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Delicate, difficult, taboo. Due to stigmas and fears, that’s how the subject of cognitive problems in MS used to be viewed by both people with MS and their doctors. However, research in the last 20 years has opened a window on MS and the mind, and the changes in thinking, memory, and emotions people with MS encounter are emerging from the shadows to be discussed and managed rather than ignored.
Cognition refers to the high-level operations of the human brain, which include our abilities to learn and remember information, pay attention, solve problems, speak fluently, and think quickly. We now know that at least some decline in cognition occurs in about 50% of people with MS and that cognitive decline does not correlate with physical decline. Only 5% to 10% of people with MS have cognitive problems that seriously disrupt their daily living. In other words, 9 out of 10 people with MS are free of severe cognitive problems. That does not mean that changes that are annoying rather than disruptive should be ignored.
Cognitive changes are often mild and subtle: you might find it harder to come up with the right word, remember what to get at the store, keep up with a conversation, or think as fast as you once did. Changes might also show up in the form of depression or mood swings.
How MS Affects the Brain
Stress, depression, and fatigue—all common in MS—can each disturb memory and attention. Natural aging and some medicines can also be blamed. Cognitive problems due to MS, on the other hand, come from direct damage to brain tissues.
MS attacks myelin, the tissue covering nerves in the brain and spinal cord. The lesions (scars) left behind can stop or slow nerve impulses and cause both the physical and the cognitive deficits of MS. Studies using magnetic resonance imaging (MRI) in people with MS have shown that having a large number of lesions in the cerebral hemispheres of the brain, where the more complex brain functions take place, is strongly related to cognitive problems. Cognitive problems are also strongly related to brain atrophy, which results when nerve tissue is lost.
People with MS who experience forgetfulness may fear that their symptoms are a sign of Alzheimer’s disease. Such fears are unfounded; MS and Alzheimer’s disease are 2 different diseases that affect the brain differently. The effects of Alzheimer’s are more severe, rapid, and widespread in the brain, and the disease always progresses, disrupting moment-to-moment memory, use of language, and, eventually, self-awareness. In contrast, MS-related deficits may stabilize at any time, and the people experiencing them are usually able to compensate with use of reminders and thinking aids. MS tends not to affect general intellectual ability, long-term memory, or reading comprehension.
Ways to Help Improve Thinking
More and more doctors and nurses regularly ask their MS patients if they’re having problems with memory, thinking, or emotions. If your healthcare professional does not ask, you should raise the issue yourself and describe any specific changes. Do not consider cognitive symptoms any less important to discuss than physical symptoms like spasms or a urinary tract infection. Your healthcare professional may have treatments and strategies that can improve your cognitive problems. Research on drug treatments and cognition is far from complete, but doctors today consider 3 main strategies.
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An early start on MS disease-modifying therapy (DMT), chiefly the β-interferons (IFN β-1b [Betaseron®], intramuscular IFN β-1a [Avonex®], and subcutaneous IFN β-1a [Rebif ®]) and glatiramer acetate (Copaxone®). The impact of DMTs on cognition is still being studied, but because they reduce the rate at which new lesions develop and accumulate in the brain, they are likely to slow cognitive decline.
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Treat depression, fatigue, and other MS symptoms that disturb thinking. Finding the right drug and dosage may take time, but be sure to discuss treatment options with your doctor to help combat these symptoms.
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Target cognitive symptoms. There are some medications available that have been used to target specific cognitive symptoms. Ginkgo biloba, an extract of the leaves of the ginkgo tree, is a popular over-the-counter product that is considered a complementary or alternative medication (CAM). It was shown to slightly improve learning and memory in a small MS trial. Much larger studies must be done before any definitive benefits are determined. A lot remains to be learned about ginkgo biloba and other CAMs used for MS-related cognitive problems, so be sure to discuss options with your doctor. |
More Strategies and Tips
There are methods that can be used to compensate and live well in spite of cognitive changes that do not require medications. Techniques that can help with memory, attention, and general thinking, range from simple to sophisticated (see Table). All offer alternative ways to perform functions that have become difficult.
