| Cognitive Challenges and Strategies for Families Living with Multiple Sclerosis |
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Cognitive dysfunction is commonly seen in people with multiple sclerosis (MS).
Problems can range from mild symptoms in areas of attention, information processing,
memory, planning, insight and/or problem solving to occasionally severe problems
affecting one’s ability to function at work or home. Cognitive dysfunction is not
strongly correlated with physical disability. However, it is one of the top reasons
for unemployment in people with MS. It can also cause frustration for the person
with MS and their family and friends.
Cognition is defined as “awareness with perception, reasoning, judgment,
intuition and memory; the mental process by which knowledge is acquired”.
It is how a person 1) understands and uses language; 2) sustains and shifts
attention and ‘multi-tasks’; 3) learn and remember new information; 3) plans
and performs complex tasks and 4) solves problems and monitors behavior.
Cognitive dysfunction can result from difficulty in any of these areas.
Cognitive challenges are not surprising in MS because the thought processes
of the brain are interconnected to the conscious areas of the brain via
myelinated nerves. This results in difficulty with transporting memories to
the storage areas of the brain and in some cases retrieving them from the
storage areas. This problem is different from that of Alzheimer’s disease.
Because cognition is extremely complex and affects aspects of memory, behavior
and language it is important to assess and identify the specific deficits.
Following formal assessment, proper strategies can be developed to compensate
for the cognitive problems. Neuropsychological testing can be very time
consuming and costly but provides comprehensive information in areas of
cognition and emotion. Shorter cognitive screening techniques may also
be used to determine cognitive deficits, the need for further testing and/or
treatment planning. Stress, anxiety, depression and fatigue can all interfere
with cognitive function. Therefore, psychological or emotional issues need to
be determined and treated if present.
Treatment of cognitive dysfunction is primarily done through the introduction of
learning and memory strategies. Cognitive rehabilitation has not been well
established for MS, but clinical results are extremely encouraging.
Rehabilitation often takes the form of strategies which may include the use
of daily planners or calendars, electronic aids such as computers or personal
digital assistants (PDAs), lists and pill organizers. Other strategies include
repeating information to verify or clarify, using associations or visual
images to help improve memory and ‘combining senses’, “say it, see it, hear
it and do it” when learning new things. It can also be helpful to organize
your home or work environment so that items you use remain in the same place.
Some specific techniques you can use during conversation to improve learning and memory include:
- Asking someone to show you what he/she means by either demonstration or a picture. This ‘combines senses’ and will facilitate learning.
- If you are having trouble understanding or recalling information you hear, write it down or ask someone else to write it down.
- Ask someone to slow down or say it again. Often information is delivered too quickly to process, therefore asking the person you are speaking with to slow down or repeat can be helpful.
- Eliminate visual or auditory distractions. Turn off the TV or stereo when speaking with someone in person or on the phone. These visual and auditory distractions can make learning or remembering more difficult.
- If you can’t eliminate the distraction (i.e., people talking at a party) then remove yourself from the distraction. Ask, “can we talk in a quieter place?”.
- Take a break. If you are having difficulty concentrating then often taking a short break will allow you to refresh.
- Do one thing at a time. Many people have difficulty switching from one topic or task to another. It is best to either finish the task or find an appropriate stopping place before switching to something else.
- Rest!! As stated earlier, fatigue can have a significant impact on cognition.
If fatigue is a problem. Strategically scheduling a short rest can be helpful
in improving learning or memory.
Incorporating family and friends into treatment for cognitive dysfunction is essential.
Making sure family members and friends understand cognitive challenges and strategies to
help compensate for these problems can decrease emotional stress and frustration.
Family and friends can also help reinforce strategies learned.
Neuropsychologists, speech/language pathologists and/or occupational therapists
are the main healthcare professionals involved in the assessment and treatment of
cognitive dysfunction. If you are experiencing cognitive problems, speak to your
physician about referral to one of these professionals for a more formal assessment.
Cognitive impairment can be frustrating for the person with MS and his or her family
and friends. Identification and understanding cognitive dysfunction is an important
first step in establishing a proper treatment plan.
Cognitive rehabilitation strategies can be very helpful in improving learning,
memory and maintaining overall function and quality of life.
Randy Schapiro, MD
Pam Miller Sorensen, MA, CCC-SLP
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| - reprinted with permision from- The Heuga Center. |
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