Understanding use and predictors of compensatory cognitive strategies in people with multiple sclerosis

Cognitive impairment is common in multiple sclerosis (MS) and affects daily functioning. Compensatory cognitive strategies can help mitigate these challenges, but their naturalistic use and predictors remain unclear. This study aimed to examine the frequency and types of strategies used and to determine whether demographics, objective cognitive function, or perceived cognitive function are independently associated with the use of compensatory strategies.

A secondary analysis of baseline data from 268 people with MS was conducted. Compensatory cognitive strategy use was assessed via the Compensatory Cognitive Strategies Scale, perceived cognitive function via the PROMIS Cognitive Function Abilities Short Form, and objective cognitive function via the NIH Toolbox Cognitive Battery. Descriptive statistics characterized compensatory strategy use. A hierarchical linear regression analysis was performed to identify significant predictors of compensatory cognitive strategy use.

Participants (mean age = 50.8 ± 11.9 years, 77.2 % female) most frequently used electronic reminders (86.6 %), established routines (83.6 %), and broke tasks into smaller steps (84.7 %), while work-related strategies were the least utilized. Lower perceived cognitive function (β = -0.232, p < .01) and walking disability (β = 0.182, p < .01) were significantly associated with greater compensatory strategy use.

Perceived cognitive function, rather than objective cognitive function, was associated with compensatory cognitive strategy use. Neuropsychological assessments should identify individuals who are cognitively impaired, especially those unaware of their deficits, to provide guidance on effective strategies. Future research should evaluate compensatory cognitive strategy training to improve long-term functional independence in MS.