b'note, however, that cognitive decline does notservice versus spending time in the grocery always parallel the progression of physicalstore during the summertime. Alternatively, disability.Infact,cognitionmayremainutilize a handicap parking permit to shorten relativelyunaffectedinsomeindividuals,the walking distance and cooling devices to while others may experience a gradual declinemanage heat-related fatigue if you choose to that signicantly interferes with all aspects ofgo to the store.their life (e.g., daily activities, socialization,Plan the best way for you to accomplish the and employment). most important tasks, taking into consideration T how it will make you feel physically, cognitively, ThheeTThhrreeeePPssIndividuals with MS can experience cognitiveand emotionally.fluctuations in daily performance. SuchSufficient sleep is also a crucial element uctuations occur because of the effects ofoffatiguemanagement.Withoutagood fatigue, sleep, heat, mood, medication effects,night of sleep, individuals with MS wake up and environmental demands. Fatigue (physicalatadisadvantagebeforetheyevenbegin or cognitive), which is common in MS, cantheir day. Ensure your sleep environment is worsen symptoms, making mental effort morecomfortable (e.g., quiet, cool, dark), limit use taxing and cognitive performance throughoutof your bed for sleep and sex (e.g., avoid eating the day more variable. Given the many waysand watching TV in bed), and implement the in which physical and cognitive fatigue can15-minute rule: if you cannot fall asleep in 15 exacerbate cognitive impairment, managingminutes, get out of bed and do something fatigue is critical in MS. Specically, energyrelaxing until you become sleepy. This avoids conservation, sleep hygiene, and aerobicany associations your brain may make with exercise. learning to stay awake while in bed. Lastly, Energy conservation can be summed upimplementingaroutineaerobicexercise using the 3 Ps: planning, prioritizing, andprogram not only improves activity tolerance pacing. Make a list, prioritize the tasks onbut also reduces fatigue and improves cognitive the list, and then pace the rate at which youfunctioning. perform the tasks across a day, week, or month.I nddiivviidduuaalliizzeeddaapppprrooaacchheessInIt may be benecial to perform more demandingSeveraladditionalstrategiescanbe tasks earlier in the day at peak energy levels. implemented to improve or optimize cognitive Takerestbreaksthroughoutthedayfunction. Given the chronic and variable (preferably before the onset of fatigue) tonature of MS, however, these strategies must ensure you will be able to engage in activitybe adapted and individualized. Cognitive throughout the entire day. For example, choprehabilitation is a common approach used by vegetables for dinner in the morning andoccupational therapists, speech therapists, refrigerate them until its time to cook. Modifyand neuropsychologists to promote restoration the task by chopping during sitting to conserveor compensation.some energy for later in the day. Better yet,Restorative approaches are typically prep meals over the weekend with the help ofemployed in earlier stages of the disease. your family. If chopping is too time consumingThis is because restoration aims to restore or fatiguing, purchase prechopped vegetables.function using existing neural circuitry through Also consider the use of a grocery deliverymass practice of tasks that stimulate attention, 9 msfocusmagazine.org'