Dual-Task Training for MS: A Practical Guide to Boosting Cognitive Function

We've all seen it in our MS patients: that frustrating cognitive fog that can be just as debilitating as the physical symptoms. For years, we've addressed motor and cognitive deficits separately. But what if we could tackle both at the same time? That's the idea behind dual-task training (DTT), and the latest research is showing some promising results.\n\nA 2022 systematic review and meta-analysis by Abasıyanık et al. found that DTT has a large, positive effect on executive function in people with MS. This is a big deal, as executive functions – things like planning, problem-solving, and self-monitoring – are crucial for everyday life. While the review found non-significant improvements in processing speed and working memory, a more recent 2025 randomized controlled trial by Ekici et al. showed that an 8-week DTT program did significantly improve cognitive function, as well as balance, fatigue, and walking speed. This suggests that the right DTT protocol can indeed move the needle on processing speed.\n\nSo, what does a DTT program look like in practice? The Ekici et al. study provides a great template. Their 8-week program involved twice-weekly sessions of both motor-motor and motor-cognitive dual-tasks, supplemented with a home exercise program. Motor-motor tasks could be something like walking while bouncing a ball, while motor-cognitive tasks might involve walking while counting backwards by sevens. The key is to challenge the brain and body simultaneously, forcing them to work together more efficiently.\n\nWhen selecting patients for DTT, it's important to consider their baseline cognitive function. A 2025 secondary analysis of the CogEx trial by Sandroff et al. found that patients with existing learning and memory impairment and higher premorbid IQ showed the greatest improvements in processing speed with a combined cognitive and exercise intervention. This doesn't mean that other patients won't benefit, but it does suggest that those with more cognitive reserve may have more to gain.\n\nIt's also important to be aware of potential contraindications. Patients with severe cognitive impairment may struggle with the demands of DTT, and those with significant balance issues may be at increased risk of falls. As always, a thorough initial assessment is key to ensuring patient safety and maximizing the chances of a positive outcome.\n\nIn our clinic, we've started incorporating DTT into our treatment plans for MS patients with cognitive complaints. We've found that it's a great way to keep patients engaged and motivated, and we're seeing real-world improvements in their ability to multitask and navigate their daily lives. It's not a magic bullet, but it's a powerful tool in our toolbox for helping our MS patients live their best lives.