Cognitive Rehabilitation in MS

Cognitive changes are common among individuals with multiple sclerosis (MS), affecting 40-65% of the MS population.  Much like physical MS symptoms, cognitive changes vary widely from person to person. Whereas many individuals with MS experience slowed processing speed as their predominant cognitive difficulty, others may experience problems across a number of cognitive areas, including attention, learning, memory, problem-solving, and word-finding. Given the wide range of cognitive difficulties, treatment for cognitive impairment in MS is not a one-size-fits-all approach. 

What is Cognitive Rehabilitation?

Cognitive rehabilitation is a systematic treatment program designed to help individuals with MS improve functioning in everyday activities, including but not limited to  

• Learning and remembering  
• Communicating more effectively with others  
• Completing tasks more accurately or efficiently 
• Staying organized.  

Cognitive rehabilitation therapy can encourage restoration and improvements in cognitive function while also teaching specific strategies to compensate for cognitive impairment. The balance between restorative and compensatory strategies will vary, making cognitive rehabilitation therapy a highly specialized treatment.  

Such variability has made it difficult for researchers to study cognitive impairment and cognitive rehabilitation in MS. Fortunately, emerging research from experts in the field supports new recommendations for cognitive rehabilitation in MS, as described below. 

New Practice Standards and Guidelines for Cognitive Rehabilitation in MS

Over the past decade, numerous MS research groups have sought to develop effective treatments for cognitive impairment in MS. However, the quality of these treatments, as well as the research methods used to investigate their effectiveness, have varied widely. In a recent systematic review of the scientific evidence for cognitive rehabilitation over the past 10 years, only six (15%) exhibited high-quality (Class I) ratings in terms of their design and methods.  

Therefore, although cognitive rehabilitation is an exciting and growing field, patients should carefully evaluate programs or interventions that claim to improve cognitive function, especially commonly advertised “brain training” programs. 

Recent Treatment Strategies that Show Promise

In recent research, one cognitive rehabilitation therapy has stood out from the rest in terms of its effectiveness in improving cognitive impairment – the modified Story Memory Technique (mSMT).

• The mSMT is a 10-session intervention that involves the use of specific mental strategies to improve verbal learning and memory. The mSMT has been shown to be effective in three separate studies, including a brain imaging study that showed increased activity in brain regions involved in learning and memory.  
• The mSMT is the only cognitive rehabilitation intervention that is currently considered a Practice Standard – meaning that the evidence is strong enough to suggest the mSMT is among the highest in quality and efficacy, and is recommended for use in individuals with MS and cognitive impairment.   

Two additional treatments have also shown promise:

• Attention Processing Training (APT) for improving attention  
• RehaCom for rehabilitation of general cognitive abilities. 

However, due to the limited number of studies on these treatments, APT and RehaCom are currently considered Practice Guidelines – meaning that although evidence for these interventions is encouraging, additional high-quality studies are needed before these interventions can be considered Practice Standards.

Where To Turn for Help

Your MS treatment team is a first-line resource for addressing cognitive changes.  

• Talking to your neurologist or your primary care doctor about your cognitive changes is an important first step.  
• They can help direct you to a neuropsychologist – a clinical psychologist specializing in assessing and treating cognitive impairment. He or she will work with you to identify your areas of strength, determine additional factors in your life that may exacerbate your cognitive difficulties, and, importantly, make treatment recommendations to help improve or compensate for your cognitive difficulties.  
• If the neuropsychologist determines that you are experiencing significant depression, he or she will first recommend treatment to improve your mood. Depression can have a significant impact on a person’s thinking and memory. The goals of this treatment are to relieve the depression and reduce its impact on your cognitive functioning. While some neuropsychologists provide treatment for mood disorders, others may refer you to another mental health professional.  
• Your providers may also help you connect with a speech-language pathologist for evaluation and cognitive rehabilitation therapy. 
• An occupational therapist can assist you with applying cognitive strategies in your everyday activities and teach you fatigue management and energy conservation techniques that can significantly impact your cognition.

Cognition as a Piece in the Wellness Puzzle

Finally, we would be remiss without emphasizing that cognitive function, although of high importance, represents only one aspect of overall health and wellness. Maintaining regular physical activity, making healthy nutritional choices, getting adequate sleep, and enlisting support from friends, family, and others in your life are all key components to supporting health and wellness that also have important implications for your cognitive and emotional wellbeing.