What cognitive impairments affect people with multiple sclerosis?

Cognitive impairment affects about 40-60% of people with MS. Common deficits are heterogeneous but often include reduced processing speed, impaired attention and concentration, memory problems, and executive dysfunction (planning, flexibility, working memory).

What is the Find the missing numbers activity?

An exercise that requires locating missing numbers within a numeric sequence (for example, 1–50). Participants search for absent numbers and follow rules such as not recording them until all are found.

How does Find the missing numbers train processing speed in MS?

Processing speed is trained by imposing a time limit for completion. Any time-restricted version of the task encourages faster visual scanning and decision-making under tempo constraints.

How does the activity train memory and working memory for people with MS?

Memory is trained by requiring participants to store all found numbers mentally until the final write-down; working memory is challenged by alternating search directions, forcing manipulation and updating of stored information.

How can therapists customize the exercise for individuals with MS?

Customize sequence length, number of missing numbers, time limits, number of exercises, pauses, and session performance goals. Start from an individualized baseline and modify difficulty to keep tasks neither too easy nor too hard.

What clinical benefits does this single exercise offer for people with multiple sclerosis?

Provides multi-domain cognitive training (processing speed, attention, memory, executive functions), promotes functional relevance, saves session time, and supports therapist-patient interaction and goal-setting.

One Cognitive Exercise, 4 Uses for Multiple Sclerosis

Juan Portillo Rivas, a health psychologist at ACODEM, suggests a NeuronUP activity for working on the cognitive impairments associated with multiple sclerosis.

Given NeuronUP’s eminently practical and functional philosophy, we thought it would be useful, practical, and enjoyable to use one of the platform’s activities to briefly and simply review aspects of cognitive impairment associated with multiple sclerosis (MS). If you’re interested in more theoretical information about this disease, I encourage you to visit the website of the Córdoba Multiple Sclerosis Association.

Some preliminary considerations

Not everyone diagnosed with MS ends up developing cognitive impairment. According to Fisher (2001), cognitive impairment affects between 40% and 60% of people with MS.
The main characteristic of cognitive impairment in MS is its heterogeneity and variability between individuals, so it’s risky to propose cognitive deficit profiles in MS.
Even so, according to Cummings and Benson (1984), there is a profile of cognitive impairments associated with MS, characterized by the presence of problems with processing speed, attention and concentration, memory, and executive functions.

Based on this profile, I suggest an activity that lets us work on all of these functions in a single exercise.

The most complete cognitive exercise for people with multiple sclerosis: Find the missing numbers

The activity is Find the missing numbers. Most of you who use the platform will be familiar with it; for those who aren’t, here’s how it works.

What does it involve?

It involves finding a series of numbers missing from a given sequence.

Customizing the activity

The basic exercise I start from and then modify is this:

Sequence from 1 to 50,
5 missing numbers,
between 4 and 7 minutes, depending on the person,
the missing numbers aren’t written in until all of them have been found,
session goal: 3 correct exercises in a row or 4 correct exercises non-consecutively,
always try to start with a baseline adjusted to the person’s situation and change variables based on the results,
it should never be too easy or too hard,
set a performance goal at the start of the session.

NeuronUP activity: Find the missing numbers.

Working on different executive functions

Below, we explain how we use this exercise with people with multiple sclerosis to work on the following functions.

To work on processing speed

The variable to change is the time limit for the exercise. In fact, any activity or exercise, for any function, becomes a processing speed exercise when we set a time limit.

To work on memory

Unlike in the original exercise, the boxes with the missing numbers aren’t crossed off one by one as they are found; instead, the person has to “store in memory” all the numbers until they find the last one, and only then do they write them all in.

I gradually change the number of missing numbers to remember.

To work on sustained attention and concentration

I change:

The length of the number sequence,
the number of exercises,
the break between exercises.

To work on executive functions

Specifically flexibility, planning, and working memory: the exercise requires the therapist’s active participation and continuous interaction, because the person has to say each time they find a number, since at that moment the search sequence changes (flexibility).

The person starts searching from 1 in ascending order; when they find the first number, they “call it out” aloud, and the search sequence changes to descending from 50 until they find the next one. At that point, they have to manipulate the information about the numbers they have stored so as not to start the search again from 1 or 50 (working memory) and waste time.

Conclusion

Many things can be worked on with a single exercise, which, on the one hand, makes it more functional (in daily life, we rarely use a single cognitive function) and, on the other, saves time.

I hope you find it useful. I’m sure it can be improved in many ways. Use your imagination to create your own most complete cognitive exercise for people with multiple sclerosis.