Cognition in MS

Introduction
For many, the emotional and cognitive effects of Multiple Sclerosis represent its greatest challenges. Whether a person with MS will experience these problems cannot be predicted from age, level of physical disability, duration of MS, type of MS, or intelligence tests. Up to half of all people with MS will have some degree of cognitive disruption Fortunately only 10% of people with MS will have cognitive problems that significantly interfere with everyday activities. For those 10% it is a frustrating or even devastating change in their normal thinking process.

MS may be accompanied by a variety of emotional reactions and people with MS face some very special challenges. However, like everyone else, they are trying to do their best to cope with what life has sent them. In most instances, they cope very well and often are stronger for having met these challenges.

Cognition
The areas of cognitive functioning that are most commonly affected in MS include the following:

• Memory
• Visual spatial abilities
• Attention and concentration
• Word-finding
• Speed of information processing
• Abstract reasoning and problem solving

Typically, MS affects some cognitive functions but leaves others relatively intact. For this reason, MS is not likely to lead to the sort of global cognitive decline seen in Alzheimer’s disease. People with Alzheimers, for example, have difficulty storing information from moment to moment. People with MS tend to have a difficulty with retrieving that information. But as MS can affect any part of the brain, almost any cognitive function can be impaired. In some cases, MS-related cognitive changes can be very pervasive, rendering the individual unable to deal adequately with day-today tasks.

There are some common misunderstandings about cognitive dysfunction in MS and the following is by way of reassurance :
• MS does not equal Dementia (as mentioned above)
• MS does not mean that intelligence has declined.
• MS is not a mental illness (although some people with MS experience depression, and this requires medical and psychiatric treatment).
• Cognitive functioning can be assessed
• Cognitive problems can occur at any level of physical disability

Cognitive changes can have a significant impact on one’s ability to live and work. Family members are often unaware that MS can cause cognitive problems and this misunderstanding can result in anger and confusion.

Many factors will determine your response to cognitive problems, including the impact of the disability on your normal way of life, previous ways of coping, and the support you receive from others. You and your carers should remain vigilant as to cognitive changes and if this happens it is wise to obtain a professional evaluation to clarify the nature and cause of the problems.

What can you do?

The health professionals who can help are neuropsychologists, occupational therapists, and speech language therapists. Keep this in mind as often input is needed from a professional trained to assess and treat people with cognitive problems.

As the impact of cognitive changes can be stressful, it may also be helpful to talk to a counsellor or your doctor about how you are feeling.

Hints and tips

• Keeping to a routine is important, as is being consistent. For example, when you open the door to your house, put your keys in the same place every time.
• It might help to get an ‘organiser’. Set it up with sections for everything that affects your day-to-day living. Sections for appointments, for phone numbers, addresses etc.
• Using mental pictures or images to remember something can be a good technique to aid memory.
• Having people repeat or write down instructions often helps. It is important that the person conveying the message, instructions or directions to you knows that you have understood. Repeat it back to the person, and ask for clarification if necessary.
• Keep your mind as active as possible. Reading, doing crosswords and puzzles are good ways of keeping mentally challenged, and it is best to find activities that suit you. However, you do need to be aware of your energy levels and be careful not to tire yourself out.
• Regular rests to recharge your brain (and body) become important when you have MS. Use energy conservation and work simplification techniques to ensure the best possible use of your physical and mental energy. Be aware of and alert for mental fatigue (a decline in cognitive performance following a task requiring continuous mental effort).
• It is also best to avoid noisy and/or distracting environments as these can make it difficult to concentrate.
• It is also important when learning a new task that you allow plenty of time to learn it. If you are having trouble, shift your attention to another task and come back to it later.

It is important that you know that you are not going crazy, that many people with MS experience similar problems with their thinking and memory. In particular, it is important for friends and family members to be aware of the relationship between MS and cognitive dysfunction.

Tags: cognitive decline, cognitive dysfunction, emotional reactions, MS-related, multiple sclerosis

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