Multiple Sclerosis Centers of Excellence
Understanding Cognitive Dysfunction
Brett Parmenter, PhD
Cognition refers to a person’s ability to perform high-level brain functions and includes things like thinking, learning, remembering, and understanding. Approximately 50% of individuals with MS will develop cognitive dysfunction over the course of their disease. For some people, cognitive dysfunction can be very mild and not easily noticed by those around them. For others, it can be significant and make it difficult to work or take care of things at home. When a person has cognitive dysfunction, there may be feelings of depression, anxiety, or insecurity. Three areas that are commonly affected by cognitive dysfunction in MS are information processing, learning and memory, and executive functioning.
Information processing includes working memory and processing speed. We use working memory when we need to remember something but cannot write it down, such as remembering a phone number for a few moments before dialing it. While this can be difficult for most people, those with working memory problems find it even more challenging. Processing speed refers to how quickly we can deal with information that we see or hear. A person with slowed processing speed might have difficulty keeping up with conversations and feel like others are talking too quickly. If processing speed is particularly slow, it is important that an individual not be placed in danger, such as driving a vehicle. Problems with information processing can also make other cognitive functions difficult, such as problem solving or memory.
People with MS can have problems with certain aspects of learning and memory. Remembering the name of your third-grade teacher or what you ate for breakfast are two examples of what is called episodic memory. People with MS can usually remember things from their childhood but may have difficulty remembering things that happened yesterday. Studies have shown that people with memory problems because of MS tend to remember more when information is repeated or when they have reminders.
Executive functioning is a broad term that refers to things like organizing an event, being able to do more than one thing at a time, and problem solving. An individual with such problems might find it difficult to plan a party for a large group of friends or “let go” of a topic in a conversation and move on to a new one. This can be even more noticeable if the person also has slowed processing speed and these tasks must happen quickly.
Although there is no cure for cognitive dysfunction because of MS, there are things that people can do to try to lessen the effects.
Working Memory Tools
It can be helpful to write down phone numbers, addresses, directions, shopping needs, etc. as soon as you learn them. A calendar, organizer, or application on a computer or smartphone are good for tracking appointments and activities for you and your family. These can also be used to remember names as well as conversations. If you tend to lose things, pick a designated place for objects. Using visual reminders is a great way to keep on track. For example, place the laundry basket upside down in an obvious location when laundry is being washed.
Processing Speed Tools
If you find that you can’t keep up with a conversation, ask people to slow down when talking to you or ask them to repeat themselves. Allow yourself extra time to complete tasks and plan your most challenging tasks at a time of day when you feel at your best. If you feel like something is taking too long to complete, take a short breather and come back to it with a fresh mind.
Executive Functioning Tools
Give your full attention to the task at hand and reduce the noise and distractions around you. Trying to do too many things at once can be difficult and overwhelming. Get organized or have someone help you get organized. Reducing clutter can improve focus. If you run into a problem you just can’t solve, ask for some advice or find someone that can help. Getting enough sleep, maintaining adequate nutrition, and taking care of your physical and emotional needs can also be useful. While it can take time and practice to get used to doing these things, many people find them helpful and studies have shown that using such strategies can make someone feel less depressed or anxious.
If there are concerns about cognitive dysfunction, talk to a medical provider. Early assessment and treatment are important as cognitive dysfunction may affect quality of life. In some cases, it might be helpful to see a neuropsychologist who is a doctor with specialized training in cognitive problems. This type of doctor can do specific testing to see if there are problems and, if so, how severe they are. Once a person knows if he/she is having cognitive problems and what type, the individual can work with a doctor or therapist to come up with strategies to help manage the cognitive challenges.