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.
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| 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.