MS is a challenging condition from a number of points of view and one with which RehaCom can help. With MS, the condition can affect insight, attention, memory and planning ability - as well as lead to depression and anxiety that affect the family as well as the individual. Age of onset varies typically between 20 and 40 and the range and severity of symptoms can vary significantly. Estimates are that between 25 and 65% of people with MS will have some cognitive issues and these can occur at any point int he disease process. Occasionally the cognitive issues can occur as the most significant symptom.
Two recent Cochrane Reviews found that cognitive training was found to significantly improve working memory, memory span and visual memory. Cognitive training combined with other neuropsychological rehabilitation methods was found to improve attention, immediate verbal memory and delayed memory.
Cognitive impairments can occur in all subtypes of the MS and some research suggests differences in the deficits between types but this is not a consistent finding. Relapsing remitting type is thought to experience more working memory and verbal fluency problems. The worst effects are thought to be associated with secondary progressive MS.
The cognitive status can be stable or symptoms can progress. Some research evidence suggests that cognitive symptoms can remit - confusingly, other studies say the opposite. An MRI scan when available is a good guide - if lesions show improvement on an MRI scan, cognitive symptoms can improve. It is believed that high, pre-diagnosis IQ may be a protective factor. Males with early evidence of grey matter change visible via MRI scan will have a poorer cognitive prognosis. There is a positive correlation between symptoms and the total volume of brain matter damaged by lesions.
Cognitive problems can have a big impact on many aspects of life, relationships, self-esteem and confidence as well as the ability to work.
As this disability is “hidden” the effects may be subtle and perhaps missed because of this. For example, persons with attention deficits may find it harder to sustain attention and concentration over time. They may find it harder to multi-task or cope with situations that demand divided attention. We might pick up on these things by observing
- Can they focus on conversation?
- Do they seem to lose track of their thoughts or intended actions?
- Do they report difficulties with reading and following what is happening in TV programmes?
- Are they easily distracted by noise?
Memory problems are the most commonly reported cognitive symptom. Science suspects that memory problems in MS are thought to be associated with problems of retrieving information rather than deficits with the brain’s ability to encode and then store information. Persons with MS might have difficulties with
- working memory - remembering recent events
- remembering to do things
- learning new things
However, these persons may have a preserved
- Long term memory
- Recognition memory
- Procedural skills
- General knowledge
However, learning often is slower and needs more effort in this group.
How would might know if memory is an issue? We might recognise issues of memory if:-
- The persons consistently reports forgetting things
- They forget and miss appointments
- They cant give a clear medical history
- They can't recall what was talked about the last time you met
- They dont know who else is helping them
This note is not intended to be an exhaustive exploration of cognitive difficulties and MS. If you are concerned, as always seek medical help and resist the temptation to self-diagnose.