Strategies to Help with Cognitive Problems
For many years, cognitive issues were not believed to be a symptom of MS. In more recent years, however, researchers and physicians have come to find that roughly half of the MS population will experience some type of change with cognitive functioning. Thankfully, cognitive problems are usually not severe and tend to fluctuate, sometimes worsening when tired, overheated, or under stress.
Frequently individuals with MS who are experiencing cognitive problems find that they simply can't remember things as well as they once did - a problem shared by many with or without MS. They may forget that they put water on the stove to boil, where they left their glasses, or when they have an appointment. Executive function may also be compromised for some individuals, affecting one's judgment and the ability to make appropriate choices. Some may experience an unexpected "lapse" of memory or cognitive functioning, possibly affecting their ability to find the right words, concentrate, or recall what they were talking about.
If you or someone close to you is experiencing cognitive issues - whether mild or severe - seeing a medical professional is an important first step. Often a physician will refer someone to a neuropsychologist, who can make an evaluation through various cognitive tests - and make sure that something other than MS is not involved. After an assessment has been made, individuals having cognitive problems may employ several strategies to help them better cope with the changes they may be experiencing.
In the book, Multiple Sclerosis: A Self-Care Guide to Wellness, second edition (edited by Nancy J. Holland, EDD, RN, MSCN and June Halper, MSCN, ANP, FAAN; published by The Paralyzed Veterans of America and Demos Medical Publishing, LLC, 2005), one section is devoted to "Coping with Cognitive Changes." It lists the different types of cognitive functions that may be affected by MS, which include difficulties with the following:
- Memory
- Abstract reasoning
- Information processing
- Word-finding
- Visual and spatial organization (such as driving or reading a map)
- Ability to shift between tasks
- Attention and concentration
- Organization and execution of complex sequences
To enhance one's ability to concentrate, this book recommends: identifying (and avoiding) distractions; establishing quiet time; determining a time when you are at your best and using that time to perform more complex tasks; learning energy-saving and pacing strategies; finding out how long your attention span can last and taking breaks while working when you know that your attention is no longer sharp; and breaking tasks down into sections so you don't have to complete a task all at once. Puzzles, meditation, and reading can also help enhance your ability to concentrate.
If having trouble processing information, ask those around you to not speak as quickly, allowing you time to assimilate the information. By letting family and friends know what is going on, they will be able to help you to cope with any cognitive challenges you may be experiencing.
If having trouble finding a certain word, the best idea is to wait and let the word come to you later. You may also try to talk more slowly, allowing yourself extra time to process information. Additionally, if you study and expand your vocabulary, you may have synonyms at your disposal to substitute for the words you can't find.
Other important strategies include getting organized. This can help substitute for any lapses in memory. For instance, use a journal and/or a calendar to help keep track of things you need to remember and appointments you need to keep. Use checklists for shopping and other tasks. Select a central place in your home to keep things that are easily lost—such as glasses and keys —to help avoid the frustration and wasted energy of searching for lost items.
Another very helpful resource is Shelley Peterman Schwarz's new edition of her book, Multiple Sclerosis: 300 Tips for Making Life Easier (published by Demos Medical Publishing, LLC, 2005). In this second edition, Ms. Schwarz presents tips that cover all the basics: from issues around the home and managing meals, to taking care of yourself, handling medical issues, and even travel. The book also includes a section on improving memory and concentration. Among others, some of her tips include:
- Write reminders (self-adhering Post-it® notes may be helpful) and put them where easily seen.
- Keep a small spiral notebook with a small pen or pencil with you to jot down things you need to remember.
- Use a gardener's apron while at home; it has big pockets and can carry the small notebook and other items (glasses, portable phone, etc.), allowing you to work "hands-free" around the house and conserve energy by not having to take extra steps to retrieve things.
- If you like gadgets, an electronic organizer (also known as a personal data assistant or PDA) can keep addresses and phone numbers, appointments, notes, to-do lists, etc.
- Your computer, pager, or cell phone can be programmed to "beep" when you need a reminder for taking medicine, performing a task, or attending a meeting.
- If you have trouble remembering if you have done a task, remind yourself by speaking out loud; for example, when leaving the house, say, "I'm locking the door," out loud, and this may help your memory.
- When running errands, plan your route in advance and write down the stops you need to make in sequence; this will help you to remember everything you need to do, saving time and energy.
- If you are out and need to remember something to do when you return home, call and leave yourself a message on your answering machine.
Another excellent resource is a book which focuses on the experiences one goes through with changes in cognitive function. Titled Facing the Cognitive Challenges of Multiple Sclerosis (written by Jeffrey N. Gingold and published by Demos Medical Publishing, LLC, 2006), this book tells how the author came to find he had MS, and how he tried to conceal and cope with cognitive issues as well as other MS symptoms - all while working as a lawyer and continuing his strong roles as a devoted father and husband.
While telling his story, Mr. Gingold talks first-hand about the thoughts that went through his mind as he would unexpectedly encounter a lapse in memory, an inability to recall words, or find himself lost on a familiar road. He includes details about the other symptoms he was experiencing, consulting doctors, going through the different tests involved with MS, and taking medication.
When taking a different path, his advice includes: if retiring from a career, choose to do something different that is challenging and interesting; don't think you are without options - many choices are available; keep your mind active by reading books, keeping a diary, and doing crossword puzzles (challenge your mind); sometimes you need to say "no" to requests from others to maintain clear thinking; ask for clarification, reminders, and direction when in a confusing situation; pause, relax and breathe calmly when having a temporary lapse in thinking; limit visual distractions and remove clutter from your home; keep lists of daily responsibilities and activities.
The story the author tells is honest, intelligent, and often humorous. Throughout the writing he notes facts about MS and strategies for acknowledging and coping with the cognitive changes MS may impose. Readers with MS may relate to and learn from his experiences, while readers without MS may better understand the effects of cognitive issues and how one feels to suddenly encounter these perplexing symptoms.
Multiple Sclerosis: A Self-Care Guide to Wellness (MSAA book # 264) is available through MSAA's Lending Library and is highlighted on page 51 of this issue. Facing the Cognitive Challenges of Multiple Sclerosis (MSAA book # 158), as well as the newest edition of Multiple Sclerosis: 300 Tips for Making Life Easier (MSAA book # 60), are expected to be available through MSAA's Lending Library by the time this issue is received by our readers; please see page 51 for more information. All three of these new books may also be purchased through Amazon (at www.amazon.com) or Barnes & Noble (at www.bn.com); Barnes & Noble may also be contacted by calling (800) 843-2665.
