Cognitive Symptoms of MS
Multiple sclerosis (MS) is most often recognized for its disabling physical effects, such as gait disturbance, impaired sensation, heat intolerance and optic neuritis. However, the cognitive dysfunction associated with MS can often be more debilitating and detrimental to a person's well-being. MS patients with cognitive dysfunction often experience difficulties with employment, family and social relationships and activities of daily living.
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What is MS?
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MS is an autoimmune disease affecting the central nervous system (CNS). The body's immune system attacks myelin, replaces it with hardened tissue and creates lesions. Myelin, a type of white matter in the CNS, acts as an insulator and forms a protective layer, called the myelin sheath, around the axons of the CNS. In MS, the destruction of myelin and the resulting lesions interfere with communication within the CNS, causing a variety of devastating side-effects.
Variability of Cognitive Symptoms
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Just like the physical symptoms, the cognitive symptoms of MS and their severity are highly variable, unpredictable and can vary from person to person. These symptoms may be the first symptoms a person experiences but more often occur in later stages of the disease. Symptoms of cognitive dysfunction generally appear gradually and rarely improve significantly after their onset. Cognitive symptoms can be permanent or can wax and wane.
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Memory Dysfunction
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Memory dysfunction, the most common cognitive symptom in MS, involves difficulty with free recall of recent events or recently-learned material. Although a MS patient has difficulty with recall, the disease does not affect the person's ability to remember events and newly-learned material. The person is simply slower at recalling recent events or recently-learned material.
Verbal Fluency
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MS does not affect general conversational skills, intellect or long-term memory. At the same time, verbal fluency dysfunction is a common symptom in MS patients and usually involves slowed free recall of words describing concepts. A person may have the word "on the tip of her tongue," but have difficulty finding the word to express an idea or concept. MS typically does not affect recall of words naming objects.
Cognitive Fatigue
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While the most common physical symptom of MS is fatigue, fatigue also presents cognitively. MS patients tire more quickly during problem-solving or planning activities, and this is called cognitive fatigue. This causes difficulty with problem-solving and planning.
Treatment
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Currently, MS has no cure, and treatment can be difficult. Early intervention can reduce or slow the number, frequency and severity of relapses. Treatment typically involves medication, which can cause undesirable or intolerable side-effects and has been largely less than effective in addressing cognitive dysfunction. A multi-disciplinary approach may prove especially helpful in patients with moderate to significant cognitive dysfunction.
Multi-discplinary Approach
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A multi-disciplinary approach, involving neuropsychologists, speech and language pathologists and occupational therapists, has demonstrated efficacy in treating cognitive dysfunction associated with MS. Cognitive retraining uses repetitive drills and mental stimulation to improve cognition, and compensatory strategies employ organizational skills and coping methods to improve activities of daily living. Activity, organization and routine, such as making lists, using a planner and maintaining a schedule, can compensate for cognitive deficits. Cognitive problems can be most effectively minimized if a patient is willing to confront and constructively manage cognitive deficits.
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