At least 65% of people with MS will experience changes in their thinking, attention, or memory. For some, it's their very first symptom.
Cognitive challenges are very common in people with MS. That's because MS is a disease of the central nervous system (CNS), which includes the brain, spinal cord, and optic nerves.
How Your Brain Changes Because of MS
Problems with thinking, memory, attention, and other cognitive functions in MS result from damage to the nerve pathways that process information in the brain.
As damage occurs to the myelin coating around the nerves, and to the nerve fibers themselves, brain tissue is lost. The severity of cognitive impairment a person may experience is related to the amount of loss that has occurred.
The good news is that cognitive symptoms generally progress slowly, which means there’s plenty of time to develop strategies for managing them.
The Effects of MS on Cognition
When faced with the phrase “cognitive changes,” many people become rightfully concerned. You may be wondering what exactly these changes can be.
Like every other aspect of this disease, each person’s experience is unique. Here are some of the common cognitive changes:
The hallmark of MS-related cognitive change is a slowing of information processing speed. You may be able to think, learn, and remember, but everything feels slowed. (This foggy feeling is often referred to as "brain fog" or "cog fog.")
Perhaps you can’t keep up with conversations, react quickly to things going on around you, or put together sentences as quickly as you did before. Things that used to be automatic may now take a great deal of effort.
You may also experience difficulty remembering new information—a conversation you just had, the plot of a program you just watched, or an article you just read.
These memory difficulties are related to slowed information processing speed; your external environment is moving too fast for your brain to store it in your memory.
Challenges With Focus
Another common problem is with attention.
Perhaps before MS you were good at multitasking or handling many stimuli at once. Now you may find it difficult to do so.
If you get distracted from a project, you may also have difficulty refocusing.
Or, you may notice that once you focus on something, you have difficulty switching your attention to something else—even when you need to.
“It’s on the Tip of My Tongue!”
All of us struggle to find words sometimes, but you may notice that your “tip-of-the-tongue” episodes are more frequent than they used to be.
This can be frustrating in conversation, causing frequent interruptions while you search your mind for the missing word.
Trouble With Executive Functions
We’re all “executives” in our everyday lives. We evaluate, plan, prioritize, and problem-solve.
For many people with MS, though, these executive functions are severely challenged.
You may find it hard to plan and organize a multi-step task like cooking a meal or paying your bills. You may have difficulty sorting out a problem to find a solution. Or you may get overwhelmed when trying to figure out what to do first.
You may find that physical tasks that were once easy or part of your "muscle memory" are no longer innate.
Perhaps you get lost while driving or have difficulty remembering which way to turn when you leave your office to go to the restroom. Or you might have difficulty doing jigsaw puzzles or assembling toys for your kids.
Common Questions About Cognitive Changes
It can be confusing—for yourself and for other people—to understand cognitive changes and their effects on your life. Here are some answers to common questions.
Do these cognitive symptoms mean I'll experience more physical symptoms?
No! Cognition challenges are independent of physical disability. This means: a person may have significant physical challenges without experiencing cognitive problems, and a person may have significant cognitive challenges without experiencing many physical symptoms.
Are MS cognitive changes similar to Alzheimer's disease?
They are not! Alzheimer’s causes a continuous decline in all types of mental, behavioral, and social functioning. In MS, selective areas of thinking and memory are affected.
Will I need to leave my job?
You can remain on the job as long as you want to and feel able. Cognitive changes progress slowly, and you can compensate for these challenges in your life. This is important because cognitive symptoms, along with fatigue, are the most common reason people leave the workforce early. Learn more about MS and employment here.
Could these cognitive changes just be normal aging?
You’ve probably noticed that cognitive MS symptoms are also common changes seen in the elderly and women going through menopause.
People may try to reassure you by saying, “Don’t worry! That happens to me all the time!” However, if you feel that your challenges are greater than those of your peers, or are progressing faster than theirs, you need to advocate for yourself with your healthcare team.
Finding Help with Cognitive Symptoms
With all these possible changes, you may wonder how to go about getting help.
1. Report any changes to your MS provider.
It's important to be open to the possibility that your thinking or memory may have changed a bit. Take note if you feel like your mind is moving slower or differently. Sometimes your loved ones are the first to notice changes, so be open-minded if they mention it. The sooner you get evaluated, the sooner you can get help, and the more likely you are to be able to continue functioning optimally at work and at home.
2. Get cognitive screenings.
MS specialists recommend that every person with MS have a cognitive screening at the time of diagnosis and every 6-12 months following. If your MS provider hasn’t suggested a screening, you can request one. The National MS Society (1-800-344-4867) can refer you to someone who can provide a cognitive screening test.
3. Follow through if additional testing is needed.
If your screening indicates a potential problem, additional testing is recommended. Neuropsychologists, speech/language pathologists, and occupational therapists all provide cognitive evaluations, although they use varying tests. The neurological evaluation is the most in-depth and is the kind of testing that’s required for anyone who is applying for Social Security Disability on the basis of cognitive symptoms.
4. Find out your areas of strength and weakness.
A cognitive evaluation identifies the specific areas in which you are having difficulty. It also identifies your areas of strength. With that information, a cognitive remediation specialist (speech/language pathologist or neuropsychologist) can teach you strategies to compensate for the problems you are having. For example, substituting organization for memory so that you spend less time looking for things, creating task templates to help you complete multi-step tasks, offering tips for word-finding difficulties, helping your create a family calendar to track everyone’s schedules.
Communicating With Others About Your Cognitive Challenges
Cognitive changes are one of those frustrating invisible symptoms of MS that others find so difficult to understand. Family members, friends, or colleagues may wonder why you ask questions multiple times, forget recent conversations, seem confused when you never used to, or take much longer to complete tasks. Taking steps to educate others will help you manage cognitive challenges more easily.
- Once you have been screened and/or evaluated for cognitive changes, it's important to share the information with your family members and friends. You can explain what the changes are and let them know how they can be of most help to you. Conversations that happen in quiet, distraction-free places are more likely to be successful. Making eye contact while talking and checking with one another to ensure that you’re hearing and understanding what’s said can reduce a lot of frustration
- If the cognitive remediation specialist recommends some strategies that would help you in the workplace, you may want to request accommodation from your employer. Making the decision to disclose at work is a very personal one, but getting the accommodations you need may be essential for remaining in the workforce.
Clearing the Fog
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Tips for Cognition
Here are some examples of compensatory strategies for cognition changes.
Feeling forgetful? Try this psychology trick.
Combat cognition challenges with organization.
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