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 Cognition is basically another word for ‘thinking’. It includes many different functions, including our abilities to pay attention, learn and remember information, solve problems, and use language to express our ideas.
It is reported that 50% of people with MS admit to experiencing cognitive problems to some degree or another, rising to 80% if we include the most severe cases. The most frequent cognitive abnormalities in MS are subtle defects in abstraction, memory, attention and word finding. They are usually associated with Pseudobulbar Affect (Emotional Lability) and decreased speed on information processing. Thought processes of the brain are interconnected to the conscious areas of the brain via myelinated nerves. There can be problems transporting memories and processing of thoughts creating difficulties with concentration and reasoning-“I have the concentration span of a gnat,” is a familiar phrase to many. A certain amount of short term memory loss or forgetting to do things is also common. Recent surveys have shown that mood disorders and depression are frequent in people with MS. An association may exist between MS and manic-depressive disease (bipolar disorder). Reactive depression is also common in MS. One example of a cognition issue is when a person will be mid-sentence, then the next word they are about to utter will have eluded them and they are rendered speechless for seconds until they remember that word, if in fact they do remember it at all. Another example is that many find themselves insisting on finishing a sentence before another person speaks, not out of sense of rudeness but merely because if they are interrupted, they may forget what they are talking about or lose their train of thought. This can be very frustrating to the person with MS and other people involved in the conversation so it is important to establish a relationship where there is an element of awareness of the problem on the part of others. The third example is of memory loss, or to use a less harsh term, ‘forgetfulness’, which can be very frightening to a bright individual and his or her carer. Sometimes a person can feel as if they are no longer the same person inside as they had been prior to MS. This is a fallacy and with awareness of the condition from carers, spouses, friends and relatives, this fear can be allayed, though many people with MS need constant re-assurance of how they and others perceive themselves regarding, ‘dottiness’. At the risk of trivialising what is an upsetting feature of MS, many find they can laugh off this newly found trait. The culprits which exacerbate the cognition process are:- Therefore it is worth trying to avoid these as much as is relatively possible or if not avoided, kept to a minimum. It is also important to note that many people take drugs to alleviate other MS symptoms, e.g. Gabapentin and Amitryptilene for pain or spasms. These are known to impair cognitive function therefore again it’s worth bearing in mind on a bad day just what drugs the body has digested. So how can we deal with all this? There are many ways but it is up to each individual to try and test what will work for them and their families. Here is a list of coping strategies…. 1. Keep a notepad to hand always and make lists, e.g., shopping lists, lists of things to do, and so forth. 2. Use Post- it Notes ™ to write reminders and put them in obvious places in the room 3. Use a calendar for appointments and reminders of special days. 4. Organise your environment so that things remain in familiar places. 5. Carry on conversations in quiet places to minimize environmental distractions.6. Ask people to keep directions simple. 7. Repeat information and write down important points. 8. Establish good eye contact during any discussion. 9. Keep the mind active by doing a daily crossword or puzzle. 10. Most computer users will be familiar with Outlook or Yahoo Calendar in which they can write down appointments and reminders and receive those reminders in their e-mail. 11. The rapid development of mobile phone technology has enabled us to set our phones to remind us of things, therefore this may be better suited to those who are in the workforce.12. Lastly-the good old egg-timer or kitchen timer can be set at intervals during the day if a person is at home all day. There are a wide range of books available on the subject of memory training which are useful, because contrary to those with other Neurological diseases, persons with MS can store new memories and are capable of learning new information. Those familiar with computer technology may like to take a look at the following site which deals with memory training. http://www.mindtools.com/memory.html Is there any drug or remedy a person with MS can take to aid cognition? During the last few years, there have been numerous studies looking at ways to stabilise or improve cognitive dysfunction. Some of these studies looked at whether the MS disease-modifying drugs could slow the progression of changes in cognition. Results were mixed, with interferon beta-1a showing the most potential. Studies have also looked at other treatments that may temporarily improve cognitive functioning. Medications used for Alzheimer's patients, including donepizil or Aricept®, may have a role here but further research is needed. This leaves us with alternative therapies such as the herbal extract Ginkgo Biloba. This works by increasing blood flow to the brain it may also help in that it is a good anti-oxidant which will prevent organs from free-radical damage. However it is best to check with your health practitioner before taking this as it can thin the blood therefore should not be taken by people already taking blood-thinners such as Warfarin or Aspirin, neither by people with high blood pressure. Another natural remedy to cognition problems is the supplementation of the daily diet with Fish Oils and Essential Fatty Acids. Further Information Cognitive Research For all the lastest research news into Cognitive Problems in MS please click here. © Multiple Sclerosis Resource Centre (MSRC)
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