Patient Blogs | Multiple Sclerosis
How to Think More Clearly With MS
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Can you think clearly with a brain damaged by multiple sclerosis (MS)? At some point in their lives, cognitive (thinking) problems affect at least 65% of people with MS, and I’m one of them.

Common cognitive issues include:

  • Memory loss, which can be short-term, like “Why did I come into the kitchen now?” or longer-term, like the names of neighbors we see every day. People without MS lose memory too as they age, but MS can accelerate mental aging.
  • Difficulty learning new things: I find it harder to use a new device or app than it should be, or to learn the rules of a new game. I stick with the old ones if I possibly can.
  • Attention and concentration: The minds of people with MS need shorter sessions to stay effective. We wear out; we get distracted.
  • Executive function, which means planning and decision making.
  • Visual/spatial functions: Our ability to see how things fit together or how far apart they are. We wind up dropping things or tripping.
  • Verbal fluency (word finding): “I know there’s a word for that, but I can’t remember it.”
  • Keeping up with tasks or conversations (called information processing speed): Sometimes, our minds can’t take in new information as quickly as media or other people put it out.
  • Shifting attention from one thing to another: MS and multitasking don’t mix, like trying to write something at work while also having to read some instructions.

These symptoms are sometimes called “brain fog.” Brain fog gets worse when we are tired, warm, or stressed. They can be annoying at home, but at work or school, they can be disabling. They can also lead to falls and accidents, because our bodies need our brains to coordinate them.

Cognitive symptoms come from MS-related damage to brain cells. Fortunately, doctors and therapists have found ways to slow these losses, ways to manage them, and sometimes even to heal the brain.

Preventing MS Cognitive Damage

MS psychologist Robert Motl, PhD, says physical exercise is known to improve cognitive function in aging adults. He says increased blood flow to the brain from exercise helps repair nerve damage.

You have probably heard that MS causes brains to shrink. Exercise has been shown to slow and reverse brain tissue loss.

Exercise also seems to spruce up the cells we still have. You may have noticed that you feel sharper when you’ve moved your body.

What kind of exercise? Aerobic exercise has proved in studies to help thinking. Motl says that strength exercises (weights or resistance training) probably help too, but studies have not yet shown it. I would say do whatever movement you’re comfortable with. It’s all good.

Motl also says the brain is like a muscle. Exercising it makes it stronger, while ignoring it may cause it to deteriorate. The MS Society suggests brain activities such as:

  • Creative writing
  • Journaling
  • Reading
  • Handiwork
  • Board or card games
  • Drawing or painting
  • Crossword or jigsaw puzzles
  • Computer brain training programs

Two strategies that are more challenging but very rewarding are:

  • Learning a new language
  • Learning to play an instrument

In addition, engaging with other people in the neighborhood, at work, at church, in a support group, or wherever, helps people think clearly. Thinking obsessively about worries or past hurts doesn’t help.

14 Tips for Managing Cognitive Problems

The following tips come from the MS Society, WebMD, other health publications, and my own experience:

1. Short-term memory: “Say it, hear it, write it, see it, do it.” The more different ways you take in information, the better you’ll remember it. Like, if you get up to go get a cookie from the kitchen, say out loud, “I am going into the kitchen for a cookie.” When you have an idea, say it out loud and/or write it down. Repeat out loud information you’ve just heard or read. You’ll be much more likely to remember it.

2. Write everything down. My mother-in-law, Rachel, had severe memory loss before she died at age 92. She managed by writing everything down in little notebooks; one for family, one for household tasks, one for foods to buy, etc. She was able to live quite normally by checking those books. If you can’t write, perhaps you can use a voice recorder to jot things down.

3. Use memory aids. “For example,” according to the MS Society, “to remember the name of someone you just met, associate her/his name with a friend or family member of the same name, or with a place, color or event that sounds like the new name.”

4. Get more organized. Keep things in physical or electronic files. Have calendars available, and write in your activities and appointments. Keep things in the same place each time you use them.

5. Take breaks. Cognitive fatigue sneaks up on us, and our thinking falls apart without our realizing it. I remember taking a neuropsychiatric exam to qualify for SSDI disability. It was like a long series of puzzles and games, the kind of thing I’m usually good at. I remember blitzing through the first half-hour and wondering, “I may be blowing my application by doing this too well.”

But after 30 minutes or so, everything got harder. I would look at a question and could not understand what they were asking. I didn’t want to stop; I knew this was the kind of thing I used to excel at. Finally, after I hadn’t gotten anything right for 10 minutes, the psychiatrist had to gently say, “Let’s stop now.” I qualified for SSDI based on that test.

Trying to work through brain fog can be like driving through dense fog in the real world. We need breaks until the fog clears. Unfortunately, this can be hard at a job, but do the best you can. Move around or close your eyes. Self magazine suggests a cold shower or splashing cold water on your face. Schedule your breaks, and take them.

6. Don’t multitask! Stick to one thing at a time. Avoid distractions, like TV or computers or listening to other people’s conversations.

7. Set reminders for things you need to do at certain times. Phone alarms are good for that.

8. Don’t make major decisions when you’re stressed, warm, or tired.

9. If you have people in your life who love you and know you well, listen to them. When my partner, Aisha, tells me, “You look like you’re getting too warm, It’s time to go home now,” I need to listen to her. I want to keep going, and sometimes I could, but pushing through fatigue can lead to mistakes and accidents.

10. We think better when we get enough sleep.

11. Eating healthy food helps people think. Sugary foods don’t.

12. Reduce stress by relaxing or meditating, or whatever soothes your soul.

13. Slow down! Like with our bodies, MS slows our brains’ thinking speed. Don’t rush things.

14. You can ask your doctor about medications to help you think, but there is no agreement now on what works.

Cognitive issues can be embarrassing and frustrating, but they are manageable, and they’re not our fault. We should not judge ourselves when we make mistakes, just learn to be as organized and careful as we can.

The MS Society also has articles and videos on improving cognition with MS here and here.


To connect with other people living with multiple sclerosis, join our MS Facebook Support Group.




Photo Credit: istetiana / Moment via Getty Images

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David Spero, RN

David Spero, RN

Diagnosed since 1989

David Spero, RN, became a writer and health coach after being diagnosed with multiple sclerosis in 1989. He writes books and blogs about living with chronic illness and the social causes of illness. A married father of two and grandfather of one, Spero is active in causes including health care, peace, and the environment. See his books; follow him on Medium or Twitter.

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