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Cognitive Problems
 It is now recognized that MS may cause problems with memory, planning, foresight, and judgment. Studies have shown that minor defects in cognition are quite common (up to 70%), even in early MS (up to 50%) . Approximately 10% of people with MS will have fairly serious cognitive difficulties. Dementia can be an accompaniment of severe disabling MS of long-term duration.
The most frequent cognitive abnormalities in MS are subtle defects in abstraction, memory, attention and word finding. They are usually associated with emotional lability and decreased speed on information processing. Thought processes of the brain are interconnected to the conscious areas of the brain via myelinated nerves. There can be problems transporting memories to consciousness and processing of thoughts…. creating difficulties with concentration and reasoning..
Occasionally, a person experiences severe cognitive difficulties and is said to have "cerebral MS." Persons who have relatively minor levels of cognitive problems are aware of them but if the form is "cerebral," the person often appears to lack clear insight into the problem.
Recent surveys have shown that mood disorders are frequent in people with MS. An association may exist between MS and manic-depressive disease (bipolar disorder). Reactive depression is common in MS.
A number of compensatory techniques can help with the cognitive problems of MS. First, the difficulties need to be identified and their extent measured and considered in the context of the person's individual circumstances. This is done through testing, either by a speech pathologist or more formally by a neuropsychologist. It should be remembered that some tasks and occupations need an excellent memory while others do not. Nobody's memory is perfect and everyone suffers from memory lapses and occasional confusion. Stress, anxiety, and fatigue all decrease cognition, especially memory. Poor concentration may add to the problem. Depression must be treated. A person with MS often does not recognize his or her depression but may respond to medication and therapy. Psychological tests may be necessary to make the diagnosis of depression.
The following strategies have been found to be helpful in managing cognitive problems:
- Make lists - shopping lists, lists of things to do, and so forth.
- Use a calendar for appointments and reminders of special days.
- Establish a memory notebook to log daily events, reminders, and/or messages from family and friends.
- Use a tape recorder to help remember information or make up lists.
- Organize your environment so that things remain in familiar places.
- Carry on conversations in quiet places to minimize environmental distractions.
- Ask people to keep directions simple.
- Repeat information and write down important points.
- Establish good eye contact during any discussion.
In this age of computers, both electronic and non-electronic organizers may be very helpful in helping to bring better order to one's daily life. Cognitive rehabilitation has not been well established for MS as yet but there are preliminary research findings suggesting that computer retraining can help attentional problems in MS.
Cognitive problems may be minimized in everyday life if a person with such a problem can be made aware of the problem and is willing to manage them constructively. The quality of interaction with family and friends relies on awareness and understanding of all parties involved. It is important that family and carers are aware of the cognitive problems and help in minimising or overcoming them. Cognitive aspects of MS are also important in determining a person's capacity to work and to remain in employment. Expert advice is available for both rehabilitation and counselling options. Most national MS Societies have publications addressing cognitive problems in MS.
References
Schapiro R. Symptom Management in Multiple Sclerosis 3rd Edn. 1998 Demos Medical Publishing Co, New York pp103-105
Paty DW & Ebers GC (Editors). Multiple Sclerosis 1998 F.A Davis Co Philadelphia pp159-160
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