Cognitive Functioning and Multiple Sclerosis
by Diane Holmes on Saturday, August 2, 2014
Prior to the 1980s MS was believed to affect only physical functioning. Newer research, however has found 43% - 80% of people with MS experience cognitive symptoms. Research has also found cognitive symptoms can occur in people with minor physical symptoms and is not related to how long they have MS.
Like physical symptoms of MS, cognitive symptoms are related to the size and location of lesions. Missing any of the four steps of "working memory", (paying attention, learning information, retrieving information, and putting information into action) affect cognitive functioning. Symptoms can include:
- Memory: difficulty remembering the plot of books, losing items, forgetting names or appointments, problems learning or recalling new information.
- Information processing: reduced information processing speed, although accuracy is maintained. Information from two sources at the same time can slow cognition, interfere with working memory, and affect planning and executing tasks.
- Attention and concentration: problems screening out distractions and dividing attention such as having a conversation while the TV is on, difficulty sticking to one task, and organizing information for
- recall later.
- Ability to shift between tasks: difficulty resuming a task after an interruption, and shifting back and forth between tasks.
- Conceptual reasoning and problem solving: These symptoms can be subtle and difficult to recognize. Symptoms include problems following complex instructions, solving puzzles or riddles, or not "getting" jokes.
- Executive function: Trouble organizing and following through with tasks, establishing priorities, and not knowing how to begin a task.
- Visual perceptual functioning and spatial orientation: Getting lost in a familiar area, confusing "right" and "left", and problems judging distances between objects, which causes problems when driving.
Other cognitive problems can include "cognitive fatigue," especially doing a series of calculations, "emotional disturbance" such as depression, euphoria, bi-polar disorder and pathological laughing or crying, and "Pseudobulbar affect disorder," related to the ability to regulate emotions. Cognitive functioning can also be affected by fatigue, depression and side effects of medications.
There are a number of tests to measure cognitive function. Test results are used by neuropsychologists, psychologists, speech-language and occupational therapists, and counselors to develop an individualized cognitive rehabilitation program. In his book, "Facing The Cognitive Challenges of Multiple Sclerosis" author Jeffrey N. Gingold suggests four goals for living with MS.
- Goal 1: Cognitive Education - inform your support team (medical and family) of your symptoms and use humor to cope.
- Goal 2: Take Action - find activities that keep your mind sharp.
- Goal 3: Reach for Available Answers - learn about cognitive symptoms and plan your
- life accordingly.
- Goal 4: Leave Room for Slow Hugs - cherish the people you love and enjoy life.
Wise words from a person living with MS!