Cognitive difficulties brought on by MS are an incredibly tough thing to accept, especially in the very young. We aren't supposed to experience memory loss like this in our 40s, 30s and even 20s. When that familiar face says "hello," on the street one day, you know you recognize this person...but you think: "what was that name again?" Embarrassing to say the least.
According to the National MS Society:
- Cognitive problems are only weakly related to other disease characteristics — meaning that a person with almost no physical limitations can have significant cognitive impairment, while a person who is quite disabled physically can be unaffected cognitively.
- Changes can occur at any time — even as a first symptom of MS — but are more common later in the disease.
- Cognitive function correlates with number of lesions and lesion area on MRI, as well as brain atrophy.
- Cognitive dysfunction can occur with any disease course, but is slightly more likely in progressive MS.
- Being in an exacerbation is a risk factor for cognitive dysfunction.
- Cognitive changes generally progress slowly but are unlikely to improve dramatically once they have begun.
These cognitive issues can make life incredibly difficult for patients who experience them, especially when individuals are still employed. Performing well in cognitively challenging careers becomes difficult, and can be a cause of great frustration for patients.
Like any MS symptom, these changes are caused by lesions, as well as brain atrophy over time. Medications used to treat MS symptoms can also be responsible for causing cognitive issues. Pain medications, anxiety medications, and muscle relaxants can cause patients to become sleepy, fatigued, and even confused. We should all be cautious when using these types of medications, especially when driving or doing other dangerous activities.
What can be done about these issues?
Occupational therapists, speech and language pathologists, and neuropsychiatrists can perform a specific battery of tests to determine the severity of the cognitive impairments. Then, computer-assisted tools such as memory aids, and other forms of cognitive rehab can be used to improve memory and learning. The other key point is that lesion load, or the number of lesions seen on MRI, can correlate with cognitive problems. Therefore, it is natural to assume that staying on a disease-modifying drug is important in keeping the lesion load low.
In my own life, I have experienced a great deal of cognitive decline over the last few years, and I am only 40! I began to notice that I was forgetting the reason I entered a room, where I put important things in my home, where I set my keys, and even names. I was horrified when I noticed these changes! Some of these things can be blamed on normal aging, stress (6 kids!), and perhaps lack of sleep/rest. However, I am quite sure that MS has a lot to do with it. All we can do as patients is educate ourselves, educate our families, and be aware. Communication with our providers is important as well, and we need to be sure that we are receiving every available treatment. Don't ever assume that nothing can be done for you. Training your brain by reading, writing, and continuing to learn are excellent ways to keep the mind working! "Use it, or lose it," as they say!