A to Z of MS Cognition and cognitive symptoms

About half of all people with multiple sclerosis have some degree of problem at some time with aspects of thinking - memory, attention span or concentration. Cognition is the term that covers all aspects of thinking and these symptoms are referred to as cognitive problems.

For most people the symptoms are relatively mild and like other symptoms can fluctuate from day to day, worsen during relapse and improve during remission.

As with physical symptoms, not all people with MS will experience all of these problems. Cognitive problems can be made worse by some medications, including those used to treat pain and depression.

Many people may not recognise cognitive symptoms as an aspect of their MS and they can arise early in the course of the condition although the greater the disease duration and severity the more likely problems are to occur.

Whilst frightening, cognitive changes are generally mild and management strategies can provide effective methods of lessening if not eliminating the functional effects.

Common cognitive problems

Memory

Many people with MS report that their memory is not as good as previously. Memory difficulties are primarily related to the recall of recent events or information and forgetting to carry out planned actions in the future. Both these situations lend themselves well to using systems to record information and to act as reminders or prompts, eg diaries, notice boards or mobile phones.

Information processing

This problem is described as experiencing difficulties with being able to follow a series of complex, instructions, especially if the information is given rapidly.

Problem solving

This may arise as the result of an individual being so agitated and anxious about a task, that they are unable to mentally structure their thoughts to instigate a series of separate actions. Consciously breaking down a task into simpler steps or stages can allow progress.

Word finding

Also called 'tip of the tongue' phenomenon, this is a recall problem rather than the loss of memory for that word.

Concentration and attention

This tends to occur when a lot of information is being delivered to a person at once and only some is relevant, for example where several people are talking at once.

Management of cognitive symptom

Management of cognitive symptoms often involves finding strategies to minimise the effects of symptoms, and sometimes a retraining approach whereby progressively more challenging exercises are given to strengthen impaired function. Management often involves psychologists, speech and language therapists and occupational therapists.

Compensatory strategies that might be used include:

• establishing a fixed routine, eg always keeping things in the same place
• using a large page-to-a-day diary and developing the habit of consulting it
• prioritising tasks to do only one thing at a time and removing distractions (background noise, TV, etc.)
• using technology as a memory prompt eg dictaphones or mobile phones
• avoiding jobs which need concentration when fatigued or anxious

StayingSmart

StayingSmart is a website designed for people who want to know, or know more, about how multiple sclerosis can affect thinking.

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