How Severe Can It Get?Cognitive problems in people with MS can become severe enough to make it difficult to work in a profession that requires speedy or complex problem-solving. Most people, however, can develop coping techniques that keep cognitive symptoms from interfering with daily life too much.
Real, debilitating dementia as a symptom of MS is very rare, occurring in less than 5 percent of patients, who are usually very severely affected by other MS symptoms. In contrast to other types of dementia, such as that caused by stroke or Alzheimer's disease, the following problems are NOT usually associated with MS-related cognitive dysfunction:
- Aphasia: Aphasia is the inability to understand the speech of other people and/or express oneself verbally. While people with multiple sclerosis (MS) often have trouble finding words or communicating, this is more often dysphasia, a symptom of MS that is not as severe as aphasia.
- Agnosia: Agnosia is difficulty recognizing familiar things, such as shapes, sounds, objects, people and smells.
It Comes and Goes: Just like many other MS symptoms, cognitive problems will probably be worse at certain times. Other times, you may feel like your old self. See if there is a pattern to this (you may want to keep a symptom log or at least jot down notes for a couple of days). As much as possible, plan critical tasks for those times when you feel your sharpest. Also, notice if certain things make your cognitive problems worse – music, sounds from the television, encounters with certain people, even different kinds of lighting can have profound effects on cognition. When possible, adapt your environment and situation to make things better for you.
Remember, Life is Complex: Fight the urge to be hard on yourself or get too frustrated when something “slips through the cracks” and you are late to an appointment or forget to return a phone call promptly. If you think about it, pretty much everything we do involves many, many steps, requiring: use of long-term and short-term memory, monitoring and adapting to the reactions of others, simultaneously performing many related and unrelated tasks – all while often fighting fatigue or a number of other symptoms that we might have. Try an experiment for yourself: Take a child grocery shopping, cook dinner while talking on the phone or observe yourself getting ready for a meeting. Look at how many things have to happen to get from Point A to Point B and marvel that anyone gets anything accomplished.
My ExperienceThe first cognitive problem that I became aware of was a gradual fear of driving. At first, I would feel anxious that I would forget directions and be so preoccupied with getting lost that I would be stressed out when I went anywhere. Then I noticed that driving along even very familiar routes was becoming increasingly scary – I would be afraid to change lanes, nervous that I was going to run red lights, distracted by too many cars, frightened of big trucks and uneasy if the lighting was too bright, too dark, too dappled. As I had not yet been diagnosed with MS, I just told myself that I was being silly and kept pushing it, until the anxiety started really limiting my activities.
Since my diagnosis, I have noticed many more cognitive symptoms. Conversations are sometimes hard to keep up with and I often find myself making a point out of context. I know that I repeat myself a lot and have a habit of not finishing sentences. When I am writing, I fight the urge to steer away from certain words that I seem to have forgotten how to spell.
I've made several adaptations when it comes to driving: I haven't driven on the highway in many years, and I prefer to drive alone, so that I can focus 100% of my attention on the road and what I am doing. But on good days, I still try to make small neighborhood trips during quiet traffic times. Aside from driving, I have noticed that I sometimes want to avoid conversation so people don't pick up on any of my cognition problems. But because I want to stay engaged and social, I make a serious effort to chat with people -- I figure no one will be seriously injured (unlike driving) if it takes me a couple of minutes to find the word that I am looking for or I tell a story for the second time in five minutes.
Sources: Olek, MJ. Comorbid problems associated with multiple sclerosis in adults. UpToDate. Last updated May 22, 2008.
Olek, MJ. Comorbid problems associated with multiple sclerosis in adults. UpToDate. Last updated May 22, 2008.