How Your Brain Can Benefit From Cognitive Remediation Therapy

Living in this fast-paced world, it’s likely that you’ve experienced one of those moments that make you wonder if you’re losing your memory: You can’t recall a co-worker’s name; you forget the word you were trying to say; you misplace your keys for the third time. Brain fog can be quite common.

The good news is that these occasional memory errors are not usually cause for concern. “To some extent, almost everyone will notice some decline in memory once they get into their 50s,” says Olga M. Nikelshpur, Ph.D., a neuropsychologist at the Center for Memory Loss and Brain Health at Hackensack Meridian School of Medicine. 

But sometimes, experiencing memory lapses can be a sign of a more serious condition, such as Alzheimer’s disease, or a symptom of other neurological conditions such as multiple sclerosis (MS) or Parkinson’s disease, to name a few. Recent research suggests that 41 percent of patients with MS experience some level of cognitive impairment; another study of patients with Parkinson’s disease showed that 40 percent had cognitive impairment.

Though it has not been shown to help those with progressive cognitive decline due to dementia, cognitive remediation therapy (CRT) can help people with MS and Parkinson’s disease, as well as patients who have had a stroke or a traumatic brain injury. It retrains the brain using strategies that make it easier for patients with measurable cognitive decline to improve thinking skills, including but not limited to different ways to learn new things, retain information and get back to functioning optimally. 

Here’s how cognitive remediation therapy works and who it’s best for, along with CRT-based strategies that can help all of us when we’re not feeling our sharpest. 

What Is Cognitive Remediation Therapy? 

Cognitive remediation therapy is a type of rehabilitation that retrains the brain with strategies and targeted exercises that are meant to address cognitive weaknesses that show up in a neuropsychological assessment, according to Dr. Nikelshpur. 

“To qualify for CRT and to get insurers to cover it, you need to have weaknesses documented by a formal neuropsychological evaluation,” she explains. This assessment will inform the goals of CRT, which is geared toward helping people do their best in daily life, whether at work, at home or in social situations. 

Who Is Cognitive Remediation Right For?

While most people occasionally feel as if they could benefit from a dose of brain retraining, CRT has only been proven to bring measurable benefits to people with documented, significant abnormal decline in cognition.“There are clear benefits for people with Parkinson’s disease, stroke, traumatic brain injury, or MS,” says Dr. Nikelshpur. In contrast, “people who simply are experiencing occasional memory issues or brain fog due to normal aging or menopause haven’t been shown to benefit from the therapy,” she explains. 

What Does CRT Entail?

Typically, a course of CRT might last 18 weeks, with patients coming in once a week for an hour at a time. “But that varies — sometimes a course of CRT can be as short as four weeks or as long as a year or more,” Dr. Nikelshpur says.

CRT is all about learning to use proven strategies, such as visualization or filtering out distractions to improve focus, in everyday life. During each session, people do progressively more challenging exercises with the CRT therapist while also putting those strategies to use at home.

Each patient will walk away with strategies meant to address their specific cognitive challenges, which might include memory issues, difficulty learning, processing speed (how quickly we are able to take in, understand and respond to information) or executive functioning (the ability to do things like plan, organize, problem-solve and control emotions). 

How Do You Know If You Should Pursue CRT? 

If you feel like you’re forgetting more than usual, or even if you simply feel worried that you’re not as sharp as you used to be, the first place to start is with your primary care physician.

Depending on your symptoms, your physician might send you to a neurologist, who can do a brief in-office cognitive screen for starters. Based on those results, you might be referred for a full neuropsychological exam with a memory specialist. “The specialist will then compare the results to [those of] a typical person of the same age to see if there is an objective decline in cognitive functioning,” Dr. Nikelshpur explains.

What Kinds of Cognitive Changes Are Normal? 

It’s normal to notice a dip in memory when you hit your 50s — those occasional moments of searching for a common word or misplacing your glasses. The difference is, while these memory blips may feel scary or upsetting, says Dr. Nikelshpur, “they tend not to be disruptive to your life, relationships and work.”

If Testing Finds a Deficit, How Can CRT Help?

CRT strategies are designed to help retrain the brain, taking advantage of the brain’s neuroplasticity — or ability to change. “We’ve seen on fMRI [functional magnetic resonance imaging] scans that CRT taps into the brain’s neuroplasticity, with new connections being formed in brain regions responsible for memory and organization,” says Dr. Nikelshpur, “increasing patients’ ability to think, learn and plan efficiently.”

What Are Some Common CRT Strategies? 

CRT involves strategies designed to improve or work around measurable cognitive brain changes, including:

• Story Memory Technique, which trains patients to use visual imagery and context to improve learning and recall of new information
• Memory Notebook Training,where patients learn to use notebooks to log their activities and appointments and stay organized
• Attention Process Training (APT), which targets different types of attention (focused or sustained, for instance) by having patients do tasks of increasing difficulty
• Time Pressure Management (TPM),which helps patients learn to plan ahead, among other things, so they are not forced to make quick decisions under pressure
• Goal Management Training(GMT), which helps with executive functioning by teaching patients to be more mindful of their goals 
• Compensatory Strategies,which involve using devices to help with memory, whether a paper planner or alarms on a mobile phone

Can People Experiencing Typical Cognitive Changes Also Benefit From These Strategies? 

People with usual and expected cognitive changes can use some of these tips to function more optimally. For instance, if you rely on a digital calendar to keep track of meetings but still find that you’re missing them, try switching to an old-fashioned desk calendar and write out your appointments instead. When you write things down rather than typing them, you are more likely to remember it according to Dr. Nikelshpur. Additionally, brain training using Brain HQ Double Decision task has recently been evaluated in a large-scale controlled clinical trial and shown promising results in delaying or preventing significant cognitive decline in adults 65 and older. According to the ACTIVE study, 2 hours of training with Double Decision per week resulted in lasting improvements in thinking skills as well as reduced risk of depression, being involved in the at-fault car accidents, and loss of independence in daily living skills. 

Next Steps & Resources:

• Meet our source: Olga M. Nikelshpur, Ph.D.
• To make an appointment with a neurologist near you, call 800-822-8905 or book an appointment online.
• Learn more about New Jersey’s only nationally ranked neurology program at Hackensack Meridian Health.