Multiple sclerosis (MS) is often perceived through its physical symptoms: fatigue, balance issues, and muscle weakness. However, another aspect, more discreet yet equally impactful, affects one in two people living with the disease: cognitive disorders. This is sometimes referred to as “brain fog”. It is not a fatality, but a challenge that you can address. Cognitive rehabilitation is one of the keys to regaining control and improving your daily life. But faced with this notion, a question often arises: where to start? This article is designed to guide you, step by step, on this path.
Before seeking solutions, it is essential to understand what we are talking about. Cognitive disorders are not a sign of loss of intelligence. Imagine your brain as a vast telephone exchange, with billions of connections. In multiple sclerosis, inflammation damages the myelin, the protective sheath of the “wires” (the axons) that transmit messages. The result? Information travels more slowly or gets lost along the way. This slowdown is the source of many difficulties.
The Most Commonly Affected Areas
Even though each person is unique, certain cognitive areas are more frequently affected by MS. It is rare for all these functions to be affected at the same time, but you might recognize yourself in one or more of these situations:
- The speed of information processing: This is often the first and most common disorder. You feel like your brain is functioning in slow motion. Following a fast conversation, reacting quickly in an unexpected situation, or even reading a dense text becomes more difficult. It’s like trying to browse the internet with a very slow connection: the page eventually loads, but it takes time and patience.
- Memory: It is generally not about forgetting old memories. The problem lies more in working memory and short-term memory. You enter a room without knowing what you came to look for, you forget an appointment you didn’t note, or you have difficulty retaining new information, like the name of a person just introduced to you.
- Attention and concentration: Staying focused on a single task, especially in a noisy environment, can become a real effort. You may feel easily distracted, lose your train of thought, or have trouble doing two things at once (for example, cooking while listening to the radio).
- Executive functions: This somewhat complex term encompasses the skills that allow us to plan, organize, solve problems, and make decisions. Concretely, this can translate into difficulties organizing a trip, managing a budget, or breaking down a complex task into simpler steps.
Why Is It Crucial to Talk About It?
These difficulties are often invisible to those around you, which can lead to misunderstanding. You may feel guilty, thinking that you have become “lazy” or less capable. Talking to your neurologist, your general practitioner, or your loved ones is the first step to demystifying the situation. These symptoms are an integral part of the disease, and recognizing them is the starting point for finding suitable strategies.
The First Step: Cognitive Assessment
You wouldn’t start a long journey without a map. Similarly, before embarking on cognitive rehabilitation, it is essential to know where you stand. This is the role of the cognitive assessment, also known as neuropsychological assessment.
Why Do an Assessment?
The cognitive evaluation is not a test to judge or grade you. Its purpose is purely constructive. It allows for a precise “map” of your cognitive strengths and weaknesses. Thanks to this assessment, a professional can:
- Objectify your difficulties: Put words and measures to what you experience daily. This confirms that your impressions are not “just in your head”.
- Identify preserved functions: The assessment will also highlight all the areas where you have no difficulties. These are essential points of support on which to build your rehabilitation.
- Establish a baseline: This initial assessment will serve as a reference to track the evolution of your abilities over time and measure the effectiveness of the strategies implemented.
- Propose a personalized rehabilitation plan: Based on the results, the professional can guide you towards the most relevant exercises and strategies for you.
Who to Consult for This Assessment?
Several healthcare professionals are trained to carry out these assessments. Most often, your neurologist will refer you to a neuropsychologist. This psychologist specialized in brain functioning is the reference expert for this type of evaluation. In some cases, a speech therapist may also conduct assessments, especially if cognitive disorders are related to language or communication difficulties. Discuss it with your healthcare team, who will know how to direct you to the right person.
How Does an Assessment Proceed?
A neuropsychological assessment generally takes place in several stages. It begins with a thorough interview during which you will discuss your daily difficulties, your medical history, and your goals. Then comes the testing phase. This involves a series of exercises, often in the form of “paper-pencil” or on a computer. You will be asked to memorize lists of words, solve small logic problems, copy drawings, or react as quickly as possible to stimuli. The atmosphere is always supportive. The goal is not to succeed at everything but to do your best so that the professional can have an accurate picture of your cognitive functioning.
Rehabilitation Strategies: A Toolbox for Your Brain
The “Restorative” Rehabilitation: Training the Brain Muscle
This approach aims to directly stimulate the cognitive functions that are weakened, much like doing weight training to strengthen a muscle. This is most often done with the help of a professional, such as a speech therapist or neuropsychologist.
- Working with a speech therapist: The speech therapist is a valuable ally in cognitive rehabilitation. During sessions, they will offer you targeted exercises to work on, for example, your working memory, attention, or organizational skills. They will teach you specific techniques to memorize information more easily or to stay focused longer. The great advantage of this support is that it is entirely personalized, and the professional can adapt the difficulty of the exercises in real-time.
Compensatory Strategies: Learning to Bypass Difficulties
Sometimes, rather than struggling to restore a function, it is more effective to learn to bypass it. This is the principle of compensatory strategies. It involves implementing aids and habits in your daily life so that cognitive disorders have less impact. Think of a person with vision difficulties: they will not only do exercises for their eyes, but they will also wear glasses. Compensatory strategies are your “cognitive glasses”.
- Concrete examples for memory: Use a planner (paper or on your phone) and systematically note all your appointments. Make shopping lists. Use a pill organizer for your medications. When you put away an important object (your keys, for example), say out loud where you are putting it: “I put my keys on the entrance table”.
- Concrete examples for attention: When you need to perform a task that requires concentration, isolate yourself in a quiet room. Turn off the television and put your phone on silent mode.
Break down long tasks into several small steps of 20-25 minutes, with a short break in between.
- Concrete examples for organization: Use a large whiteboard in the kitchen to note important things for the whole family. Plan your menus for the week. Prepare your things the night before for the next day. Always put objects in the same place.
Digital Tools for Your Rehabilitation
Today, technology offers exciting new opportunities for cognitive stimulation. Many programs and applications allow you to train in a fun and regular way, directly from your home. This is an excellent complement to professional follow-up.
Brain Training at Your Fingertips
The advantage of digital tools is their accessibility. They allow you to train for a few minutes each day, which is often more effective than a long weekly session. Regularity is indeed one of the most important success factors in cognitive stimulation. These programs are designed to be progressive: the difficulty adapts to your performance to keep you in a stimulating challenge zone without setting you up for failure.
Presentation of Our Tailored Solutions: Edith & Joe
Aware of these specific needs, we have developed applications designed to support people with multiple sclerosis in their cognitive rehabilitation journey. Our programs, such as Edith & Joe, were created in collaboration with healthcare professionals, including speech therapists and neuropsychologists, to offer relevant and tailored exercises.
- Programs Designed for You: Our applications are not just simple games. They offer brain training programs that specifically target the cognitive functions often affected by MS: memory, attention, language, reasoning, and processing speed.
- Flexible Use: You can use our programs independently, at your own pace, on a tablet or computer. They are designed to be intuitive and enjoyable to use.
- A Tool for Therapy: One of the great advantages of our solutions is that they are also used by professionals. Your speech therapist can integrate our Edith & Joe programs into your rehabilitation sessions. They can assign you exercises to do at home, track your progress remotely, and adjust your program based on your results. This creates a bridge between sessions in the office and your daily training, thereby enhancing the effectiveness of the care. For example, after working in a session on a strategy to memorize a list of words, your speech therapist can prescribe a similar exercise on the app for you to practice throughout the week.
The goal of these tools is to empower you in your rehabilitation, giving you the means to stimulate your brain regularly, with supervision if you wish.
Adopting a Holistic Approach: Beyond Exercises
Cognitive rehabilitation is a central pillar, but its effectiveness is multiplied when it is part of an overall lifestyle that takes care of your brain. Think of it like a garden: you can plant the best seeds (the exercises), but if the soil is not good (your general condition), the results will be diminished.
The Impact of Lifestyle on Cognition
- Sleep: Quality sleep is absolutely fundamental. It is during the night that your brain “cleans itself”, consolidates memories, and repairs itself. Fatigue, a major symptom of MS, significantly worsens cognitive disorders. Prioritizing your sleep is one of the best things you can do for your cognition.
- Nutrition: A healthy and balanced diet, Mediterranean-style (rich in fruits, vegetables, good fats, and low in processed foods), has demonstrated beneficial effects on brain health.
- Stress and Mood Management: Stress, anxiety, and depression can greatly affect concentration and memory capabilities. Learning to manage stress through relaxation techniques, meditation, or sophrology can have a direct and positive impact on your cognitive functions.
Physical Activity: An Ally for Body and Mind
Adapted physical activity is one of the most effective non-drug treatments for MS, including for cognition. Regular movement (walking, swimming, yoga, stationary biking…) increases blood flow to the brain, promotes the creation of new neural connections, and can even improve processing speed. It is a true “fertilizer” for your brain. Discuss with your doctor or a physiotherapist about the activities that are most suitable for you.
Social and Psychological Support: Don’t Stay Alone
Living with cognitive disorders can be isolating. It is essential not to face these difficulties alone. Talk to your loved ones, simply explain what you are experiencing. Joining support groups or patient associations can also be a great comfort. You will meet people who understand your situation perfectly and with whom you can exchange tips and strategies. Psychological support can also help you better accept these disorders and develop confidence in your abilities.
Starting a cognitive rehabilitation process may seem like a mountain to climb. But remember that every step counts.
The second is to request an assessment to gain clarity. Then, with the help of professionals and suitable tools, you can build your own path, at your own pace, to tame this brain fog and continue to live a rich and meaningful life. You are not alone, and solutions exist to support you.
Our guide to supporting people with Multiple Sclerosis https://www.dynseo.com/la-reeducation-cognitive-lorsque-lon-est-atteint-dune-sclerose-en-plaques/
