Lost in thought: When cognition changes
To answer this question, Owen and colleagues conducted a study of more than 11,000 people and found no evidence for any generalized improvements in cognitive function following computerized “brain training.” The field is still in its infancy, however, and more independent research is needed.
When it comes to improving or compensating for impaired executive functions, Paskay and her colleagues emphasize the importance of preparation, and teach CogniFitness participants how best to use reminders and alarms to aid planning.
“You need a coach, just like with physical exercise,” says Dr. DeLuca. “You need someone familiar with MS and with these interventions. Comprehensive MS Centers should have lists of qualified neuropsychologists and speech-language pathologists that patients can go to.”
Such specialists can help you plan for the inevitable “mental jam,” too. That’s crucial, because the worst time to talk about a cognitive challenge is while it’s happening, says Gingold. That just heightens anxiety, making the cognitive problem feel even worse.
Anxiety and impaired recall, reasoning, problem solving and judgment can affect interpersonal relationships, too. Los Angeles resident Susan Selbrede, 48, diagnosed with MS in 2009, was chief financial officer of a business she ran with her husband until pain, fatigue and cognitive dysfunction made it impossible to work. “My communication was impaired, too,” Selbrede says. “I think because of my cognitive issues I really pushed a lot of people away.” She credits the CogniFitness program for enabling her to communicate and begin to repair business and personal relationships.
“Don’t beat yourself up for not being who you used to be,” Selbrede advises others. “It’s important to keep socializing and seeing friends.” That’s true, even if it means keeping gatherings small, so you can follow the conversation. In fact, Dr. DeLuca says studies show that keeping socially and intellectually active improves brain function. “I tell patients, ‘Get out of the house, read a book a month. Then get someone to ask you what you read about. Build stimulation into your life. That’s your therapy—it’s not a pill!’”
Drs. DeLuca and Rao agree that more thorough cognitive assessments of people with MS are necessary. “We do MRIs for physical symptoms, and we need as thorough an evaluation for cognitive symptoms,” Dr. DeLuca urges. Otherwise, the more subtle cognitive symptoms are likely to go undetected. “And patients don’t mention cognition unless you really ask about it,” Dr. Rao says.
Dr. Repovic and his colleagues at the Swedish Neuroscience Institute are creating a detailed online questionnaire that patients will be able to complete before their appointments, giving neurologists a better sense of how much fatigue, depression, anxiety and cognitive challenges are troubling them. The Cleveland Clinic is working toward a similar system using tablet computers, and hopes to roll it out to other healthcare providers. “With the National MS Society funding our research, we’re validating our cognitive tests to make this app available to clinics worldwide,” says Dr. Rao.
Dr. DeLuca believes many neurologists are deterred from evaluating cognitive problems because they have no pharmaceutical solutions to offer. “They’re trying to be efficient and act where they can have an impact. If you’re having cognitive problems, discuss them with your neurologist and contact the Society for a referral to a neuropsychologist, occupational therapist or speech-language pathologist familiar with MS. They’re trained to help you come up with solutions.”
Leslie E. Silverman is a Connecticut-based freelance writer. She was diagnosed with MS in 2007.