b'Medicine and ResearchMMuullttiipplleeSScclleerroossiissaannddCCooggnniittiioonnCChhaannggeessoovveerrttiimmeeaannddssttrraatteeggiieesst oooppttiimmiizzeeppeerrffoorrmmaanncceetoBy Nicole J. Tester, Ph.D., MOT, OTR/L, MSCSMultiple sclerosis is most often associatedspeed is one of the earliest and most common with motor, sensory, and visual symptoms.abilities affected. People with MS may process An equally signicant, but often less visible,information slower, thereby making tasks aspect of the disease is cognitive impairment.requiring rapid comprehension or multitasking Research estimates 40 to 70 percent of peoplemore difficult. Sustained attention and divided with MS experience some degree of cognitiveattention also may be impaired, leading to dysfunction. This can contribute to reducedstruggles with mental fatigue or distractions. quality of life, diminished independence, andSubtleimpairmentsinthesetwoareasof occupational hurdles. Cognitive difficulties maycognition can emerge early, and in some cases, appear early, progress at variable rates, andprior to the onset of physical symptoms.present challenges that extend beyond physicalRReellaappsseessaannddpprrooggrreessssiioonndisability.UnderstandinghowMSaffectsCognitive worsening can occur during cognition, how these impairments evolve, andrelapses. This worsening typically is temporary what strategies can mitigate their effects isand exacerbated by fatigue, stress, or other essential to optimizing functional independence. comorbid conditions (e.g., anxiety, depression). Cognitive functions rely heavily on coordinatedInherent brain plasticity, or the brains ability, activity across a variety of brain networks.and the subconscious use of compensatory These networks, known as white matter tracts,strategies can help mitigate functional effects. are areas where MS lesions often occur. ChronicAs a result, cognition may remain relatively inflammation linked to MS also releasesstable for years during the relapsing-remitting neurotoxicsubstancesthatcanleadtophase of the disease.neurodegeneration and further worsening ofIn primary and secondary progressive MS, cognition.Overtime,corticalatrophycognitive impairment often becomes more (destruction) or damage to gray matter canprominentandwidespreadbecauseof directly affect specic regions of the brain. the neurodegeneration and brain atrophy The areas of cognition most frequentlyprogression. Learning new tasks may become affected among individuals with MS includemore challenging due to a decreased ability processing speed, attention and concentration,to store new information. More importantly, memory,executivefunctioning(planningdecision-making and daily life management and problem solving), and visuospatial skillsmay be compromised because of difficulties (spatial orientation, visual perception, orwith planning, organizing, problem-solving, constructional tasks). Information processingandabstractreasoning.Itisimportantto msfocusmagazine.org 8'