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MS research update - The right word won't come to me... A study looking at slowed word retrieval in MS - 21 October 2013

Summary

About half of people with MS have some problem at some time with aspects of thinking including memory, attention span and concentration. One aspect that can cause difficulty is recalling words.

In this study, participants watched a monitor where the names of 25 very familiar animals were shown one by one. For each one, the participant had to press a key if the word was the name of an animal and a different key if it wasn't. The time taken to respond was measured in milliseconds. The test was repeated with familiar names of fruit and then objects.

The researchers found that people with MS took significantly longer to respond than the healthy controls for all three categories of words.

Background

About half of people with MS have some problem at some time with aspects of thinking including memory, attention span and concentration. One aspect that can cause difficulty is recalling words. Most people will experience this from time to time but this study looked to see if it was more common in MS.

How this study was carried out

47 people with relapsing remitting MS aged 20 to 50 took part in this study. They were all mildly affected by their MS as judged by their EDSS scores which were three or less. A score of three is defined as "Moderate disability in one functional system, or mild disability in three or four functional systems. No impairment to walking". Functional systems include sensory (numbness or altered sensations), bladder and bowel, vision and mental functioning.

All participants had been relapse free in the previous month and had no other psychological or neurological condition. They were also free of language disorders, severe sight problems, drug dependency or alcoholism which might have interfered with the tests.

29 healthy people acted as controls and were matched in gender, age and level of education.

For the tests, each participant sat in a quiet room with no distractions. They watched a monitor where the names of 25 very familiar animals were shown one by one. Each word was shown for exactly one second with a gap of exactly two seconds before the next word was shown. For each word, the participant had to press a key if the word was the name of an animal and a different key if it wasn't. The time taken to respond was measured in milliseconds.

After the test with the names of 25 animals, there was a 10 second gap before the second phase of the test which was run in the same way but with the names of 25 well known fruit. After another 10 second gap, the third phase of the test was run with the names of 25 very familiar objects.

What was found

People with MS took significantly longer to respond than the healthy controls for all three categories of words as shown in this graph of reaction times.

What does it mean?

This study shows that people who are not severely affected by their MS are still slower at information processing than healthy controls. This applies to all the categories of words that were tested (animals, fruit and objects) and so seems to be a general effect. The authors conclude that this fits in with previous research in this area.

Khatoonabadi AR, Nejad VS, Dadgar H, et al.
Speed of word retrieval in multiple sclerosis. .
J Res Med Sci. 2013 Apr;18(4):274-6.
abstract
Read the full text of this paper

More about finding the right word

Cognitive symptoms

Cognitive difficulties is the term used to describe a range of problems with slowed thinking such as poor memory, attention span or concentration and difficulty following complicated instructions or problem solving. Cognitive symptoms are common in MS but may not be recognised. Management of these symptoms involves finding strategies that minimise the difficulty, for example, if you have trouble remembering where you've put your car keys, always putting them in the same place will help. Other examples are:
  • establishing a fixed routine, for example, always doing something at the same time of day
  • using a large page-to-a-day diary and developing the habit of writing in lists of things to remember and then remembering to check regularly so they don't get forgotten
  • prioritising tasks, only doing only one thing at a time and removing distractions (background noise, TV, etc.) so that you can concentrate
  • using technology as a memory prompt, for example, timers and text reminders
  • avoiding jobs which need concentration when you are fatigued or anxious

There is more information, tips and strategies for getting around cognitive symptoms on the Staying Smart web site. You could begin with something that you would like to manage better like "I can't seem to concentrate" or "At the end of the day, I haven't got important stuff done". You will be taken to a list of tips and tricks with links to useful gadgets and gizmos, information on how friends and family can help and also support from health professionals.

Cognitive symptoms can be made worse by fatigue and pain so it is important to manage these symptoms as well as possible. Cognitive symptoms may also be the result of, or made worse by, some medications.

Word finding

Difficulties with getting the right word can be about whether that word is in your memory in the first place but it can be about bringing it to the forefront of your mind. Sometimes, the right word may feel like it's "on the tip of the tongue" but won't come to mind when you need it or takes a while to be remembered so you feel stuck in limbo while you try to think of what the word is. Sometimes, the wrong word comes out and you might say black when you mean white or tell someone to feed the dog when you meant to say about feeding the cat. This can be really frustrating for you but also for those around you.

Talking is a big part of every day life so getting words muddled up or not being able to think of the right word can feel embarrassing. It's possible to manage this better, for example:

  • Don't be too critical of yourself as the chances are that others won't think you've got any more of a problem than anyone else
  • Don't stress about finding the right word as stress can make it even harder
  • If you can't think of the word, use another one that has the same or a similar meaning or describe what you mean in a short sentence or point to it. For example if you can't think of the word for a cream colour, you could say "a bit like white but more yellowish", or point to someone's cream coloured shirt.
  • Use the reverse dictionary which allows you to put in a short description of what you mean and it offers a selection of possible words. I put in "a colour like white but more yellowish" and it came up with many suggestions and cream was top of the list!
  • Write down people's names so that you can refer to them again if you need to. You could do this in advance if you have an important meeting at work or a gathering of the wider family and you are concerned that someone's name will escape you.
  • Link a person's name to a picture so that Mrs Smith could be linked to a picture of a female blacksmith or Mr Jones could be Corporal Jones in Dad's Army.

There are more suggestions on the web site Staying Smart in a section called "I can't say what's on the tip of my tongue". Others have written in with their own tips and tricks including how to see the funny side of words that you might make up when you can't think of the ones that you mean. Some examples given are "outside clothes" for a coat and "feet clothes" for slippers.

Support from health professionals

Management may involve seeing a clinical psychologist, speech and language therapist or occupational therapist.

Further information

You can read more about cognitive symptoms and their management in our A-Z of MS. 

Research by topic areas...

Disease modifying treatments

Patti F, Morra VB, Amato MP, et al.
Protect against cognitive impairment in patients with relapsing-remitting multiple sclerosis: 5-year follow-up of the COGIMUS study.
PLoS One. 2013 Aug 30;8(8)
abstract
Read the full text of this paper

Balak DM, Hengstman GJ, Hajdarbegovic E, et al.
Prevalence of cutaneous adverse events associated with long-term disease-modifying therapy and their impact on health-related quality of life in patients with multiple sclerosis: a cross-sectional study.
BMC Neurol. 2013 Oct 16;13(1):146. [Epub ahead of print]
abstract
Read the full text of this paper

Scott LJ.
Glatiramer Acetate: A review of its use in patients with relapsing-remitting multiple sclerosis and in delaying the onset of clinically definite multiple sclerosis.
CNS Drugs. 2013 Oct 16. [Epub ahead of print]
abstract

Havla J, Kleiter I, Kümpfel T.
Bridging, switching or drug holidays - how to treat a patient who stops natalizumab?
Ther Clin Risk Manag. 2013;9:361-369.
abstract
Read the full text of this paper

Sternberg Z, Leung C, Sternberg D, et al.
Disease modifying therapies modulate cardiovascular risk factors in multiple sclerosis patients.
Cardiovasc Ther. 2013 Oct 1. [Epub ahead of print]
abstract

Genetics

Mowry EM, Carey RF, Blasco MR, et al.
Association of multiple sclerosis susceptibility variants and early attack location in the CNS.
PLoS One. 2013 Oct 10;8(10)
abstract
Read the full text of this paper

Mowry EM, Carey RF, Blasco MR, et al.
Multiple sclerosis susceptibility genes: associations with relapse severity and recovery.
PLoS One. 2013 Oct 9;8(10)
abstract
Read the full text of this paper

Psychological aspects

Genova HM, DeLuca J, Chiaravalloti N, et al.
The relationship between executive functioning, processing speed, and white matter integrity in multiple sclerosis.
J Clin Exp Neuropsychol. 2013;35(6)
abstract

Physical activity

Dalgas U, Kjølhede T, Gijbels D, et al.
Aerobic intensity and pacing pattern during the six-minute walk-test in patients with multiple sclerosis.
J Rehabil Med. 2013 Oct 15. [Epub ahead of print]
abstract

Feinstein A, Rector N, Motl R.
Exercising away the blues: can it help multiple sclerosis-related depression?
Mult Scler. 2013 Oct 14. [Epub ahead of print]
abstract

Prognosis

Filippi M, Preziosa P, Copetti M, et al.
Gray matter damage predicts the accumulation of disability 13 years later in MS.
Neurology. 2013 Oct 11. [Epub ahead of print]
abstract

CCSVI

Traboulsee AL, Knox KB, Machan L, et al.
Prevalence of extracranial venous narrowing on catheter venography in people with multiple sclerosis, their siblings, and unrelated healthy controls: a blinded, case-control study.
Lancet. 2013 Oct 8. [Epub ahead of print]
abstract

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