10 Ways to Preserve Your Brain Health if You Have MS

If you have multiple sclerosis (MS), you’re probably aware of the wide range of symptoms that could develop over the course of your disease.  Some, such as fatigue, spasticity, and walking difficulties, are well-known, whereas others, such as cognitive issues, are less commonly discussed.

Over half of all people with MS will develop problems with cognition at some point, according to the National Multiple Sclerosis Society. Usually, but not always, these changes are mild, and they don’t necessarily correspond to how severe your physical symptoms are. They can occur in anyone who has MS but are more common in people who have had the disease a long time.

As you might expect, cognitive changes are associated with the number and location of brain lesions seen on an MRI, as well as brain atrophy (shrinkage). These changes may become noticeable in different ways, such as:

• Trouble finding or remembering words
• Forgetting what to do in your home or work routine
• Trouble making decisions or judgments
• General difficulty with your job or school performance

There’s a widespread but mistaken belief that not much can be done about cognitive changes in MS. There are many things you can do to potentially improve your cognitive health.

Most of the actions you can take won’t interrupt or slow the disease process that’s contributing to your symptoms, but your brain is a complex organ that’s affected by numerous processes in your body, and changing any one of these can have an impact on your brain health.

Here are 10 steps you can take to preserve — or even improve — your brain health when you have MS.

1. Get Enough Sleep

Research shows that too little sleep is linked to worsening cognitive performance in people with MS, according to Meghan L. Beier, PhD, a neuropsychologist and assistant professor of physical medicine and rehabilitation at Johns Hopkins Medicine in Baltimore. “We know that people who get less than seven hours of sleep tend to have worse cognition,” she says.

A study published in March 2023 looked at 524 women with MS who were part of the much larger Nurses’ Health Study, a survey of more than 60,000 women on a range of health topics. The MS-focused report found a strong connection between cognitive impairment and sleep challenges like obstructive sleep apnea, insomnia, and sleepiness.

The research reflected the findings of an earlier study, from 2016, which looked at people with MS who slept poorly because of obstructive sleep apnea. That study found that less overall sleep and greater sleep fragmentation were both independently and significantly associated with deficits in visual and verbal memory, attention, executive function (the ability to plan and focus on tasks), and processing speed, accounting for 27 and 18 percent of the measured cognitive changes, respectively.

2. Work to Manage Fatigue

Fatigue can be a major factor in worsened cognitive performance in people with MS, according to Dr. Beier. “Fatigue management is really helpful,” she says. “We also know that things in the environment can have an effect on cognition, like heat. So when you’re doing something cognitively taxing, try to be in an environment that’s going to help cognition,” such as somewhere cool and relaxing.

Generally speaking, Beier says, fatigue management means planning out your days so that you don’t need to do anything physically or mentally demanding when you’re most likely to be exhausted.

3. Get Enough Physical Exercise

The right kind of exercise can help your brain function at its best, especially executive functioning, Beier notes. Some studies suggest that doing something cognitively challenging while exercising — having an in-depth conversation, doing math problems — enhances the benefits.

In a study published in 2018, researchers compared a high-intensity interval training program with a standard exercise program in 60 participants with MS. While both groups saw improvement in executive functioning, such as the ability to plan and prioritize tasks, the group that did interval training also saw improvements in their verbal memory.

4. Take Your Medication

If you don’t take your MS medication, your cognition will be worse long term, says Beier. “Consistently taking your disease-modifying medication is predictive of having better cognitive outcomes down the road.”

In a research review published in 2018, the authors concluded that both disease-modifying drugs and those for symptom management could have a positive impact on cognition in people with MS.

There is evidence that some medications that are used for cognitive improvement in other disease states, such as Alzheimer’s, may also help improve cognitive function in MS as well. There have been some studies looking at donepezil (Aricept) in MS patients with cognitive impairment that have demonstrated improved function.

5. Follow a Healthy Diet

Your diet may not be directly tied to your ability to think, but research has shown that in people with MS, nutrition can impact fatigue and depression, which can have an indirect effect on cognition, says Beier.

In people without MS, studies have shown that the MIND Diet, similar to a version of the Mediterranean diet, can slow cognitive decline associated with aging. While this finding hasn’t been validated in people with MS, Beier still recommends reducing sugar and processed grains and including vegetables (especially leafy greens), berries and other fruit, olive oil, fish, and lean meat in your diet.

6. Do Brain Exercises

If you’re experiencing worsened cognitive function in one area — for example, your verbal memory, attention, or executive functioning — you can do brain exercises designed to improve that particular aspect of cognition, Beier notes.

As a neuropsychologist, Beier assesses people with MS to determine their cognitive strengths and weaknesses and then helps develop a program of brain exercises specific to their needs. These kinds of tailored programs have the most evidence behind them, she says, but there are also general programs that have been shown to improve cognition in people with MS.

A study published in 2017 showed that in cognitively impaired adults with MS, a computer-based, 60-hour, 12-week brain exercise program significantly improved cognitive functioning, as measured by neuropsychological assessments.

7. Take Part in Social Activities

Being social with friends, family members, or even strangers in a friendly environment can be an antidote to feelings of isolation, which can lead to mental health problems like depression and anxiety. Unfortunately, many people with MS face both physical and mental barriers to social interaction.

Beier says that when some people experience a cognitive lapse, such as forgetting a word or someone’s name, “they have this visceral, emotional reaction. That’s totally normal and understandable, but it could increase anxiety and keep people from going out or talking with their friends.”

Part of the challenge in dealing with cognitive symptoms, Beier says, is learning to manage your reaction to them so you don’t lose your motivation to interact with other people or “to try new things [to] keep your brain active and engaged.”

8. Try Mind-Body Routines

A variety of activities that promote a sense of well-being and positive connection to your body, including meditation, guided relaxation, yoga, and tai chi, may be beneficial to your emotional health. That, in turn, may help improve your cognition in the long run, although the evidence is murky.

For example, one 2014 study of people with MS found that yoga helped reduce fatigue and improve mood in the short term, but it didn’t boost cognitive function. But that doesn’t mean less fatigue and a better mood wouldn’t enhance cognitive function over time, since that specific consideration was outside the scope of the study.

9. Take on a Creative or Intellectual Project

Any activity that keeps you motivated and your mind engaged may be good for your cognitive health by potentially improving your mood and, sometimes,  your executive functioning, says Beier. But there isn’t much data to support this, since everyone’s idea of an engaging creative or intellectual project is different.

Researchers in a 2013 study found that people with MS who scored higher on “active cognitive reserve” — the idea that neuronal connections in your brain can be increased through creative, cultural, or athletic activities — had a lower overall symptom burden than those who scored lower on this measure.

There may be real emotional and cognitive benefits from taking on any creative or knowledge-building activity that appeals to you, such as drawing, painting, learning a language, writing, or playing an instrument. How good you are at the activity is less important than the enjoyment and fulfillment you derive from it.

10. Get Evaluated

While there’s a lot you can do on your own to help your cognitive health, you may be able to do even more with an assessment and plan of action from a healthcare professional, such as a neuropsychologist.

Getting a cognitive evaluation will identify your strengths and weaknesses so you can develop strategies to improve your weaker areas, Beier says. This effort doesn’t have to begin with a neuropsychologist, she emphasizes. You can start by talking with your neurologist or primary care provider about getting screened for cognitive problems.

Ultimately, Beier says, “I hope that people advocate for themselves to get their cognition assessed in some way or another.”