Thought Control: Keeping Your Brain Sharp With RRMS
Got brain fog? Cognitive issues are an unfortunate side effect of relapsing-remitting multiple sclerosis (RRMS). “Approximately 30% of people with RRMS will have some cognitive decline or impairment even at the time of their diagnosis,” says Meghan Beier, Ph.D., rehabilitation neuropsychologist at Johns Hopkins Medicine in Baltimore. Over the course of a lifetime, more than half of RRMS patients experience cognitive change. This can be tough to manage, but there are ways to address and reverse it—some of which you can do right from home.
What Is RRMS?
RRMS is the most common form of multiple sclerosis, comprising 85% of MS cases. It gets its name because of the cycle of relapses (aka flares) and remissions patients go through—you might feel good for several weeks or months then have a sudden onset of symptoms. If you have RRMS with progression, that means your MS symptoms are getting worse each time you relapse. The disease gradually gets more severe over time, including the cognitive symptoms.
How Does RRMS Affect the Brain?
MS causes lesions on the brain, and depending on where those lesions are, specific symptoms can vary. “Everybody’s symptom presentation with MS is different,” says Rebecca Cunningham, assistant professor of clinical occupational therapy at the University of Southern California in Los Angeles. “However, the most common areas of cognitive deficit include memory, information processing speed, attention and concentration, visual-spatial abilities, executive functions, and verbal fluency.” You may have trouble processing information quickly, remembering new things you learned, or finding the right words to articulate what you want to say.
If You Can, Work With A Rehabilitation Specialist
Medication won’t be the cure-all for cognition problems. “There’s not really a medication that can improve cognition other than staying on your disease-modifying medication,” Beier says. Cognitive rehabilitation therapy can help you develop a personalized approach to treatment. Beier explains that a specialist can help you “start to engage that neuroplasticity that our brains are so good at”—in other words, retrain your brain to process information more effectively. But you can also practice some of these same strategies on your own.
Pick Puzzles to Try at Home
Cunningham says many of her clients enjoy doing things like jigsaw puzzles, Sudoku, or Dominoes—all easy, fun games you can have around the house. Research has shown that doing puzzles regularly can help stimulate the brain and improve cognition in the general population, and this is also true for people with RRMS. “Each of these games and play-based activities challenge our cognitive abilities in different ways,” she notes. Plus, they can be fun ways to bond with other people in your household.
Download Mind Game Apps
There’s a world of options right at your fingertips, whether you have an iPhone, iPad, or Android (or even a laptop or desktop!). “Some apps have actually been studied in the MS population,” Cunningham says. She recommends one called Lumosity, while Beier highlights a program called Brain HQ. “It’s been studied not only in healthy aging adults but also in multiple sclerosis,” Beier says, “and the people who engaged in that program saw an overall improvement in their cognition.”
Hop on the Video Game Train
Even if you don’t consider yourself a gamer, you may want to jump on the bandwagon to try Dr. Kawashima's Brain Training on Nintendo Switch. (There’s also an older version of this game formatted for Nintendo DS.) The popular game includes all kinds of creative exercises and tests, from math problems to rock, paper, scissors to photographic memory challenges. You can also track your results and share them with friends and family each day, which provides an additional source of motivation as you see your scores improve over time.
Mindfulness is frequently cited as a stress-reducing tool, but it can also help improve attention and executive functioning. “You’re focusing on the present moment, and when your mind drifts to something else, you notice it and bring it back to the present,” Beier says. “That is an exercise in managing your attention.” Popular apps like Headspace and Calm make it easy to start meditating if you’ve never done it before—they offer short guided meditations with different themes, including focus and concentration.
Take Memory Breaks, Then Try Again
Beier explains a technique called spaced learning that can help people with MS remember things more easily. “If somebody was practicing a speech to give at work, they might want to practice it and then wait for a few minutes,” she says. “Take a break, then practice it again, rather than practicing it multiple times in a row. This helps people with MS give their brain a break and allows it to process the information before jumping back in.”
Quiz Yourself on New Information
“There’s something called the testing effect that has also been helpful for people with MS,” Beier continues. “If you are trying to learn somebody’s name, when you hear their name, test yourself on it right afterwards or have a partner or friend test you on that person’s name.” This will help you retain the information because you’ve solidified it multiple times in your head. You can try this with pretty much anything—names, dates to remember, even items on your grocery list.
Remember, Healthy Living Can Also Help
These mind games are even more effective when combined with an overall healthy lifestyle. Things like stress, poor sleep, and an unhealthy diet all contribute to memory and attention deficits. “We want to make sure we’re addressing the cognitive abilities themselves,” Cunningham says, “but we also want to encourage our clients with MS to be looking at their behavioral choices to ensure they are doing things like eating, stress management, and exercise to benefit their cognitive abilities.” This holistic perspective will help you make the most out of your brain-training treatment plan.
RRMS Basics: National Multiple Sclerosis Society. (n.d.) “Relapsing-remitting MS (RRMS).” nationalmssociety.org/What-is-MS/Types-of-MS/Relapsing-remitting-MS
Cognitive Impairment Prevalence with MS: Behavioural Neurology. (2017.) “Cognitive Impairment in Relapsing-Remitting Multiple Sclerosis Patients with Very Mild Clinical Disability.” hindawi.com/journals/bn/2017/7404289/
Rehabilitation Therapy: National Multiple Sclerosis Society. (n.d.) “Rehabilitation.” nationalmssociety.org/Treating-MS/Rehabilitation
Puzzles for Brain Health: International Journal of Geriatric Psychiatry. (2019.) “The relationship between the frequency of number‐puzzle use and baseline cognitive function in a large online sample of adults aged 50 and over.” onlinelibrary.wiley.com/doi/abs/10.1002/gps.5085