Multiple Sclerosis Condition

Cognitive Changes
 
MULTIPLE SCLEROSIS (MS) is a disease that causes damage to nerve fibers in the brain and spinal cord. Because demyelination occurs in the brains of most people who have MS, cognitive functions can be affected. It is only within the last 20 years or so that MS professionals have acknowledged cognitive impairment as a significant issue for many people with MS and begun to study it intensively. Cognitive dysfunction remains a difficult topic for many people with MS - and their doctors - to think about or discuss. Like the emotional aspects of MS, however, cognitive changes have the potential to affect any and all family issues.
 

Multiple Sclerosis Condition

Research has shown that approximately 50% of people with MS have no apparent cognitive changes. Approximately 40% have cognitive changes that can be measured by psychological tests but are only mildly or moderately disruptive of everyday activities (e.g., someone who has to write everything down because of memory problems). A small proportion of people with MS, probably no more than 5-10%, have cognitive changes that are severe enough to seriously disrupt day-to-day life (e.g., a person who cannot manage personal finances because of extreme confusion and disorganized thinking).

What exactly is meant by "cognition?" The word comes from the Latin verb "to think" and refers to the "higher" brain functions such as memory and reasoning, in contrast to more primitive functions such as sensation (e.g., vision, hearing) and motor function (e.g., strength, coordination). In MS, a number of these "higher" functions may be affected. The ones most commonly affected are:

• Memory. Memory is probably the function that is most frequently cited as being affected by MS. This may be true for a couple of reasons: memory is crucial to almost everything we do; and memory lapses are easy to spot because they involve discrete bits of information and minor disasters (e.g., missed appointments). Memory is a catch-all term that encompasses many processes such as learning information (e.g., studying for an exam) and retrieving information (e.g., taking an exam). In recent years, increasing attention has been focused on "working memory," which refers to the short-term storage of information that is required, for example, to hold a phone number in memory for a few seconds. MS can affect almost any part of the memory process. As a result, people with MS-related memory loss may need to spend more time learning new material if they want to retain and eventually recall it when needed.
• Attention and concentration. All other cognitive functions depend on good powers of concentration. Attention and/or concentration problems may be manifested as the inability to focus for long periods of time or as extreme distractibility during a task. In MS, it is the more complex forms of attention that seem to be affected (e.g., divided attention tasks, which require a person to pay attention to more than one thing at a time). Because fatigue and stress can also affect these functions, the person with MS may be at very high risk for attention and/or concentration problems.
• Word-finding. Everyone at some time or other has had trouble thinking of a word or name that was "on the tip of the tongue." In MS, this seemingly innocuous problem can become so frequent that it is very disruptive of normal conversation. 
• Slowed information processing. People who have MS often say that they are still able to do everything they previously did in the intellectual sphere, but that they have to do it all more slowly. For example, processing more than one "channel" of information at a time may be impossible, particularly if it is all moving quickly. Unfortunately, much of everyday life demands rapid-fire, multi-channel processing with quick shifts from channel to channel. For example, Mom may be sitting in the kitchen balancing the checkbook when the phone rings. Just as she is answering it, the kids start yelling at each other in the next room and someone rings the doorbell. If you add to this scenario a slight slowing of thought processes and response time, and some difficulty walking, you can easily see how an ordinary day in the life of a person with MS can become very stressful. 
• Reasoning, problem solving, judgment. For some people with MS, the first hint of cognitive loss is not a memory lapse, but a poor judgment call or an inability to perform analytic work that previously seemed straightforward. For example, a securities analyst may find that she is no longer able to juggle all of the factors that need to be considered in developing a stock analysis, or that the time it now takes her to complete each analysis significantly reduces her effectiveness and productivity on the job. 
• Visual-spatial abilities. Most people freely admit that they have difficulty programming their VCR and assembling those toys labeled "some assembly required." However, MS can seriously impair visual-spatial abilities, including certain functions that are critical to safe driving such as being able to follow directions and quickly process right/left choices. 
• Executive functions. The ability to organize and execute complex sequences, which is an essential skill for adults, is often impaired in MS. The ability to plan, prioritize, schedule, and implement a complex task (e.g., cooking a Thanksgiving dinner, doing one's income taxes, or completing a project at the office) may thus be compromised, with significant ramifications for both work and family life.
• 
  Other functions. Because MS can affect any part of the brain, there is no cognitive function that one can safely say is never affected by MS. Some, like language functions, however, do not seem to be as affected in MS as they are following a stroke, for example. While most individuals with MS-related cognitive impairment will experience change in only one or two areas, some people with more severe impairment will experience changes in several different functions.

 

To find out more, you can check out Multiple Sclerosis Condition.

Multiple Sclerosis Early Symptoms

Emotional Release 

WE HAVE MANY ways to describe the fact that feelings are inherently changeable. In addition to "mood swings," we also refer to emotional instability, emotional instability, and even the more pejorative emotional incontinence. These terms overlap and are often used to refer to a phenomenon that we will call emotional release. Differing from the mood swings previously described, emotional release refers to instances in which a strong emotion seems to "take over" and overwhelm the person in a crescendo of feeling. 
 

Multiple Sclerosis Early Symptoms

For example, the person who is thinking or talking about a topic that generates a certain intensity of feeling suddenly becomes choked up and starts to cry. That person is not crying because the feeling of sadness or distress is so intense, but simply because the emotional buildup was strong enough to trigger a crying response that he or she is then unable to control. Although the phenomenon is usually over as quickly as it begins, it can create embarrassment and confusion in a person's professional life, and tension and misunderstandings at home. When emotional release occurs in the context of a family discussion or argument, the strong and sudden release of emotions may precipitate an escalation of the whole situation, leading to raised voices, anger, and alienation.
 
Although many people take this phenomenon for granted as part of their "personality," it is probably due, at least in part, to demyelination in brain centers that are related to the modulation of emotion. People who experience emotional release have found some simple strategies to be useful. The first step is to become aware of the buildup of feeling and the circumstances that tend to precipitate it. Once the person has developed some skill at this kind of self-monitoring, he or she is often able to catch emotional release in its very early stages, as the feelings are welling up but before they crescendo. At that point, the person attempts to take an emotional time-out, pausing for a few deep breaths, slowing or halting the conversation momentarily, and attempting to prevent the emotional reaction from getting out of hand. At times, we could all probably benefit from this strategy because it may carry the additional benefit of preventing the utterance of statements that are later regretted.
 
Uncontrollable Laughing And/Or Crying (Pseudobulbar Affect)
 
EMOTIONAL RELEASE INVOLVES the exaggeration of very real emotion. A different, relatively rare phenomenon involves the experience of episodes of laughing and/or crying that do not seem to be connected to any emotion. A seemingly insignificant or innocuous incident precipitates an uncontrollable bout of hilarious laughter or intense sobbing. The person does not feel happy or sad even though the emotional expression seems to suggest it. It is generally assumed that this phenomenon is a direct result of demyelination in parts of the brain that are responsible for the control of emotions. 

Because these episodes are so unpredictable and disconnected from actual feelings, the strategies suggested for dealing with emotional release are not likely to be helpful. One group of researchers has found that the antidepressant amitriptyline can be helpful in controlling this unusual phenomenon. Preliminary findings from a large, placebo-controlled trial of Neurodex (a combination of dextromethorphan and quinidine) in people with MS, indicate that this drug may be a safe and effective alternative. 

Although no studies have been published, anecdotal reports suggest that the SSRI antidepressants (e.g., fluoxetine (Prozac) and sertraline (Zoloft)) may also be useful in treating these episodes. For the family, these episodes can be particularly unnerving. However, by understanding the real nature of this unusual experience, family members may avoid labeling such behavior as "crazy" or deliberately disruptive. To find out more, you can check out Multiple Sclerosis Early Symptoms.

Multiple Sclerosis Disease Symptoms

Bipolar Disorder
 
BIPOLAR DISORDER IS a relatively rare condition that is related to depression. It may be characterized by alternating periods of depression and mania, or just mania. Manic episodes are usually characterized by some combination of the following: unrealistic optimism; agitation and/or irritability; hyperactivity; sleeplessness; non-stop or rapid talking; a tendency to start myriad projects that are never completed; and uncontrolled expenditures of money. 
 

Multiple Sclerosis Disease Symptoms

Bipolar disorder is more common in people who have MS than in the general population. It is generally treated using a mood-stabilizing drug such as lithium or divalproex sodium (Depakote), although an antidepressant may also be necessary if there are depressive episodes. Manic episodes can be frightening and disruptive for everyone in the family, particularly when uncontrolled spending is part of the pattern. In this situation, legal safeguards should probably be considered to protect the financial stability of the family.
 
A Word About Suicide 

SUICIDE - CONTEMPLATED, ATTEMPTED, and completed - is thought to be more common in MS than in the general population. A study in Denmark found that completed suicide was twice as common among people with MS than in the general public. In recent years, additional interest in this subject has been generated by the controversy over assisted suicide. Thoughts about suicide are so frequent in MS because of the high rates of clinical depression and because of the ways in which MS can erode quality of life and cast a pall over the future.

It is beyond the scope to enter into the philosophical debate concerning the "right" to commit suicide. We do know that suicidal feelings may pass when mood improves or one's life situation takes a turn for the better. Thus, the goal for all concerned - those with MS, their family members, and their healthcare providers - should be to ensure that the quality of life is the best that it can be given any limitations imposed by the disease. Effective symptom management and emotional support are essential factors affecting quality of life. All those who live or work with MS need to be aware that active intervention and support are of particular importance at those times when suicide seems like the only viable route.
 
Mood Swings
 
FAMILY MEMBERS HAVE long complained that one of the most difficult things to deal with are the mood swings of the person with MS. While everyone in the world probably has mood swings from time to time, people with MS seem to be at greater risk for them. Is this the result of some complex alteration in brain structure, or just the frustration that goes along with disability? We do not know. Whatever the cause, the bursts of irritability, anger, sadness, and frustration can make family life very unpleasant. There is no easy solution to this problem. Family counseling and support groups are often helpful. A mood-stabilizing medication such as divalproex sodium (Depakote) or one of the SSRI antidepressants is sometimes recommended. Most important are awareness and understanding on the part of all concerned, of the strong feelings that are being expressed. Quite often, exploration of these feelings will suggest possible ways to resolve some of them, thereby improving quality of life for the family as a whole.

Euphoria
 
EUPHORIA IS A relatively rare MS phenomenon, in which the person is unrealistically optimistic, happy, and even giggly in the face of seemingly dire circumstances that would make most people profoundly depressed. Euphoria is almost always associated with moderate to severe cognitive dysfunction. 

Because euphoric expression seems to come out of nowhere and tends to be inappropriate to the situation, the euphoric individual is often emotionally "out of sync" with others. As a result, the person may feel emotionally isolated from family members, and they from him or her. Social isolation may make matters worse, and the individual who is severely disabled and euphoric would probably benefit from increased social contact. To find out more, you can check out Multiple Sclerosis Disease Symptoms.

Multiple Sclerosis Symptoms And Diagnosis

Solutions
 
WE HAVE THUS far talked about adaptation and adjustment as if they were natural processes at which we are all skilled. To some extent, it is true that we all have within us the potential to cope with incredible stress and loss. However, there are a variety of ways to realize that potential to its fullest, and no two people (even in the same family) are likely to do it in exactly the same way.
 

Multiple Sclerosis Symptoms And Diagnosis

The National Multiple Sclerosis Society offers a wide variety of educational programs and materials for individuals and family members living with MS, as well as a program specifically for the newly diagnosed entitled "Knowledge Is Power". Although not everyone who is newly diagnosed is ready to become an expert on MS, learning about the illness, both at the time of diagnosis and further down the road, can help restore some sense of control over what is essentially an uncontrollable disease. Focusing on the aspects of the illness that you can control - and acknowledging those you cannot - will enhance your chances of success.

Open communication between family members has been recommended so often that it has become a cliche. However, many forms of family strain can be prevented or relieved by the understanding and sensitivity that come from good communication. Even within the most close-knit families, personalities and coping styles may differ significantly. Thus, two members of the same family may respond to the MS with different, even conflicting, coping styles. Perhaps one wants to avoid all talk about MS and pretend for, as long as possible that it never happened. The other person wants to talk and read about it, go to MS meetings, and meet other families living with the disease. Family members need to acknowledge and respect one another's emotional needs and coping styles. There is no one "correct" way to deal with MS, and adjusting to it may require more time for one person than for another.
 
Support groups offer many people an opportunity to compare experiences and feel less alone. Family counseling can be extremely helpful, especially if you are finding that achieving effective communication on your own is blocked by angry feelings or different styles of dealing with stress and anxiety. There are many ways to "help nature along" and speed the process of putting MS in its place.
 
Emotional Changes
 
THE DISTINCTION BETWEEN emotional responses and emotional changes is somewhat arbitrary. In the previous posts, we talked about some of the emotional responses that are most common in MS (i.e., those that almost everyone goes through at one time or another in the ongoing adjustment process). They are referred to as responses because it is assumed that they involve reactions to the altered life circumstances brought on by MS.

Here, some of the less common emotional experiences that can occur in MS are discussed. These include more serious emotional changes, along with a few that have a physiological basis rather than being reactions to the stress of the disease. In reality, there is a great deal of overlap among these various categories of emotional experiences. Moreover, we are often guessing when we attribute a specific cause to any emotion because we do not know for certain what is caused by stress and what is the result of demyelination.
 
You may go through your entire life without experiencing any of the things described. However, if these changes are part of your life with MS, the discussion that follows should help you understand what is happening and why.

Depression
 
THE TERM DEPRESSION is used in a variety of ways. In everyday language, the term is used loosely to refer to feeling down in the dumps. You might hear someone say, "Oh, she's depressed because she got a C on her final exam." This is not depression in the technical sense, but rather a situational and transient sadness or "dysphoria." In contrast, clinical depression (or major depressive disorder) is a serious and, at times, life-threatening psychiatric condition that meets specific diagnostic criteria. These criteria include profound sadness, loss of interest in everyday activities, changes in appetite and sleep patterns, feelings of worthlessness and/or guilt, lassitude, and thoughts of death or suicide. 

Major depressive disorder is more common in MS than in either the general population or among other disability groups. Research has shown that upward of half of all people with MS will have a full-blown, major depressive episode during the course of their illness. People are at particular risk for these episodes during exacerbations. The person who is in a major depressive episode may be unable to function and may withdraw from daily life and social interactions.
 
While such episodes are generally self-limited, there is considerable research showing that medication, either alone or in combination with psychotherapy, can help to shorten the episode and prevent or delay future episodes. In this situation, psychotherapy does not mean going to a support group, peer counselor, or other relatively informal form of intervention. Generally, a psychiatrist should be consulted and psychotherapy may be indicated with a mental health professional (e.g. psychiatrist, psychologist, or social worker).
 

The antidepressants most commonly used in MS today are the selective serotonin reuptake inhibitors (SSRIs) including fluoxetine (Prozac and generic formulation), sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa), and escitalopram HBr (Lexapro). Other antidepressants used in MS include buproprion HCL (Welbutrin), venlafaxine (Effexor), and trazodone (made by several manufacturers), as well as the older tricyclic medications (amitriptyline, desipramine, and nortriptyline, each of which is made by several manufacturers). To find out more, you can check out Multiple Sclerosis Symptoms And Diagnosis.

 

Multiple Sclerosis Signs And Symptoms

Re-Emergence
 
DEALING WITH EMOTIONS is an important part of the adjustment and coping process, but it is not the only part. In addition to coping with their emotions, people living with MS are generally called upon to make a variety of concrete changes in their day-to-day routines. When people are first impacted by MS symptoms, the disease may feel like a huge, looming monster that uses all the space in the family's life. There may be so much that needs to be done differently - such as getting from one place to another, managing tasks at home or at work, or enjoying leisure activities - that MS always seems to be in the way and underfoot.

Multiple Sclerosis Signs And Symptoms

As people gradually make the necessary changes, however, and become accustomed to some modified ways of doing things, it becomes somewhat easier to "sweep MS into a corner." Although MS is never going to go away, the family can reach the point where the disease no longer drains quite as much attention and emotional energy. At that point, people are able to continue with their lives, secure in the fact that although MS is a part of their lives, it does not have to be the whole of it.
 
The ability to "sweep MS into a corner" - or "keep it in its place" - may last only as long as the disease is quiet and stable. With each significant change or loss, the disease looms large once again, requiring people to repeat the process of grieving and adaptation. Some have described life with MS as a kind of emotional roller coaster, defined by all the dips and turns of this unpredictable disease.
 
Stress 

THE ISSUES DISCUSSED thus far have one thing in common-they all entail stress. Stress is anything that impinges on us and demands some change on our part that is accompanied by an emotional reaction. Life is full of stresses both large and small, painful and happy. Larger stresses (i.e., losing a loved one, losing a job, or getting married) are often referred to as "stressful life events." The smaller stresses of everyday life, such as getting stuck in traffic or misplacing one's keys, might be thought of as "hassles." Having a chronic disease like MS adds a considerable amount of disease-related stress to the common stresses of modern life. Learning to cope with this increased stress load is a major challenge for individuals with MS and their families.

A major stress that accompanies MS is the fear that stress itself may make the disease worse by precipitating exacerbations. Anecdotes abound concerning sudden and traumatic worsening of MS following major life events. There have been more than two dozen studies that have tried to sort out the relationship between stress and the onset or exacerbation of MS. Some of these studies have found a complex interplay between stress and the immune system, and it has been proposed that stress may worsen MS by promoting the inflammatory process. Sufficient evidence to support such an idea is lacking, however, and the relationship between stress and MS remains far from clear.
 

Sometimes family members worry that their behavior has somehow caused the stresses that worsened a loved one's MS. Many people with MS have been told to quit working in order to cut down on the stress in their lives, or to simplify their lives in order to avoid stress. There is no scientific evidence whatsoever to support either of these ideas. Stress is an unavoidable part of life, and a person can create unnecessary, additional distress simply by trying to avoid the unavoidable. One can, however, learn how to cope with stress more effectively. Better coping is not going to slow down the progression of the disease, but it is likely to make life much happier for everyone. To find out more, you can check out Multiple Sclerosis Signs And Symptoms.