Memory Challenges and Strategies for MS

When we think about the effects of Multiple Sclerosis (MS), physical symptoms like fatigue, balance issues, or vision changes often get discussed early on in the diagnosis workup. But for the majority of those living with MS, cognitive changes—especially those involving memory—will play a significant role at some point along the journey. Memory breakdowns can have a negative impact on daily life with MS, affecting abilities critical to manage the diagnosis (such as scheduling appointments, planning daily routines, and remembering to take medications) and live a full and purposeful life (including balancing work, life, and community responsibilities.) Like some other MS symptoms, cognitive challenges may be invisible to others, resulting in feelings of shame and embarrassment. As a Speech-Language Pathologist (SLP), I support individuals living with MS to optimize their cognitive-communication abilities towards person-centered goals related to maintaining independence and a good quality of life. I find that education about memory and MS is an important place to start; even if you’ve yet to experience memory changes, building awareness and taking a proactive approach can make a big difference.

Though many people consider memory as a binary–either “good” or “bad,” or you remember something or you don’t–memory is not a single function; rather, it includes several different systems, each with its own purpose and challenges. In this post, I’ll walk through the types of memory and strategies that can be trained in therapy to help people adapt and thrive. 

Working Memory: How We Mentally Manipulate Information to Remember

What It Is

More of an active mode of the brain vs. a storage system, working memory holds and manipulates small units of visual or verbal information in our mind for higher level cognitive skills like solving problems or making decisions. It helps us to follow directions, solve math problems, or hold an idea in mind while waiting our turn in a conversation. Working memory requires solid attention and sensory inputs, like vision and hearing, that allow us to process incoming information.

MS Impact

MS can slow down processing speed and make it harder to hold onto multiple pieces of information at once. People may lose their train of thought mid-sentence or forget what they were doing after an interruption, even a minor one. If you’re navigating any vision changes, that reduced sensory input may affect working memory for spatial or visual information, like locating an item that someone set down for you.

Strategies to Try

• Identify and manage distractions that can affect attention to incoming information you want to remember; turning off app notifications is a good example 
• Jot down keywords to help keep ideas in mind during conversations or meetings
• Repeat instructions aloud, or write them down
• Use checklists to keep track of multi-step tasks
• Avoid interruptions when possible, especially for tasks that require focus

Short-Term Memory: Our Mental Inbox

What It Is

Short-term memory refers to the passive storage of information; it is the form of memory that many of us think of when we talk about “memory”. It stores information briefly and, for information deemed significant, transfers it to the more permanent long term memory. 

MS Impact

People with MS may find that new information doesn’t “stick” easily. This can result in forgetting recent events or conversations, misplacing or losing items, or struggling to recall information that you’ve read or heard. Short term memory impairments often complicate everyday life, especially modern life that is prone to information overload.

Strategies

• Prioritize information to remember (like deadlines for work, or a new friend’s name)
• Repeat the information that you want to remember
• Use visual associations
• Have a reliable calendar, planner, or notetaking system
• Make these portable with phone apps like Notes, Reminders, or calendars that sync with other systems or important people in your life
• Quickly store incoming information via voice assistant apps like Siri or Alexa
• Offload memory demands for high-stakes tasks, like weekly pill organizers for medications or autopay for routine bills
• For those who enjoy photos or writing, journals promote memory for special daily moments (these are also easily accessible on many phones or tablets)

Long-Term Memory: Our Brain’s Filing Cabinet

What It Is

Long-term memory stores knowledge and experiences over days, years, or even decades. This includes facts (semantic memory), personal experiences (episodic memory), and how to do things (procedural memory). Where short term memory holds onto small amounts of information for a brief period of time (and forgets it if not used routinely), long term memory can store more information for longer.

MS Impact

Long-term memory is often preserved in MS, but retrieving specific information—like a word, date, or name—can become harder. For those with more advanced cognitive changes, long term memory retrieval can be affected by issues with attention, information processing, or communication systems for sharing memories, like talking or writing.

Strategies

• Give yourself time to retrieve information. It may help to offload time pressure for recall in conversation (like retelling a story to a family member at dinner) by taking time to pull up the details during a quieter period ahead of time
• Use cues or prompts to jog your memory; since many people have extensive photo libraries on their phones, organizing event or task specific albums for meaningful topics (like a special vacation or hobby) can be an enjoyable and cognitively stimulating strategy 
• When attempting to learn new information, try rehearsing and repeating it, which helps with retention over time

Prospective Memory: Remembering to Remember

What It Is

Prospective memory is the ability to remember to do something in the future—like taking medication at a certain time, keeping an appointment, or calling a friend back. It takes an intention and a plan to take action at the right time, or in the right place. This form of memory may be considered more of an executive function, as it takes planning to happen.

MS Impact

This type of memory is often impacted in MS. You might remember that you have to do something, but forget when or where you planned to do it (or never get around to making a plan at all.) 

Strategies

• Whenever possible, try to take action “now” vs. delay; this offloads the cognitive demand later in the day when cognitive or physical energy may be less
• Set phone alarms, calendar reminders, or visual cues (like a sticky note on the door)
• Take advantage of hardwired habits—e.g., put medications next to your toothbrush to “stack” a new habit, and reduce the need to create novel plans to remember
• Delegate prospective memory to someone else; this could look like asking someone to remind you to tell them a story when you get together (just make sure their memory strategies are dependable!)

How a Speech-Language Pathologist Can Help

If you’re noticing memory changes, especially those that consistently or significantly impact your daily functioning, a Speech-Language Pathologist trained in cognitive-communication disorders can play an important role on your MS care team. We assess for cognitive strengths and challenges and tailor strategies in partnership with you to mitigate symptoms, reduce frustration, and enhance life participation. Treatment related to memory (and other cognitive domains) can support sustained employment, help to maintain health, and sustain social connections. SLPs can partner with you to explore environmental supports that can make memory tasks easier, like creating systems to reduce clutter and distractions, building routines, and avoiding multitasking when focus is needed. Unlike “brain games” or apps claiming to improve memory, SLPs specializing in person-centered care develop strategies that apply to your everyday needs and situations.

You’re Not Alone

Memory changes can feel scary—but they are a common and treatable part of life with MS. You don’t have to navigate them on your own. Talk to your neurologist, therapist, or MS care team about seeing a Speech-Language Pathologist who can help you better understand how your brain works—and how to build your own personal memory strategy toolkit.