Lost in thought: When cognition changes
Finding what works
Detecting cognitive problems is helpful only inasmuch as therapies and strategies are available to manage them, however. “The search continues for a pharmacological solution to improve cognitive dysfunction,” says Dr. LaRocca. A medication used to treat memory and other cognitive problems in Alzheimer’s disease generated some early excitement about possible use in MS, but the research didn’t pan out. “Double-blind, placebo-controlled studies of stimulants haven’t been as promising as we’d like, either,” he says.
Behavioral treatments can improve function, however. “People with MS can substitute strategies for memory, like using an iPad or smartphone calendar,” Dr. LaRocca says. Calculators, online maps and GPS units, voice recorders and even old-fashioned pen and paper can also help people deal with cognitive challenges. “It’s not ‘improving memory,’ but creating workarounds for tasks that demand memory,” Dr. LaRocca says.
Gingold learned some of those workarounds the hard way, so he wrote a book, Facing the Cognitive Challenges of Multiple Sclerosis, to share coping strategies. When engaging someone new in conversation, he explains that he may respond slowly after he processes information. “I don’t want people to think I’m ignoring them, or that I don’t care,” he says. “I ask people to give me information in small bits so I can digest it first.” He also asks people to email him information, because he knows he can’t listen to details and simultaneously write them down. “I pretend it’s because I have bad handwriting,” he says, laughing.
Gingold keeps a positive outlook and remains focused on adapting to his changing cognitive abilities. “I’ve learned to better organize myself [and] cut a lot of the mental and visual clutter that was distracting. I avoid large gatherings where I can’t focus on one conversation at a time. And I listen to more jazz and less rock, because I must quiet things down,” he shares.
The therapeutic approach
Speech-language pathologist Licia Paskay, MS, CCC-SLP, says Gingold’s approach is exactly right. “Paying attention helps you store the memory in the first place,” she says.
In CogniFitness, a program that Paskay and her colleagues run for the Society in conjunction with the Marilyn Hilton MS Achievement Center at UCLA, “we help people become more aware of distractions and manage them,” Paskay explains.
With attention under control, people can focus on improving memory. Dr. DeLuca says one technique is to space learning episodes over time. Another method is to “self-generate” information you want to remember by periodically testing yourself about it. Sometimes you can combine both approaches. For example, if you’re trying to remember when you have a doctor’s appointment, study it on your calendar several different times during the week (spaced learning). “That reinforces the encoding of the information,” Dr. DeLuca explains. Then bolster it with self-generation; family can help with this, too. “If you have an appointment on Friday, have a family member ask you to retrieve the information the Sunday before. On Monday, they can provide hints to help you retrieve the memory again, saying, ‘There’s something you have to do Friday. Do you remember what?’ If you can self-generate the response, then it’s more deeply encoded in the brain,” Dr. DeLuca says. Even further, his research shows that associating information with specific imagery and also adding context or meaning to the information significantly improves learning and memory in MS.
While researchers and clinicians acknowledge that working on such skills in a therapeutic setting can be effective, the jury is still out on the use of popular home-based computer “brain training” programs, like Lumosity or BrainHQ.
A 2011 study found that people who used Lumosity for 20 minutes a day for five weeks had significant improvements in visual attention and working memory. However, the authors had a financial interest in the outcome, and the number of people studied was small (25). And, as Owen, et al., the authors of a 2010 study published in the journal Nature, point out, “The central question is not whether performance on cognitive tests can be improved by training, but rather, whether those benefits … lead to any general improvement in the level of cognitive functioning.”