Many people with multiple sclerosis (MS) expect to cope with physical challenges like problems with walking or seeing, but the disease's central nervous system damage often causes mental health symptoms, too. In addition to anxiety and depression, more than half of people with MS experience some cognitive function change, reports the .
Cognition refers to all the higher-level brain functions that make you unique. That includes your ability to:
- Absorb new information
- Recall information
- Make decisions
- Organize your thoughts
- Prioritize completing tasks and thoughts
- Communicate clearly, including finding the right words
- Perceive your environment accurately
- Perform calculations
Tirisham Gyang, MD, of the Ohio State University Wexner Medical Center in Columbus, noted that the most common cognitive challenge patients with MS face is a reduction in processing speed, meaning "the speed at which you're able to process information, manage that information, and then use that information."
The Connection between Cognition and MS
The same disease process that forms lesions in the brain and damages the neurons is also responsible for any cognitive changes you experience as a person with MS. In addition to brain lesions, brain atrophy is another feature of MS. This means that your brain shrinks over time and brain cells can lose their connection with other brain cells.
The extent of the cognitive challenges you may face depends on the number and severity of brain lesions you have, as well as their specific location.
While every patient's situation is unique, here are a few generalizations about MS-related cognitive changes:
- They are most common in progressive MS but can happen with any type of MS.
- There is no direct correlation between cognitive health and your level of physical limitations.
- Cognitive changes are often mild and may gradually worsen over time. In a small number of people with MS, cognitive difficulties can become severe.
- They are more likely to occur during an MS exacerbation.
- They are a leading reason people with MS may leave the workforce.
Talk to Your Doctor
People with MS are often the first to realize they may be facing cognitive challenges. Family members or coworkers often notice changes, too, sometimes even before the person with MS does.
If you suspect you may have cognitive changes, it's important to talk to your doctor about your concerns. The doctor will typically ask about any new or worsening physical or mental symptoms at every visit, but don't hesitate to raise the subject yourself if necessary.
Research is ongoing to find a medical treatment that can stop cognitive decline in people with MS or reverse existing damage. One thing your doctor can do is help ensure that you receive any needed accommodations. "I often write letters for patients who have work or school issues stating that they need more time to complete tasks or need extra breaks throughout the day," Gyang told 鶹ý.
"Cognitive changes often occur early in the disease process, so it's extremely important to make sure the MS is very well-controlled via an effective disease-modifying therapy to address existing inflammation and prevent new inflammation," she continued. "That will often limit the effects of MS-related cognitive challenges."
Cognitive Rehabilitation Can Help
After ruling out other causes of cognitive dysfunction such as vitamin deficiencies or thyroid disease, your doctor may also send you for a comprehensive cognitive assessment. This is when a neuropsychologist tests your cognitive functioning using a variety of assessments. This evaluation, which may take several hours, will provide specific information about any cognitive deficits. The assessment can also help rule out other conditions that can contribute to cognitive problems, including uncontrolled mood disorders, sleep difficulties, and medication side effects.
"At our center, we are quick to send our patients for these assessments, because otherwise it's very difficult to know for sure that a patient's cognitive challenges are MS-related," Gyang explained. "Once a neuropsychologist performs baseline testing, we can monitor the patient over time to see if the cognitive dysfunction is getting worse."
Cognitive rehabilitation focuses on both . Restorative activities often include memory exercises and strategies, while compensatory activities focus on helping you develop workarounds for your specific challenges.
For example, possible restorative strategies include:
- Using memory aids like mnemonics and word associations.
- Practicing recalling information in "safe" settings before you need to remember it.
- Relying on multiple sensory inputs, like reading, writing, and saying information you need to remember.
Possible compensatory strategies include:
- Centralizing needed items and information in one physical place in your home.
- Developing new calendaring techniques to help you keep track of everyone's activities.
- Learning how to limit distractions and avoid sensory overload.
- Training yourself to complete one thought or activity before starting another.
Look at Your Lifestyle
Gyang also works with patients to assess any lifestyle issues that could affect cognitive clarity. For example, difficulties sleeping are also extremely common with MS. "If you're extremely tired due to poor sleep, your thinking could also be affected. We will work together to resolve any sleep issues you have," she said.
Getting a moderate amount of healthy exercise can also help protect against cognitive decline, as does eating well and staying hydrated. She also recommends learning stress-management techniques and building them into your day: "Stress can definitely affect your cognitive skills," she said.
Finally, as with other aspects of MS, cognitive challenges vary widely between people with the disease. That makes it extra important to view your doctor and medical team as your partners as you work together to manage your challenges.
"MS patients often have completely different needs from each other, so everything we do has to be customized to that specific patient," Gyang said. "There's a lot of things that the patient can do by themselves, but then there are other issues where the provider needs to come in, and then add some other disciplines to help the patient achieve their goals."
Read previous installments in this series:
For Your Patients: What to Expect After a Multiple Sclerosis Diagnosis
For Your Patients: What Are the Different Types of MS?
For Your Patients: Coping With the Mental Health Challenges of Multiple Sclerosis
For Your Patients: The Benefits of Early Aggressive Treatment for MS
For Your Patients: Understanding Progressive MS and Relapsing MS
"Medical Journeys" is a set of clinical resources reviewed by doctors, meant for physicians and other healthcare professionals as well as the patients they serve. Each episode of this journey through a disease state contains both a physician guide and a downloadable/printable patient resource. "Medical Journeys" chart a path each step of the way for physicians and patients and provide continual resources and support, as the caregiver team navigates the course of a disease.