Management of cognitive problems

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Once you have received a cognitive evaluation and cognitive impairment has been identified, you and your doctor will discuss treatment options and other management approaches. There are three types of treatments used for cognitive dysfunction in people with MS. These include symptomatic treatments, disease-modifying treatments, and cognitive remediation.

 

What are the drug treatment options for MS-related cognitive problems?

Symptomatic treatment is at present limited to one medication, the drug Aricept (donepezil), which is FDA approved for the treatment of Alzheimer’s disease. Aricept has been found to provide a modest benefit in some patients with MS-related memory problems.

Disease-modifying treatments, including interferon beta drugs (Avonex, Betaseron, Extavia, and Rebif), and Copaxone (glatiramer acetate) , Tysabri (natalizumab), Gilenya (fingolimod), and Aubagio (teriflunomide), are effective both in decreasing the number and severity of exacerbations and reducing the number of CNS lesions (as confirmed by results of magnetic resonance imaging or MRI).

Evidence shows that the higher number of lesions (lesion load) in the brain, the higher the risk a person faces for developing cognitive dysfunction. Therefore, it makes sense to start a disease-modifying treatment, as early as possible after diagnosis of MS, to help lower the risk for developing cognitive problems and to help keep existing problems from progressing.

 

What does cognitive remediation involve?

Cognitive remediation (also called cognitive rehabilitation) is a type of treatment that provides practical, solution-oriented interventions to manage cognitive changes. Cognitive remediation includes two different types of interventions, restorative interventions and compensatory interventions.

Cognitive Remediation

Description
Example
Restorative interventions
  • Physical therapy for the brain
  • Cognitive evaluation used to identify areas of impairment and specific exercises given to strengthen functions
  • Computerized exercises to improve attention and memory
Compensatory interventions
  • Strategies to compensate for deficits (also called workarounds)
  • Remediation specialist can recommend compensatory strategies for all deficits, including memory, reading comprehension, executive function, and attention
  • Substituting organization for memory by using work and family calendars, filing systems, reminders, and lists
  • Alarms and computer reminders

Apart from any formal course of therapy, you can take a number of practical steps on your own to manage cognitive problems on a daily basis. These include strategies for organizing important information, keeping track of schedules and activities, and approaching tasks in an organized manner.

Practical Tips for Dealing with Cognitive Problems in MS

Personal organizer (paper or electronic)
  • Keep your important information, including to-do lists, contacts, reminders of birthdays and other occasions, and appointments, in a single place
  • Electronic resources, such as computers and smart phones, can provide programmed reminders or “ticklers” to help keep you up-to-date on appointments, birthdays, and other time-sensitive information
Family calendar
  • A family calendar that everyone is responsible for keeping up-to-date can be useful for coordinating activities and reminding you of scheduled events and activities
Filing system
  • A well-organized and up-to-date filing system will help you keep track of important documents
System to process bills
  • Develop a system that helps you anticipate and process regular bills
  • An electronic resource, such as a computer or smart phone, can help witih programmed reminders or “ticklers”
Take care of mail on daily basis
  • Being disciplined about sorting and responding to mail immediately, including any bills that come, will help you keep on top of things
Computerized master checklist for repetitive tasks
  • Developing a checklist for common repetitive tasks, such as shopping or packing, will help you approach these tasks in an organized and systematic way
Step-by-step project templates
  • Developing project templates for common repetitive activities will help you keep on-task and make sure that you approach tasks in an organized and systematic way
Distraction-free zone in house
  • Designate a place or “zone” in your house where there is to be no commotion or noise, where you can retreat to collect your thoughts, meditate, or have a quiet conversation
File of driving directions
  • Make sure you have driving directions handy for commonly used destinations, such as your doctor’s office or the bank or different family member and friends
  • Electronic devices, such as GPS navigators and smart phones, can make this easy and paperless
Pen and paper near each phone
  • Keeping pen and paper next to each phone in your house will give you a way of reminding yourself of calls and conversations and important commitments and appointments
Have one place for everyday items
  • Having a single place where you keep everyday items, including keys, glasses, wallets, and cell phones, will help you to avoid misplacing things
Schedule to optimize cognitive energy
  • Schedule your family and work activities for times when you have your best cognitive energy and are most alert