Another Response Regarding Cognitive Function in MS

Lori Ann Kostich M.S. CCC-SLP
Mandell Center for Multiple Sclerosis Treatment and Research

“I want to get back to the way I was.”  As a Speech Language Pathologist who works with persons with Multiple Sclerosis  (pwMS) I hear this often.  PwMS are referred to me by our Neurologist and Neuropsychologist because they report, or demonstrate changes in cognitive –communication or cognitive-linguistic status, and the medical staff believe the pwMS will benefit from a course of therapy.  The response I am compelled to give to that initial statement, is, based on the current treatments available, there is no turning back time.  The changes in the brain are happening, and they are what they are.  The ability to process information slows, and the ability to learn new information (how I think of short term memory) becomes more difficult.

But, having said that, therapy from a Speech Language Pathologist, Occupational Therapist, Social Worker, or Psychologist, can be very effective in helping a pwMS manage the changes in cognitive function.  Therapists have training and experience helping pwMS develop new routines, change personal habits, make workflow adjustments at the pwMS’ place of employment, and help family members understand the changes the pwMS is experiencing.  As part of my practice, I spend a great deal of time doing working on attention and training strategies such as visualization, to help with managing new information.  The most important part of each therapy session is asking the pwMS that I am working with how they are going to APPLY what was trained in the therapy session to their daily routines.  Therapy addressing cognitive functioning is not like blood pressure medication where you take it and you get better. The onus is really on the pwMS to take the training and strategies home (or to work) and practice them and “tweak” them until whatever issue is better.  The most successful outcomes I have had have been when the pwMS worked just as hard outside the therapy setting as they did when sitting across the table from me.

Commenting on medications that some of my patient’s claim makes them think better, is out of my scope of practice.  So I am not going to.  But, please keep in mind that the effects of any medication last only as long as the medication is in a person’s system.  In my opinion, it is better to participate in a course of therapy to learn how to manage the cognitive-communication/cognitive-linguistic symptoms for the long term (if you teach a man to fish…).

If you are noticing changes in your ability to pay attention, remember new information, or a decrease in your ability to stay organized tell your neurologist, especially if this is affecting your ability to work.  A referral can be made to a Neuropsychologist, Speech Language Pathologist, Social Worker etc.  Ask for the help.  This type of therapy will not make the lesions go away, but it can give you some control over the cognitive changes that are happening.