In an SPMS Cog Fog?

The mental fuzziness that often accompanies secondary progressive multiple sclerosis can be annoying, embarrassing, or down-right scary. Boost your brain function with these tips.

If you’re living with MS and you’ve lost—and found—your wallet or keys in a weird place like the freezer, you’re not alone. About half of people with multiple sclerosis experience mental sluggishness and can have trouble with memory, attention, and processing new information, according to the National Multiple Sclerosis Society. Many of these foggy brain episodes crop up (or become more frequent) during secondary progressive multiple sclerosis (SPMS), when you find you’re not generally getting any relief from MS-related symptoms despite ongoing treatment. “While most people experience cognitive issues, even in their very first presentation of multiple sclerosis, it tends to worsen over time,” says Devon Conway, M.D., a neurologist in the Cleveland Clinic’s Mellen Center for Multiple Sclerosis.

Why Does Cog Fog Happen?

Multiple sclerosis, a disease of your central nervous system, causes inflammation up and down your brain and spinal cord. This inflammation leaves behind lesions that damage the myelin sheaths that cover the brain neurons responsible for sending messages between your brain and the rest of your body. “The cables that connect areas of your central nervous system to each other are injured, which means that they can’t carry messages from one part of your brain to another efficiently or quickly,” explains Lauren Krupp, M.D., director of the multiple sclerosis division in the department of neurology at New York Langone Health in New York City.

The result? Cog fog—short for cognitive fog. “Conversations suddenly become harder because you can’t remember a word, and even just reading the newspaper can become exhausting,” adds Dr. Krupp. People with MS are also more susceptible to both fatigue and depression, both of which can impact memory. As a result, you may find it hard to do your job, socialize, and do all the other activities that make up your day-to-day life.

It’s a good idea to get assessed for cognitive changes at each neurologist visit, recommends Dr. Conway. This can be done in less than five minutes with a simple test like the symbol digit modalities test (SDMT), where you pair specific numbers with easy-to-draw geometric figures. But this test only looks at processing speed, not other parts of cognitive functioning like visual spatial skills, memory, or executive functioning. If you, your friends, or family members notice other changes like having trouble recalling words, difficulty remembering things, or having a hard time at multi-tasking, you’ll need to see a neuropsychiatrist for more formal testing, called neuropsychological evaluation. This test usually takes several hours.

Unfortunately, unlike other diseases that can cause memory problems, like Alzheimer’s, there are no drugs out there that have been shown to improve the cog fog that can occur with MS, says Dr. Conway. A large review of 16 studies published in the medical journal Neuroscience & Biobehavioral Reviews looked at drugs used to treat Alzheimer’s, such as Aricept (donepezil) as well as stimulants such as methylphenidate and modafinil and found none were any more effective against cog fog than a placebo.

What Can You Do to Deal with Cog Fog?

Cog Fog Infographic
Laura Supnik

With a lack of treatment options available for SPMS-related cog fog, experts agree that lifestyle modifications (and some clever brain-building therapy) can make a huge difference.

Break a sweat. Physical activity has long been known to help symptoms of MS, but it’s also key to combatting cog fog. “Exercise enhances blood flow to the brain, boosting crucial nutrients like oxygen to it,” says Dr. Krupp. A University of Illinois study published in the medical journal Neurorehabilitation and Neural Repair found that the more fit people with MS were, the higher they scored on tests to assess cognitive function. Another study published in the Journal of Sport and Exercise Psychology found that people with MS who were physically active had faster cognitive processing speeds than those who were more sedentary.

Get other health conditions in check. People with multiple sclerosis are more susceptible to other conditions that can impact brain functioning, like thyroid disorders or sleep apnea, says Dr. Conway. Your doctor can perform certain tests, like bloodwork or even a sleep study, to rule out these disorders. It’s also a good idea to go over your medication list thoroughly with your neurologist because other drugs you may be on to treat symptoms, such as steroids, seizure medicines, and even anti-cholinergics (like certain bladder medications), are linked to memory problems.

Eat a Mediterranean style diet. Patients with MS who followed a Mediterranean-style diet—a plant based diet rich in healthy fats such as fatty fish, nuts, and olive oil—have been found to have less severe depressive and cognitive-impairment symptoms among patients with multiple sclerosis (MS), according to a Johns Hopkins study.

Try cognitive rehab. This type of therapy—essentially physical therapy for your brain—takes place once or twice a week for several weeks or months and includes exercises designed to beef up your memory, concentration, and spatial skills. “The sessions are really tailored to what your needs are, with the idea that the better you become, the harder the exercises get,” explains Dr. Krupp. Exercises include spaced rehearsal, where you repeat information over intervals spread out over time to “train” your brain to get better at storing data. Another technique involves reinforcing something by using all your senses—visualizing it, repeating it, and writing it down.

A big part of cognitive rehab is learning compensatory strategies to help make up for the parts of your brain that are no longer working so well. While they don’t help address the underlying problem, they do help you function better, points out Krupp. These include:

  • Sharpening your focus. Multi-tasking is much more difficult when you have MS. To improve your concentration, focus on one thing at a time. For example, if you’re watching a TV show, focus on the names of all the characters. As you practice and your focus gets stronger, apply it to every day tasks like being involved in a conversation.

  • Being strategic. Try to plan your most challenging mental tasks for your best time of day, and schedule periodic breaks so that you can take a breather whenever “cog fog” starts to creep in.

  • Using visualization. Creating mental pictures can help boost memory. Before leaving the house, for example, take a few seconds to visualize the route you’ll take.

  • Staying organized. Make sure important items like house and car keys are always stored in one spot, like on the kitchen counter. Record every critical thing that you need to remember—appointments, to-do lists, phone numbers, family schedules—on your iPhone.

Hallie Levine
Meet Our Writer
Hallie Levine