Changes in thinking and memory are common with PPMS, but steps like staying active and keeping your mind engaged can help support your brain health.

Primary progressive multiple sclerosis (PPMS) affects more than your mobility. You may also start experiencing problems with cognition (your ability to think, remember, and reason).

A 2020 study estimated that 34% to 65% of adults with multiple sclerosis (MS) have some form of cognitive impairment. The risk is even higher in progressive forms of MS, with some studies showing that nearly 74% of people experience cognitive problems after about 11 years of disease progression.

These cognitive changes can look like:

  • thinking difficulties
  • issues with remembering things, especially from the past
  • issues with learning new tasks
  • problems with multitasking
  • forgetting names
  • issues with following directions
  • taking longer to think through or respond to information
  • issues with coming up with the right words

Since PPMS primarily affects the spinal cord rather than the brain, cognitive changes may come slowly.

Learn some of the ways you can boost your brain health every day.

Exercise doesn’t just help your body; it can also support your thinking and memory.

If it’s difficult to perform certain activities because of mobility issues, you can try exercises that work for you, like walking, swimming, yoga, or tai chi. These can be changed or adjusted to fit your needs.

If you’re just getting started, try exercising for a few minutes at a time. As you build strength, you might work up to 30 minutes before taking a break. However, be sure to check with your doctor before trying something new.

Not getting enough sleep can worsen thinking and memory problems. People with PPMS often have trouble sleeping because of discomfort at night.

Try to get as much sleep as possible — it can help your health, mood, and thinking.

Memory games can help strengthen both short- and long-term memory, which can be affected by PPMS. From internet games to smartphone apps, there are many options to try.

Writing is also good for your brain. Even if you don’t write a lot, keeping a journal can help you practice finding words and putting sentences together. Plus, reading your old entries later can help keep your reading skills strong.

Along with memory games and writing, you can keep your brain sharp by doing puzzles and problem-solving activities. Try a word game or a math game on your own or download a problem-solving app. You can also make it fun for everyone by having a weekly family game night.

Short-term memory problems with PPMS can make it easy to forget things like appointments, birthdays, or other plans. Instead of feeling bad about it, try using a personal organizer.

Most phones have calendars and alarms you can set to remind you of important dates. If you prefer, you can use a paper calendar instead.

You might also want to organize your home office with a new filing system. Create folders for documents like bills, medical papers, and records. Being organized from the start can make it easier to keep track of what you need every day.

Reading is fun, but it’s also a great way to keep your brain active. Whether you like paper books, ebooks, or magazines, reading can help challenge your thinking.

You might even join a book club. This will not only encourage you to read more but also give you a chance to socialize and connect with others.

A few disease-modifying therapies have Food and Drug Administration (FDA) approval for progressive forms of MS. For example, ocrelizumab (Ocrevus) is FDA approved for PPMS and may help slow the progression of the condition.

Doctors may also recommend other treatments to help manage symptoms like pain, muscle stiffness, or issues moving around.

At the same time, some medications, whether for MS symptoms or other health issues, can affect your thinking and memory. If you’re noticing problems with focus, forgetfulness, or mental clarity, it’s worth checking if any of your medications could be playing a role.

Medications that are most likely to affect concentration, thinking, and sleep include:

  • antidepressants
  • cholesterol-lowering drugs
  • muscle relaxers
  • seizure medications
  • steroids

Your doctor may be able to adjust the dose or switch to a different medication to help lessen any effects on your memory and thinking.

It’s also important that all your doctors, including your pharmacist, know about everything you’re taking. This is so they can watch for potential drug interactions or side effects that might be mistaken for something else.

Counseling for PPMS is available one-on-one or in a group setting. Individual counseling involves therapy techniques to help improve your well-being and build confidence.

Group counseling gives you the chance to connect with others, and just spending time with people can help keep your brain active. You might also want to check out an MS support group, like Healthline’s Bezzy MS community.

Testing for thinking and memory problems can be tricky with PPMS. Your doctor will mostly look at your symptoms to guide them. Tests that check your brain and memory may also help.

One test your doctor might use is called the paced auditory serial addition test (PASAT). In this test, you listen to numbers and have to add them together as you go. It only takes a few minutes, but it can feel stressful for some people.

Along with brain-boosting activities, your doctor may also suggest a mix of occupational therapy and speech therapy to help support your thinking skills.

Cognitive changes like memory or thinking problems are common in primary progressive multiple sclerosis (PPMS), especially as the disease progresses. However, there are ways to support your brain health and stay mentally sharp.

Simple activities like reading, writing, puzzles, and memory games can help keep your mind active. Joining a book club or having a regular game night adds social time, which also benefits your brain.

Staying organized is another helpful tool. Using calendars, reminders, or setting up a filing system can make it easier to keep track of daily tasks and reduce stress.

Talk with your doctor if you notice changes in your thinking or memory. They can check your medications, recommend therapies, or suggest other ways to help.

Most of all, remember that you’re not alone. With the right strategies and support, you can keep living a meaningful and fulfilling life.