How To Manage Memory Issues When You Have nrSPMS

When you’re living with non-relapsing secondary progressive multiple sclerosis (nrSPMS), your multiple sclerosis (MS) symptoms can slowly get worse over time — and not just your outward-appearing physical symptoms.

Research shows that up to 65% of people with MS experience some level of cognitive impairment. You may have trouble thinking clearly, remembering and concentrating. And these issues are often more frequent and more severe in people with secondary progressive MS (SPMS) than in those with relapsing-remitting MS (RRMS).

So, what can you do about it? Neurologist Kimberly DiMauro, DO, shares strategies for preserving your cognitive function when you’re living with MS.

9 tips for managing nrSPMS-related memory issues

To manage your MS on the whole, your provider may prescribe a type of medication called a disease-modifying therapy (DMT). The benefit of currently available DMTs for SPMS is limited, but Dr. DiMauro says, “There is active research ongoing to try to identify better treatments for the nrSPMS patient population.”

That means you’ll have to turn to other strategies to preserve brain power and function. Here’s what Dr. DiMauro recommends.

1. Get assessed

Your provider needs to figure out exactly what is at the root of your cognitive issues, whether it’s MS, something else or a combination of the two.

“A neuropsychological assessment, which is done through a variety of tools and clinical assessments, can help identify factors that are contributing to your thinking and memory problems,” Dr. DiMauro explains. “When we treat those factors, we often see improvements in brain function.”

Factors that can worsen symptoms and decline may include:

• Certain medications
• Depression, anxiety and other emotional disorders
• Sleep disorders (which are common with MS)
• Thyroid disorders
• Vitamin B12 deficiency

“This type of testing can also be especially helpful if you’re having trouble at work or school,” she shares. “Depending on the results, we might recommend different accommodations that can help, like a quieter workspace or more time to take exams.”

2. Try cognitive rehabilitation

Your healthcare provider may prescribe cognitive rehabilitation as part of your nrSPMS treatment and management plan.

“Cognitive rehabilitation is a type of personalized treatment plan to strengthen and improve your mental/thinking skills,” Dr. DiMauro explains. “You’ll also learn practical strategies and workarounds to help you carry out everyday activities that have been affected by your MS.”

Cognitive rehab can help you learn to better manage daily tasks like preparing meals, managing your finances and taking your medications.

3. Keep your mind active

Keeping your brain active can help preserve your ability to think and analyze the world around you. It can also help prevent mental and psychological symptoms from getting worse.

Doctors call this “cognitive engagement.” It includes activities like:

• Doing crossword puzzles and other word games
• Drawing and other forms of art
• Playing an instrument
• Reading
• Taking up a brain-engaging hobby, like learning a new language
• Writing

4. Learn new coping strategies

What doctors call “compensatory strategies” are tactics that help you make up for areas where your abilities are lacking.

“Anyone can benefit from learning compensatory strategies,” Dr. DiMauro says. “But when you’re dealing with MS-related cognitive decline, they can be especially helpful.”

Here are a few to try:

• Create routines. Following a set routine can lessen your mental load, which can help preserve your brainpower for other aspects of life.
• Write it down. Having a hard time remembering your to-do list? Jot it down and hang it up. Keep a notepad with you or take notes in your phone.
• Set reminders. Hang up a calendar or start using an app that will keep you organized and provide reminders — or both!
• Reduce clutter. Think of clutter as a physical manifestation of multitasking. When your space is clear and organized, you free up the space for your brain, too.
• Stop multitasking. Studies show that trying to do multiple things at once makes us worse at all of them. Give your brain a break by putting an end to multitasking and instead, focus on doing one thing at a time.

5. Manage fatigue

MS-specific fatigue is called “lassitude” — and while doctors don’t know exactly what causes it, they do know that it’s incredibly common. In fact, fatigue affects up to 80% of people living with the disease.

“Fatigue isn’t just the most frequently reported symptom of MS,” clarifies Dr. DiMauro. “It’s also often cited as the most bothersome or debilitating symptom. It affects your physical function and cognitive abilities, which takes a toll on your quality of life.”

Your MS provider can help you find ways to manage your fatigue, which may include:

• Planned breaks: Building time into your schedule for naps and quiet rest can help you conserve your energy throughout the day.
• Physical therapy: A physical therapist can create a home exercise program that suits your abilities. They can also teach you to improve your gait (the way you walk) to help conserve energy.
• Occupational therapy: “An occupational therapist can teach you strategies so you use your limited energy on the activities that are most important and most meaningful to you,” Dr. DiMauro explains.
• Sleep hygiene: A lack of sleep can make fatigue worse. Following sleep hygiene recommendations can help you rest more easily and feel better.
• Assisted devices: Mobility devices for MS may include braces, canes, walkers or wheelchairs. These devices — along with other types of aids, assistive technology and changes to your home and workspace — can help you conserve your energy and make everyday life a little easier.

6. Manage other health conditions

“Other medical conditions can affect the way your MS progresses or manifests,” Dr. DiMauro points out. “So, it’s especially important to treat any additional conditions you have and try to prevent others from developing.”

Conditions that are common in people with MS include:

• Arthritis
• High blood pressure
• Mental health disorders like depression and anxiety
• Obesity
• Osteoporosis
• Sleep disorders
• Type 2 diabetes
• Other vascular risk factors, like hyperlipidemia and coronary artery disease

7. Ask about your medications

Sometimes, the medications you take to manage other symptoms of MS can contribute to memory issues.

“It’s worth asking your care team to review whether any of your current medications might be contributing to your cognitive problems,” Dr. DiMauro suggests. “They may be able to make adjustments that can clear some of the brain fog while still managing your other MS symptoms.”

8. Focus on sleep

Research shows that people with MS are 3 to 5 times more likely to have sleep disorders than the general population.

“A lack of sleep can significantly affect daytime cognitive performance — in anyone, but especially in people living with MS,” Dr. DiMauro emphasizes.

Be sure to tell your provider about any sleep-related issues you’re experiencing, like insomnia, restless legs or waking up a lot during the night. Depending on your symptoms, they may want to evaluate you for sleep disorders.

9. Adopt other healthy lifestyle habits

When you’re living with nrSPMS, there’s a good chance you’re dealing with symptoms that can make cognition worse, from fatigue and mobility issues to trouble with mood and sleep.

“All of these factors can affect your cognition,” Dr. DiMauro says, “so it’s particularly important to adopt lifestyle habits that support your cognitive function and overall health.”

Here’s what she recommends:

• Follow a healthy diet. There’s no specific diet for MS, but what you eat can make a big difference in how you feel. Focus on nutritious whole foods and cut back on processed foods, added sugar and other foods that contribute to inflammation.
• Keep moving. What’s good for your body is good for your brain, so figure out what type of physical activity works for you. A physical therapist can help, if needed.
• Stay socially engaged. It can be tempting to isolate when you don’t feel well. But research shows that socializing makes a difference in the overall health of people with MS, including factors related to both physical and mental health.
• Address stress. Focus on self-care strategies, like building a support system, adapting activities you love and following a healthy diet, which can all help keep stress in check.
• Quit smoking. Both smoking and chewing tobacco are associated with an increase in MS activity. Talk to your healthcare provider about how to quit.

Final thoughts

There’s no cure for nrSPMS. But there are steps you can take to help preserve your cognitive function and make everyday life a little easier on yourself.

“Staying proactive about your cognitive health through your lifestyle habits, psychosocial supports and monitoring can go a long way,” Dr. DiMauro encourages.

“And if you need additional resources, your MS provider should be there to help you figure out other specific strategies to best manage your cognition.”