A to Z of MS Cognition problems
About half of people with MS have some degree of problem with memory, attnetion span or concentration at some time. These symptoms are referred to as cognitive problems. For most people the symptoms are usually relatively mild and like other symptoms of MS can come and go.
Common problems
Memory difficulties
Many people with MS report that there 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 problems
This problem is described as experiencing difficulties with being able to follow a series of, or complex, instructions, especially if the information is given rapidly.
Problem solving difficulties
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 span problems
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.
As with physical symptoms, not all people with MS will experience all of these problems. Similarly, these problems can fluctuate from day to day and can worsen during relapse and improve during remission. Some medications, including those used to counteract pain, fatigue and depression, may also have an impact on these problems.
Although research suggests that these symptoms can affect almost half of all people with MS, many people may not recognise them as symptoms of MS or may find ways to compensate for the problems without seeking treatment.
Problems can arise early in the course of someone's MS, 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.
Treatment
Treatment 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