cognition. If you are struggling with mobility challenges like spasticity, foot drop, or weakness, you have to exert extra energy even for simple tasks. As a result, you are more likely to become physically and mentally fatigued throughout the day. Sometimes using assistive devices, such as a brace for foot drop (AFO), cane, walker, or wheelchair can save precious energy, and improve fatigue.
Physical and occupations therapy
Working with a physical therapist can also be extremely helpful in identifying what devices would be beneficial, and for improving your physical strength. Occupational therapists can also help you find ways to save energy throughout the day so that you are less fatigued, and able to do more. Since many of us also have sensitivity to heat, staying as cool as possible throughout the day will also reduce your fatigue and cognition. If no other interventions or changes are effective, sometimes stimulant medications (such as Modafinil and Nuvigil) can be used to improve fatigue and attention.
Anxiety affects the ability to think
Mood and our ability to think clearly are very closely related. When you are depressed you are more likely to struggle with memory, attention, and fatigue. Anxiety often makes us more easily frustrated, which makes it difficult to think clearly. For instance, it can be frustrating to walk into a room and forget what you went in there to find. If you then get agitated and frustrated that you can’t remember such a simple thing, it makes it even more difficult to think through the problem, which starts a vicious cycle of forgetfulness and frustration.
Anxiety and frustration
If you can relate to this problem, you might be struggling with anxiety. Researchers have studied this phenomenon in mice trying to get through a maze. Anxious mice will hit a dead end, get flustered, and not be able to find their way to the exit. If you treat the mice with a type of antidepressant called a Selective Serotonin Reuptake Inhibitor (SSRI) they hit a dead end, simply turn around, and find the exit and complete the task without getting flustered.1 Treating anxiety with a daily medication can remove the amount of frustration you feel, and help your cognition in a very similar way.
Getting good sleep
Getting good sleep is also key to preventing and improving cognitive symptoms. Depression and anxiety both have a major impact on our sleep. Difficulty falling or staying asleep (such as waking up at 3AM and not being able to go back to sleep) are both very common symptoms of an underlying issue with depression and/or anxiety. Many other MS symptoms such as pain, spasticity, and bladder dysfunction also affect our sleep. If our legs are cramping, or we are getting up 4-5 times a night to use the bathroom, a good nights sleep becomes impossible.
Medications and drowsiness
Certain medications can also impact sleep by causing excessive drowsiness, or insomnia. When we are sleep deprived, our fatigue, alertness, and mental sharpness all suffer. Your healthcare provider can help you figure out if medications need to be changed to treat your MS symptoms more effectively so you can get better rest, and give you tips on getting better quality sleep. If you struggle with getting good sleep, check out the resources at the end of this series.
Diet, exercise, and cognition
Diet and exercise can also have a huge impact on our cognition. We know that regular exercise boosts cognition, improves several physical symptoms of MS (like weakness, spasticity, and bowel/bladder dysfunction), improves our mood, and helps us get better sleep. In general, it is recommended that people with MS get 30 minutes of strength training and 30 minutes of cardio 3 times a week. If you have difficulty exercising due to your MS symptoms, talk to your healthcare provider, and work with a physical therapist.
Finding something you enjoy
There are a lot of great exercises for people with MS including yoga, pilates, and swimming. Find something that you enjoy doing, and that can be adapted to your symptoms. If you have trouble affording a gym membership or exercise classes check with your local YMCA or your local MS society chapter. They often will help you pay for classes, or offer deeply discounted memberships for people with MS. Eating a heart-healthy diet full of fruit, vegetables, protein, and healthy fats is also key to keeping your body and mind it their best. There are several ongoing studies on whether diet and exercise can prevent or improve cognition, so we should know much more about this in the future.
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- Doe N, Takahashi T, Kiriyama M. Behavioral Despair during a Water Maze Learning Task in Mice. Experimental Animals. 2010;59(2):191-197. doi:10.1538/expanim.59.191.