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Brochure Managing Cognitive Problems - 1
Brochure Managing Cognitive Problems - 1
Problems in MS
CHERISH
DIAGNOSED IN 2002
Managing Cognitive Problems
BY NICHOL AS G. L A ROCC A, PHD
W ITH M A RTH A K ING
Dendrites
Demyelinated
Cell Area
body Myelin
sheath
DEMYELINATED NEURON
Axon
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that at certain times they are just too tired to tackle cognitive
tasks. Recent studies have documented the existence of
cognitive fatigue which refers to people’s perception that
cognitive functioning temporarily declines during an extended
period of cognitive effort, such as one might experience
on the job. As a result, cognitive functions may be in better
working order at some times of the day than at others.
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n Abstract reasoning, problem-solving, and executive functions.
All of these functions are involved in a person’s ability to analyze
a situation, identify the main points, plan a course of action and
carry it out. Some people with MS report that their judgment has
also been affected. More often, family members or employers
notice changes in problem solving or reasoning before the
person with MS does.
n Visual-spatial abilities. These functions include the ability to
recognize objects accurately and to draw or assemble things.
Visual-spatial abilities are involved in many everyday tasks such
as driving, finding one’s way around or packing a suitcase.
n Verbal fluency. Fluency problems are different from the MS
speech problems that slow speech down or change voice
quality. A fluency problem often manifests itself as the “tip-
of-the-tongue” phenomenon: a person wants to say a word,
it’s on the tip of the tongue, but she or he just can’t think of it.
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professional practice that is particularly affected by the person’s
cognitive changes. But another person with the same degree of
impairment might not need to make any lifestyle shift, because
he or she is able to cope using self-help measures or through
reasonable accommodations on the job. Retired individuals
with relatively fewer demands on their cognitive abilities are
likely to be able to cope quite well with everyday activities.
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information, reminders, appointments and alarms. Record
appointments, to-do lists, phone numbers, family activities,
driving directions — anything that you need to remember
but are likely to forget. Use your paper or computer/tablet/
smartphone organizer to replace little scraps of paper and
notes that may get misplaced or lost.
> When you are trying to learn something new, give yourself
extra time to practice. Studies have shown that with extra
practice people with MS can improve their ability to recall
information later.
> Set up a family calendar to track everyone’s activities.
> Assign a particular place for storing frequently used items
such as your car keys and encourage family members to
return borrowed objects to their proper spots. For example,
the scissors always go in the top drawer of the desk.
> Work on your focus and concentration. Sometimes we
“forget” things because we never really learned them in the
first place. This can happen because we are not giving our
full attention to tasks or conversations. Improving your
concentration can enhance your recall. Practice focusing on
one thing at a time when you are reading, watching TV, or
seeing a movie. For example, if you are reading a newspaper
article, focus on the main point of the article. If you are
watching a movie, focus on the names of the characters.
Then in everyday tasks, try to apply that focus on one thing
at a time. If you are involved in a conversation, focus on
what is being said — block out distractions such as noise
in the immediate environment, nearby conversations and
unrelated thoughts that pop into your mind.
> Plan your most challenging cognitive tasks for your best
time of day. To reduce the cognitive fatigue that can occur
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> Talk to a doctor, nurse or dietician about your eating habits to
ensure that you are getting good nutrition.
> After consulting with your doctor, follow a consistent exercise
program to help stay in shape physically, mentally and
emotionally.
> Keep challenging your mind with puzzles, reading, stimulating
conversation, video games, etc. The old saying, “If you don’t
use it, you’ll lose it” applies here.
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by brain disease or trauma) — preferably one who has had
experience with people who have MS. A psychologist without
this training may have difficulty selecting the proper tests and
interpreting the results.
In addition to neuropsychologists, appropriate and
comprehensive cognitive evaluations can be done by speech-
language pathologists and occupational therapists who
have experience with MS. Each of these three professions
may use slightly different tests, but all three can provide
valuable insight concerning cognitive changes. In any given
locale, one or more of these MS professionals might not
be available, and so being able to choose any of the three is
a great advantage.
A neurologist or psychiatrist can perform briefer evaluations,
but these generally detect only severe cognitive dysfunction.
Janis M. Peyser, PhD, of the University of Vermont completed
a study in which she found that almost half of the patients whom
neurologists considered to be without cognitive problems were
found to have problems when tested by a neuropsychologist.
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reduce the number and severity of MS attacks and reduce signs
of damage to brain tissue as seen on MRI, they may all, in the
long term, have beneficial effects on cognitive function.
A few other medications have shown some promising results
in small, uncontrolled studies of cognitive function. These have
included testosterone gel, monthly treatments with a combination
of cyclophosphamide and steroids, and erythropoietin (a drug
thought to have potential neuroprotective effects in MS).
However these very preliminary results need to be confirmed
in larger, controlled studies.
Other drugs have been studied for possible use in treating MS-
related cognitive changes. These have included memantine (a
drug approved for the treatment of symptoms of Alzheimer’s)
and methylphenidate. There is some initial promise with
l-amphetamine, but larger trials are needed. Unfortunately
none of these have proven to be effective in treating cognitive
dysfunction in MS.
Some doctors prescribe other types of medications to treat
cognitive changes in MS. These include medications designed
to improve attention. However, there are no published studies
to support the use of other medications for improving cognitive
functioning in MS.
Clearing up misconceptions
Cognitive dysfunction is probably subject to more
misconceptions than any other topic in MS, in part
because we tend to avoid discussing it. Let’s dispel some
misconceptions.
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n Misconception: When cognitive problems appear, they
worsen rapidly.
Although very few long-term studies have been completed,
results thus far suggest that these problems progress slowly in
most people.
n Misconception: Cognitive problems only occur in people
who are severely disabled.
On the contrary, people who are severely disabled physically
may have no cognitive problems at all. Studies completed by
Robert Heaton, PhD, formerly at the University of Colorado,
and his colleagues and by William Beatty, PhD, formerly at the
University of Oklahoma Health Sciences Center, have shown
that there is only a very weak relationship between extent of
physical disability and cognitive dysfunction in MS. On the
other hand, cognitive problems can affect people who have
very few physical problems.
n Misconception: Cognitive problems only occur late in the
course of MS.
Doctors Beatty and Heaton found that there is little relationship
between duration of MS and the severity of cognitive dysfunction.
In fact, cognitive problems can be the primary presenting symptoms
in newly diagnosed persons with MS.
n Misconception: Cognitive problems only occur in people
with progressive MS.
Cognitive dysfunction is likely to be somewhat worse in people
with progressive MS. Slowed processing speed and problems in
learning and memory are common among persons with relapsing-
remitting MS, but individuals with any kind of MS can experience
cognitive problems.
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Suggested reading
Multiple Sclerosis: Understanding the Cognitive Challenges,
by Nicholas LaRocca and Rosalind Kalb, with John Deluca
and Lauren Caruso. New York, Demos Medical Publishing,
2006, 152 pages.
Facing the Cognitive Challenges of Multiple Sclerosis,
2nd ed. by Jeffrey N. Gingold. New York, Demos Medical
Publishing, 2011, 240 pages.
The MS Workbook: Living Fully with Multiple Sclerosis,
by Robert T. Fraser, George H. Kraft, Dawn M. Ehde,
and Kurt L. Johnson. Oakland, CA, New Harbinger
Publications, Inc., 2006, 243 pages.
Improving Your Memory for Dummies, by John B.
Arden. New York, Wiley Publishing, 2002, 336 pages.
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Notes
National MS Society | 24
The National MS Society’s mission is for people affected
by MS to live their best lives as we stop MS in its tracks,
restore what has been lost and end MS forever. To fulfill
this mission, the Society funds cutting-edge research,
drives change through advocacy, facilitates professional
education, collaborates with MS organizations around
the world, and provides services designed to help people
with MS and their families move their lives forward.
nationalMSsociety.org
1-800-344-4867
25 | National
© 2016 Managing Cognitive
MS Society. Problems in MS
All rights reserved. ES6029 7/16