Cognitive engagement: Keeping the mind active with ALS
Last updated September 17, 2025, by Roslyn Marano
Fact-checked by Inês Martins, PhD
Living with amyotrophic lateral sclerosis (ALS) often brings symptoms that change how your body moves and responds. Sometimes, these changes aren’t just physical; they’re also mental.
Research shows that up to half of people with ALS experience cognitive or behavioral changes at some point during the disease.
Cognitive engagement, or keeping the mind active, may help you slow or adjust to these changes as ALS progresses.
Why cognitive engagement matters in ALS
Engaging the mind through various activities is believed to help build and maintain cognitive reserve, or the brain’s ability to compensate for neurological damage.
While more research is needed to definitively establish that brain-stimulating activities can slow cognitive decline after an ALS diagnosis, a higher brain reserve, often built up over a lifetime of education and mentally challenging activities, has been associated with better cognitive outcomes in ALS.
Staying mentally engaged is also important for your overall quality of life, as engaging in cognitively stimulating activities may help bring a daily sense of accomplishment and lift your mood.
Activities to keep your mind engaged
The most effective activities are the ones you genuinely enjoy. They don’t need to be physically demanding — they just need to spark your interest or imagination. You might try:
- Puzzles and brain games: Crosswords, sudoku, word searches, or trivia games can challenge your thinking skills. Many are available in formats that work with voice commands or eye-tracking technology.
- Reading and audiobooks: Books, poetry, or articles can take your mind to new places and ideas. Audiobooks and e-readers make it easier to enjoy reading without physical strain.
- Creative expression: Writing, painting, music, or photography can offer an outlet for your thoughts and emotions. Adaptive tools such as speech-to-text software or digital art programs can keep these activities accessible.
- Learning something new: Exploring a new subject, language, or hobby through online courses can challenge your brain in rewarding ways. Many classes let you set your own pace and take breaks when needed.
- Social interaction: Talking with friends, joining a discussion group, or participating in online meetups can be just as stimulating as a puzzle or class — and can help you stay connected.
Adapting activities as needs change
As ALS progresses, physical changes may make certain activities harder. Assistive technology can help you stay engaged.
For instance, voice recognition software can help you write or communicate without typing, and eye-tracking devices allow you to control a computer or send messages with minimal movement.
You can also incorporate switch controls into your games and apps to make them easier to use when hand movement is limited.
An occupational therapist can help you find ways to adapt your favorite activities so they remain enjoyable and manageable.
Balancing activity and rest
Fatigue is common in ALS, so paying attention to how your body and mind feel throughout the day is important.
Mental activities, just like physical ones, can be tiring if overdone. Short, enjoyable sessions may be more sustainable than longer ones, and breaking tasks into smaller steps may help you stay engaged without feeling overwhelmed. Planning activities at times of the day when you typically have more energy can also be helpful.
Above all, focus on activities that feel rewarding rather than draining. With a thoughtful approach, you can stay mentally engaged while honoring your energy levels.
ALS News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.