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Most people know multiple sclerosis (MS) as a disease that affects you physically. But many don\u2019t know that it can also impact your memory and cognition (learning and processing). <\/p>\n
Tara Kent, a 39-year-old mother of 12-year-old twins, was diagnosed with the disease seven years ago. She knows the emotional effect these mental issues can have on a person. \u201cI feel like having MS has affected my identity and how I see myself,\u201d she said. \u201cI don\u2019t recognize myself a lot of the time anymore. Like, who is this<\/em> Tara? Normal Tara would never forget this or never do that.\u201d<\/p>\n Kent\u2019s physical MS symptoms started just a few weeks before she was diagnosed, but when she was asked when she noticed something wasn\u2019t right with her memory or when her brain fog started, she had to check with her husband. According to him, it had been over the last three or four years that her cognitive and memory symptoms started and got worse. <\/p>\n Cognitive issues don\u2019t affect everyone with MS<\/p>\n<\/h3>\n \u201cCognitive problems don\u2019t affect everyone with MS, but they affect a large proportion of patients,\u201d said Bardia Nourbakhsh, M.D., M.A.S., associate professor of neurology at Johns Hopkins Medicine. \u201cCognitive problems are associated with a lower quality of life for patients, and they can end in disability and loss of jobs. They also affect personal lives and relationships.\u201d But, Nourbakhsh pointed out, it\u2019s important to note that this cognitive decline is not the same as the decline associated with Alzheimer\u2019s disease or Parkinson\u2019s disease. Cognitive decline and memory issues related to MS are more subtle and usually less severe.<\/p>\n When patients with MS tell Nourbakhsh about brain fog or cognitive issues, he refers them for testing to see how far along the decline is. He also wants to know if the problems are caused by a reversible issue, like thyroid disease, vitamin B12 deficiency or a medication side effect. Once he knows the cognitive problems are related to MS, Nourbakhsh and his patients work together to come up with a treatment plan. \u201cThere is no medication that’s been shown to improve cognitive functioning in people with MS,\u201d Nourbakhsh explained. \u201cSo the focus of treatment of cognitive problems in MS is rehabilitation. We ask our rehabilitation colleagues, including occupational therapists or a speech and language pathologist, to help with those issues,\u201d he said. While there are not yet therapies to improve cognitive functioning, there are some therapies that slow cognitive decline, and these may be used along with rehabilitation.<\/p>\n<\/div>\n Cognitive rehabilitation<\/p>\n<\/h3>\n Michelle Mioduszewski, M.S., OTR\/L, owner of Niagara Therapy, sees people with MS in her occupational therapy practice. She has found that cognitive impairment and executive dysfunction are common in these clients, she said. \u201c[Executive function includes] things like memory for detail and facts, and organization \u2014 being able to put together large pieces of information, organize it and manipulate it in your mind.\u201d<\/p>\n To help her clients manage symptoms, Mioduszewski assesses their needs. They discuss what tasks her clients do at home, at work and where they volunteer, if they do. \u201cWe sit down with the client and look globally at what has been impacted by their MS or anything else that’s going on, what\u2019s causing those challenges,\u201d Mioduszewski said. This could be anything from muscle endurance issues or fatigue to coordination or cognitive issues. \u201cOnce we determine what particular area is challenging, we collaboratively come up with a plan.\u201d <\/p>\n While Mioduszewski can\u2019t do anything about the actual memory loss, she can help clients come up with adaptations, such as using their phone to take notes.<\/p>\n<\/div>\n Discussing issues with your neurologist<\/p>\n<\/h3>\n Medical treatment is a team effort, but your neurologist can\u2019t help you if you don\u2019t share what you\u2019re experiencing. It\u2019s vital to be open and upfront about new or worsening symptoms and their effect on your life. But the idea of speaking with the doctor and asking the right questions can be discouraging for someone with memory problems.<\/p>\n \u201cMy husband is my rock and my brain for me when I can\u2019t remember. I usually have my husband with me when I do most things, so he reminds me,\u201d Kent said. \u201cHe either comes [to the doctor\u2019s appointment] with me or I will make a list of questions or things I need to talk about with my doctor.\u201d<\/p>\n<\/div>\n Coping with cognitive issues, brain fog and forgetfulness<\/p>\n<\/h3>\n Given the impact of MS-related cognitive issues, you may need more assistance than you think. \u201cMany times, we have to provide documentation for employers or schools for patients who struggle with these issues,\u201d Nourbakhsh said. \u201cAsking for accommodation is possible and available for many people.\u201d<\/p>\n People with MS can also try complementary approaches like music therapy, which helps some people with remembering things and interpreting their senses. Physical exercise also helps some people improve their memory.<\/p>\n As for other steps, the National Multiple Sclerosis Society recommends:<\/p>\n Most importantly, don\u2019t give up. Mioduszewski recalled one client who had a mess of a checkbook. \u201cWe worked on organizational strategies and how to keep track of things,\u201d she said. \u201cLo and behold, this client actually found a mistake and got money back into the account because it was a bank error. She found it because she was now so organized.\u201d<\/p>\n This resource was created with support from BMS.<\/em><\/p>\n<\/div>\n\n
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