Techniques to Improve Memory for People with Multiple Sclerosis

Generation Effect:

Information that is self-generated, or generated from your own mind, is remembered better than information supplied to you.

This effect has been studied and observed in the general population for decades,1, 2 but was recently studied in multiple sclerosis. Individuals were divided into two groups. The first group was asked to learn new information using the Generation Effect. The second group was simply provided the same information. Both groups were tested immediately after learning, 30 minutes later, and then again one week later. The individuals that used self-generation remembered significantly more than those that were simply provided with the information.3, 4

Let’s try a few examples:

1.  What is the opposite of hot?                                                    c________________

2.  Name this picture:                                                                        h________________

3.  Complete this sentence:

After the winter storm, I went outside to walk in the cold white ______.        s________________

4.  Name a body part that rhymes with sand:                                                             h_______________d

This technique can be very helpful when you generate the correct information. However, if you generate the wrong information the same rules apply. You will remember the wrong information better, even if you are corrected (i.e., provided the correct answer).

Think about trying to learn someone’s name.  Was there ever a time when you generated the wrong name and that same wrong name kept popping into your head despite knowing it was incorrect?  Or a time when you opened a particular website, entered the wrong password, then continued to enter that same wrong password during future sessions? These kinds of “memory lapses” happen to everyone. They are not necessarily examples of impaired thinking.

We just need to learn to use the Gen______n Eff__t (what’s the name of this technique again? Fill in the blanks!) to aid our memory, not work against us.

Using this Technique in the Real World.

  • Employ the help of a friend or family member. If you are trying to learn someone’s name, have your friend or family member give you hints until you can generate the name yourself. It should be easier to remember next time.
  • Can you generate any additional ways this technique can be used in daily life?

WITHOUT LOOKING, what were the 4 words you generated above?

_________________     _________________     _________________     _________________

Spacing Effect:

Retention of information is improved when individuals use spaced learning (learning that is spaced out over time), rather than massed learning (“cramming”).

Throughout school, I was told to space my studying out over time.  However, like many of my peers, I ignored this recommendation. Little did I know, this recommendation is based on cognitive research.

The Spacing Effect was also studied in persons with MS.5Individuals were divided into two groups. The first group was given a paragraph to read three times, with a 5 minute break in between each reading (spaced).  The second group was asked to read the paragraph three times in a row, with no break (massed). The spaced group remembered significantly more information in the paragraph than the group who read it three times in the row.

As adults, many of us are no longer studying to take tests. However, we can still apply this strategy to real life. For example, you may have to give a presentation at work. This requires remembering what you want to say and when.  Review your notes or slides several times, but take breaks in-between each review.  Can you think of any other ways the Spacing Effect can be used in daily life?

Testing Effect:

Information is remembered better when you are tested on it.

Remember pop quizzes?  Whether our teachers knew it or not, getting tested on material enhances retention. In fact, testing was found to be more effective than restudying for long-term memory.  In multiple sclerosis, the testing effect was even stronger than the spaced effect for retention of new information.6

What does this mean for daily life? Test yourself; have a friend or family member test you.

  • After being introduced to a new person, test yourself on their name.
  • Trying to remember where you parked your car? As you are walking away from the car (or into the store) test yourself on the location of your parking spot.
  • When you are trying to remember some facts for your presentation at work, turn your notes over and test yourself on the content.

What are some other ways you could test yourself throughout the day?


Memory is enhanced through the use of imagery (images in your mind). Several studies in MS have shown that the use of imagery enhances learning and memory.7, 8

A traditional use of imagery is a mnemonic technique called the method of loci.  Let’s pretend you need to remember a list of grocery items, but don’t have a writing utensil or paper to write them down.  You picture a well-known place or building. For example, you might picture your bedroom. Then, in your mind’s eye, “place” needed items around the familiar room.  You might picture a bag of apples on top of a pillow, milk spilled on the top of your dresser, or melted butter on the carpet. Once you get to the store, you can pull up the image of your bedroom, and use the imagery to recall the needed items.

Imagery can be used in other ways.

  • If you frequently forget where you placed your keys, try to actively create an image of where they are located when you put them down.
  • You need to pick up your kids from karate today. When the task pops into your mind, imagine getting in your car, as well as the route to the karate studio. This should help trigger the needed task when you get behind the wheel at the end of the day.
  • Can you think of other ways imagery could be useful?

Verbal Rehearsal:

Bringing your attention to the present task by verbally stating the steps out loud.

Throughout the day we are pulled in many directions. It is very common for our minds to wander to the next task or worry while in the midst of a current task, and this impacts memory.  Here are a few examples:

  • In the midst of cooking, you are worrying about your next doctor’s appointment and suddenly can’t remember how many cups of flour you added
  • You are thinking about the errands you need to run today, then realize you can’t remember if you placed those bills in the mailbox or left them on the kitchen table
  • You walk into a room and can’t remember what you were doing or looking for
  • You park the car and walk into the store while thinking about the items on your grocery list, when you come out of the store you can’t remember where the car is parked

To encode or learn information, your mind first needs to pay attention.  Too often we are thinking about something else in the midst of a current task, which disrupts your brain’s ability to learn and store new information.  Verbal rehearsal brings your mind to the present task, aids attention, and enhances encoding.

The technique of verbal rehearsal asks you to say out loud what you are currently doing, or what you want to remember.

  • “One cup of flour, two cups of flour, three cups of flour, I’m done with the flour.”
  • “I’m placing the bills in the mailbox.”
  • “I’m walking to the living room to find my glasses.”
  • “I parked the car near the tall tree with red leaves.”
  • “I’m placing my car keys on the kitchen table.”

It may feel silly at first, but it works! Eventually, when you have the technique down, you can start to say the verbal cues in your head. But first start by saying them out loud.

In Sum, these are just a few strategies that can be used to enhance your memory.  It can be difficult to incorporate new strategies into your life.  Therefore, start small!  Pick one strategy and try it for a week. When it becomes habit, or you find it does not work for you, try a second one.


1.    Greenwald AG, Johnson MM. The generation effect extended: memory enhancement for generation cues. Mem Cognit 1989;17(6):673-81.

2.    Rosner ZA, Elman JA, Shimamura AP. The generation effect: activating broad neural circuits during memory encoding. Cortex 2013;49(7):1901-9.

3.    O’Brien A, Chiaravalloti N, Arango-Lasprilla JC, Lengenfelder J, DeLuca J. An investigation of the differential effect of self-generation to improve learning and memory in multiple sclerosis and traumatic brain injury. Neuropsychol Rehabil 2007;17(3):273-92.

4.    Chiaravalloti ND, Deluca J. Self-generation as a means of maximizing learning in multiple sclerosis: an application of the generation effect. Arch Phys Med Rehabil 2002;83(8):1070-9.

5.    Goverover Y, Hillary FG, Chiaravalloti N, Arango-Lasprilla JC, DeLuca J. A functional application of the spacing effect to improve learning and memory in persons with multiple sclerosis. J Clin Exp Neuropsychol 2009;31(5):513-22.

6.    Sumowski JF, Chiaravalloti N, Deluca J. Retrieval practice improves memory in multiple sclerosis: clinical application of the testing effect. Neuropsychology 2010;24(2):267-72.

7.    Chiaravalloti ND, Moore NB, Nikelshpur OM, DeLuca J. An RCT to treat learning impairment in multiple sclerosis: The MEMREHAB trial. Neurology 2013;81(24):2066-72.

8.    Ernst A, Blanc F, Voltzenlogel V, de Seze J, Chauvin B, Manning L. Autobiographical memory in multiple sclerosis patients: assessment and cognitive facilitation. Neuropsychol Rehabil 2013;23(2):161-81.

Meghan Beier, PhD is a Rehabilitation Psychologist and Clinical Researcher specializing in multiple sclerosis (MS) at the Johns Hopkins University School of Medicine (Dr. Beier’s profile). Dr. Beier obtained her Ph.D. from Yeshiva University. She also completed a 2-year National Multiple Sclerosis Society (NMSS) funded MS rehabilitation research fellowship in the Department of Rehabilitation Medicine at the University of Washington. Her research and clinical focus is the cognitive and emotional symptoms common to multiple sclerosis.


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