Featuring Barry A. Hendin, MD
MSAA’s Chief Medical Officer

Question: What strategies can you recommend to help with cognitive issues? 

Answer: First, let’s define cognition. Simply, it is all of the processes involved in learning, remembering, and expressing knowledge. It involves how we perceive, how we think, and how we convey knowledge verbally and nonverbally. 

Although many people with MS, and at all stages of MS, express cognitive symptoms or problems, they are generally mild in nature. The most common complaints that I hear involve difficulties in memory, multitasking, learning new information, and processing speed.

Some cognitive changes may be due to MS itself. Often, however, the problems are due to, or are compounded by, other factors such as poor sleep, medication effect, pain, or depression. The first strategy, therefore, is to assess the contribution of mood, pain, medications, and sleep – and then treat them appropriately. 

After those contributing factors have been assessed and managed, many people are still left with cognitive symptoms. It could be helpful to understand the nature and severity of the cognitive problems by formal testing. Sometimes the tests are simple, such as the widely used Symbol Digit Modalities Test (SDMT). But when problems are more severe, formal neuropsychometric testing can help to define the specific problems and the best strategies for dealing with those problems. Treatments may involve cognitive rehabilitation with speech therapists or neuropsychologists. 

In formal trials, some disease-modifying therapies have shown benefit in preserving and reducing decline in memory and cognition. Disease-modifying therapies are always a corner stone of treatment! Non-pharmacologically, wellness protocols help to maintain physical, emotional, and intellectual function. Wellness includes regular exercise, healthy diet, managing mood and psychological health, managing medical problems, staying socially engaged, and staying intellectually engaged. Ultimately, cognitive symptoms occur during the lifetime in many people with MS, but there is much that we can do to understand and manage them. 

Barry A. Hendin, MD is a neurologist and Director of the Multiple Sclerosis Center of Arizona. He is also Director of the Multiple Sclerosis Clinic at Banner University Medical Center and Clinical Professor of Neurology at the University of Arizona Medical School.