Memory

Only recently has it been recognised that MS may cause problems with memory, planning, foresight and judgment, or cognition. It is now known that approximately one third of all persons with MS will have some problems in these areas and approximately 10 percent will have fairly serious difficulties. This is not surprising because the thought processes of the brain are interconnected to the conscious areas of the brain via myelinated nerves. Thus, short-circuiting may be common.

This does not mean that people are getting "dumber" but rather that they are having problems transporting their memories to consciousness. The problem is very different from that seen in Alzheimer's disease. A person may demonstrate areas of brilliance and other areas in which he or she is unable to retrieve the memory and use it effectively. Occasionally, a person experiences severe cognitive difficulties and is said to have "cerebral MS". Persons who have relatively minor levels of cognitive problems are aware of them; if the form is "cerebral", the person often appears to lack clear insight into the problem.

A number of compensatory techniques are used to work with the cognitive problems of MS. First, those problems need to be found and their extent measured. This is done through testing, either by a speech pathologist or more formally by a neuropsychologist. Remember that nobody's memory is perfect. Stress, anxiety and fatigue all decrease cognition, especially memory. Poor concentration may add to the problem. Depression must be treated. A person with MS often does not recognise his or her depression but may respond to medication and therapy. Psychological tests may be necessary to make the diagnosis of depression.

The following strategies have been found to be helpful in managing cognitive problems:

• Make lists-shopping lists, lists of things to do and so forth.
• Use a calendar for appointments and reminders of special days.
• Establish a memory notebook to log daily events, reminders and/or messages from family and friends.
• Use a tape recorder to help remember information or make up lists.
• Organise your environment so that things remain in familiar places.
• Carry on conversations in quiet places to minimise environmental distractions.
• Ask people to keep directions simple.
• Repeat information and write down important points.
• Establish good eye contact during any discussion.

This is the day and age of computers. Both electronic and non electronic organisers may be very helpful in organising your life. Cognitive rehabilitation has not been well established for MS as yet but the beginnings are taking shape. Cognitive problems may be minimised if a person with such a problem can be made aware of the problem and is willing to change his or her mode of operation by using compensatory techniques. Part of the difficulty is perceiving this awareness without creating antagonism.

Randall T. Schapiro, MD

Medical Director of The Fairview Multiple Sclerosis Center and of Rehabilitation at Fairview University Medical Center and Clinical Professor of Neurology, University of Minnesota, Minneapolis, Minnesota

Source - Randall T. Schapiro, MD. © Randall T. Schapiro, MD. Reproduced with permission.