Many people with MS will relate to the statement "MS hits each person where it hurts the most." By this, I mean that we seem to develop symptoms that limit our ability to do what we love the most.
I can certainly tell you that in my case, MS did not steal my ability to win marathons or sing opera. The "punch in the gut" MS symptom that I experienced (and continue to struggle with) is cognitive dysfunction. At my worst, I was unable to read complicated text or keep up with fast-moving conversations. It certainly made life at the academic institution where I was on faculty nearly impossible. These days, I am doing better – I have learned how to compensate for this symptom in many ways.
Over half of people with MS have cognitive issues, including problems with short-term memory, executing functioning, word-finding, and speed of information processing. Much work is being done in this area. Dr. Ralph Benedict, Professor of Neurology at SUNY Buffalo, says that much research is being done around cognitive impairment, including work on: attempts to treat cognitive impairment, risk factors (why do some people have it and others not), changes in physiology, how to measure cognitive impairment.
Two approaches to treatment of cognitive dysfunction are being studied: 1) rehabilitation and 2) treatment using medication.
One group is working on a rehabilitation approach called the modified Story Memory Technique, which has been shown to improve short-term memory in people with MS. This approach is comprised of 8 sessions of 30-90 minutes long, 2 sessions per week. During these sessions, people work with a therapist or psychologist on memory techniques. The modified Story Memory Technique teaches skills around using context and imagery to facilitate learning.
During some sessions, the patients are shown a written story. Many of the key words are written in all capital letters and the story focuses on images. An example that I have seen used is: Mr. Jones PULLED a fresh APPLE from a TREE.
Patients are asked to retell the story that they have read to the therapists. They then work with the therapist, who gives them tips to remember the story better. This exercise is repeated twice in each of the first four sessions with the same story – the goal being to recognize imagery and use it in recounting a situation that occurred or a story that was heard.
During the next couple of sessions, a list of words is given to the patients who are taught to make a story out of them to better memorize them. In the final sessions, the patient and the therapist work together on ways to apply these techniques in their lives.
This technique has been shown to have an impact on cognitive function in three studies, reports Dr. John DeLuca.
Two of these studies have been shown to improve measures on cognitive tests, comparing treatment with this technique to a placebo. Interestingly, the treatment effect was maintained for some time after the treatment ended and continued to improve during 5 follow-up tests.
The other study looked at changes in brain activity on a functional MRI scan after treatment and found greater activation in many parts of the brain when people performed a memory task.
"At this time, it is time to take this data and start designing a program to help our patients using these techniques," says Dr. DeLuca. He also said he thinks that 8 to 10 sessions will not be enough, but that booster sessions will be required, which is currently being studied.