Multiple sclerosis is known for its vicious attack on the brain, spinal column and optic nerves. The damage leaves people with obvious symptoms, such as difficulty walking, tremors, involuntary muscle spasms and fatigue.

Less obvious are the cognitive challenges that MS causes. In fact, doctors began recognizing a link only recently. “Before neuroimaging in the 1980s and 90s, doctors felt like patients were depressed or had other influences causing cognitive problems. Today we know that up to two-thirds of individuals with MS have cognitive problems, and neurologists are listening,” says neuropsychologist John DeLuca, senior vice president for research and training at the Kessler Foundation, a rehabilitation research institute. He’s also a professor at Rutgers New Jersey Medical School.

Cognitive Change

In MS, the immune system attacks and damages the coating on the nerves (myelin) and the nerve fibers themselves. The type of cognitive symptoms patients experience depends on the amount and location of damage. “If you have damage in the hippocampus, you’ll have problems with learning and memory. If you have more damage in the frontal lobes, you’ll have more problems in executive function and problem solving. If you have damage throughout the brain, it results in slowed processing speed, even early in the disease, and even if there’s limited damage,” DeLuca explains.

Slowed processing may lead to problems with:

— Learning.

— Recalling new information.

— Attention.

— Concentration.

— Word finding.

These cognitive changes can be especially problematic for people within the workforce or in school. Patients may not be able to multitask, organize, learn or plan.

[See: 5 Ways to Cope With Mild Cognitive Impairment.]

Control Underlying Conditions

When cognitive challenges make it hard to get through the day, it’s time to talk to health care providers about ways to address changes in thinking.

First on the list: dealing with underlying conditions that may be making cognition worse. Common culprits include secondary conditions that often occur in MS, such as depression — which affects 20 to 50 percent of people with MS — and anxiety. “These conditions can exacerbate cognitive dysfunction and make it difficult to cope,” says Abbey Hughes, a clinical psychologist and assistant professor at the Johns Hopkins University School of Medicine. She explains that treating mental health conditions can help improve cognition.

[See: How to Find the Best Mental Health Professional for You.]

Fatigue — a common MS side effect — also affects cognition. “When we’re fatigued, we may not be able to put forth the same cognitive effort. Performance can be impacted by that,” Hughes says. She recommends taking a five- or 10-minute break every 60 to 90 minutes. “Don’t wait until you’re burned out,” Hughes urges.

Sleep deprivation can also impact cognition. It may be caused by sleep apnea — pauses in breathing throughout sleep — which is common in MS, according to the UW Medicine Multiple Sclerosis Center in Seattle.

Tips to Cope

Your doctor may refer you for a course of cognitive rehabilitation, with therapists who teach strategies to cope with cognitive change. For example:

Try self-generated learning. A study by DeLuca and his colleagues found that you’ll remember information if you generate the answers yourself. In other words, try to figure out how to do something on your own, rather than allowing others to give you the answers.

Repeat information out loud. “If you read it and hear it, you’ll get the information twice, and it gives the brain another chance to encode or process the information and record it,” Hughes says.

Summarize information. “It’s a proactive way for people to encode information using their own words, especially if they have a hard time remembering conversations or things they read,” Hughes explains. For example, summarize a passage after you read it, and then summarize it again at the end of a chapter.

Space periods of learning apart. “If you space the learning trials apart, you’ll remember better than if you crammed. For example, read a newspaper article three times, each 15 minutes apart. You’ll remember it better than reading it three times in a row,” DeLuca says.

Minimize multitasking. Because MS slows processing speed, it limits the ability to switch tasks rapidly — say, from email to the phone to a person in the office and back to a computer. “Instead, focus on one task at a time,” Hughes advises. “For example, respond to email at 8 a.m., and return phone calls at 10 a.m.”

Chunk information. Break information into smaller chunks, the way you would with a phone number.

Visualize information. It improves the likelihood that you’ll recall it later. “If you can remember the image of a cake, and how to make it, that can help you remember cake ingredients in a store,” DeLuca says.

Give yourself more time. “Instead of scanning a page when you’re reading, be deliberate and process it. When people are given extra time to learn something, it improves their ability to encode it and recall it later,” Hughes explains.

Use smart technology. Set reminders or alarms on a smartphone. Think of it as outsourcing the task to a computer or phone, and giving your brain a break.

Make a memory book. This is helpful if technology feels overwhelming. Fill a binder with a calendar and a to-do list, and refer to it throughout the day.

Make a list. “When you prioritize your responsibilities, they become more manageable and memorable,” Hughes says.

Keep information in one place. Don’t use several calendars; use one. That will make it easier to keep track of things.

[See: 9 Foods That Can Keep Your Brain Sharp.]

Protect Cognition Now

In addition to using helpful strategies for daily activities, it’s important to protect your cognition against the progression of MS. One way to do that is by sticking to the regimen of disease-modifying medications prescribed by your doctor.

Another way is by boosting cognitive reserve — a sort of protective shield for thinking skills that’s built by a lifetime of intellectual stimulation. A study by DeLuca and his colleagues showed that cognitive reserve protects cognition in people with MS, just like it does for people without MS. “It creates a brain that’s more resistant to MS, even though the disease may progress,” DeLuca says.

Build cognitive reserve by challenging your brain to make new brain cell connections. “Go for that job, stay in school, socialize and do the kinds of activities that will stimulate your brain, like playing cards or joining a reading club,” DeLuca says.

Is there time to build cognitive reserve, even if you’re an older adult? “Yes, absolutely,” DeLuca says. And it’s a strategy that can help make your life richer along the way.

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Does MS Affect Cognition? originally appeared on usnews.com