Cognitive Impairment in Multiple Sclerosis

cognitive dysfunction and ms
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Cognitive impairment is a medical term used to describe the loss of certain mental functions including learning, memory, perception, and problem-solving. While we tend to associate the term with dementia or Alzheimer's disease, it is not always so severe or debilitating.

Nearly 50 percent of people with multiple sclerosis (MS) will experience some form of cognitive dysfunction in the course of their disease. In the beginning, the signs may be so subtle that people don't notice them. At other times, the mental glitches may be attributed to everything from getting older to simply being tired.

Because of the way the disease progresses and the parts of the central nervous system it affects, people with MS-related cognitive dysfunction will often experience the impairment of memory, attention, concentration, information processing, visual perception, verbal skills, and such executive functions as planning or prioritizing.

On a positive note, while cognitive skills may be affected, other brain functions such as intellect, conversational skills, reading comprehension, and long-term memory will remain untouched.

Types of Cognitive Impairment

Symptoms of MS-related cognitive impairment can vary from person to person. Moreover, the severity and frequency of symptoms may also fluctuate, ranging from intermittent events to more persistent, debilitating disorders. Among the more common symptoms:

  • Short-term memory deficit is the inability to remember simple, recent tasks or events. It may be as innocuous as not being able to remember a phone number you just looked at, forgetting if you took your medication or not, or losing track of what you were just talking about.
  • Problems with abstract conceptualization involve intangible concepts, ideas, or theories that we can't get our heads around. It's about not being able to conceptualize things needed to make plans or take action. Abstract conceptualization is key to learning and planning.
  • Attention deficit means being easily distracted or unable to keep your mind on the task at hand.
  • Slowed information processing simply means that you are taking longer to process what you are reading, hearing, or experiencing through your senses. As a result, you may get lost because you are less able to process spatial information or be less able to comprehend social cues in conversations or meetings.

Cause of Cognitive Impairment

While many of the symptoms of MS-associated cognitive impairment mirror those of other conditions like attention deficit disorder (ADD) or social anxiety disorder (SAD), the causes are very different.

MS is characterized by an abnormal immune response which causes the progressive damage to the protective coating of nerve cells (called the myelin sheath) and the formation of lesions throughout parts of the central nervous system.

Moreover, the disease can cause atrophy and shrinkage in certain parts of the brain and spinal cord, including the corpus callosum which connects the right and left sides of the brain.

In the end, the symptoms vary by where the injury is located and may be complicated by other typical symptoms of MS such as depression and fatigue.

Severity of Symptoms

Cognitive problems are sometimes severe enough to interfere with work or any situation that requires quick or complex thinking. Even in social situations, awkwardness and anxiety can develop as the signs of dysfunction become more apparent. Isolation is not uncommon.

On the other hand, it is rare for a person with MS to develop the type of dementia seen in Alzheimer's or after a stroke. When it does happen, it tends to occur more to those who are severely affected by other serious MS-related illnesses.

Coping with MS Cognitive Dysfunction

Research on the treatment of cognitive impairment in MS is still in the early stages. Current disease-modifying drugs may provide some relief by preventing the progression of the disease. Other experimental treatments are being explored but, to date, none have been shown to actively reverse the symptoms of impairment.

This doesn't mean there is nothing you can do. In fact, by becoming better aware of your condition, you can often find ways to "work around" any challenges you may be facing and adjust your lifestyle to better cope. 

  • Start by managing your moods. If you are experiencing mental or emotional changes you can't explain, see a doctor and have it checked out. In some cases, you may be experiencing symptoms of depression that are not only common in people with MS but imminently treatable.
  • Find support. Rather than coping on your own, turn to family, friends, counselors or support groups. The more these concerns are out in the open, you less you will feel the need to hide them, excuse them, or minimize them. Isolation is probably the worst thing you can do.
  • Plan your day. Always schedule your most challenging task for the time of day when you feel at your sharpest. By doing, so you may be able to be just as productive and better able to prioritize tasks.
  • Compensate for shortcomings. If your memory is poor, focus on organization. If you need to learn something new, take extra time to practice and make plenty of notes to refer to. If you have an attention problem, set a time by which complete an activity and use an alarm to keep you on schedule (or remind you if you're off track). 
  • Exercise your brain. While your brain is not a muscle, it functions like one. The more you give it a workout (with mental arithmetics, memory games, puzzles), the more you likely you will retain certain, key processing functions. Don't let your brain go to mush.
  • Get enough sleep. Avoid anything that might stimulate you before bedtime and try to go to sleep and wake up at the same time every day, including weekends.
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Article Sources
  • Gingold, J. (2011) Facing the Cognitive Challenges of Multiple Sclerosis (2nd Edition). New York, New York: Demos Medical Publishing.
  • National Multiple Sclerosis Society. "Managing Cognitive Problems in MS." Washington, D.C.; published 2016.