Recognising changes in cognitive function
The term ‘cognition’ collectively refers to a group of high-level brain functions including information processing, memory, attention and concentration, processes such as planning, prioritising and problem-solving, visual perception, and verbal fluency.1,2 What some people might not realise is that it’s not unusual for people living with multiple sclerosis (MS) to experience problems with their cognition, or cognitive function.
Cognitive problems in MS are often the result of changes in the brain, with specific cognitive symptoms depending on the area of the brain that’s affected.4,5 But you should keep in mind that factors outside of the disease process can also play a role in the onset of cognitive impairment in MS. Depression, anxiety, stress, fatigue, and a lack of sleep can all influence cognitive performance.4,5
Read on to gain a better understanding of the benefits of recognising any changes in your own cognitive function and to discover the signs to look out for.
Changes in cognition
For most people living with MS, any changes in cognitive function are mild and only affect one or two areas of cognition. But for a small minority, changes are more noticeable and can be more challenging to live with on a day-to-day basis.1
It’s probably no surprise to hear that a decline in cognitive function has the potential to impact many aspects of someone’s life, affecting relationships, social activities, and employment to name a few, which all feed into and have a negative influence on quality of life.1 Experiencing cognitive problems can also be emotional and distressing. Those affected may find their symptoms embarrassing, feel like they are losing their sense of self or that they are ‘going mad’, or feel vulnerable with low self-esteem.6-8
However, it’s important to remember that there is no ‘one size fits all’ when it comes to the cognitive symptoms of MS. People are affected in many different ways and this can influence the way that someone reacts to these changes.6
Given the wide impact that cognitive problems can have on the lives of people living with MS, it’s key that any changes in cognitive function are detected early so they can be managed as soon as possible. Assessment of cognitive function early in the MS disease course has been shown to help predict future impairments, limitations, and disease progression.5 Therefore, early recognition of cognitive changes may also allow for a tailored approach to MS management that aims to reduce the future impact and disease progression.5
As humans, we simply aren’t that great at judging our own cognition, so it can be really tricky to identify changes in your cognitive function and it’s totally normal for small differences over time to go unnoticed.3,8
These changes also tend to develop slowly, making it harder to recognise a decline in cognition, and it can be easy to blame subtle changes on other things, such as being busy at work or not getting a good night’s sleep.8,9 Many people who experience mild changes in cognitive function also find that they have picked up small tricks to compensate for changes without even realising it.9
Although there are lots of signs that may indicate a decline in cognition, those which arise are different for everyone and will largely depend on the cognitive function that’s affected. For example, if your short-term memory is affected, you may find it harder to remember new things more than you usually would.
While this isn’t a complete list, here are some common examples of things you should look out for and might notice if you’re experiencing problems with cognitive function: 1,8
Difficulty finding the right words to say in conversation
Difficulty keeping up with tasks or conversations
Trouble learning and remembering new things
Difficulty making decisions or showing poor judgement
Find that multitasking is tricky and slow
Planning and problem solving is more challenging – knowing what you want to do but unable to figure out how to do it
Having poor concentration and being easily distracted
Taking longer to read than normal
Getting lost due to difficulties processing spatial information
Difficulty remembering what to do at work or during daily routines at home
Problems with job performance
Decreased academic performance, including falling grades and social challenges
There are certain disease factors that are associated with cognitive symptoms. So if you can, try and pay particular attention to changes in your cognitive health if or when any of these factors apply to you:1
Later in the disease course
Although they can occur at any time, even as a first symptom of MS, cognitive changes are more common later in the disease process
High number of brain lesions
Cognitive decline is associated with a higher number of brain lesions, as well as brain atrophy
Progressive MS
Cognitive dysfunction can occur with any type of MS, but is slightly more likely in progressive types of MS
Talk to your doctor about changes in your own cognition
If you’re experiencing any new cognitive symptoms or changes in your cognitive function, talk to your neurologist or MS nurse. Create your own Talk To Your Doctor Guide that you can take with you to your next appointment to support the conversation you have on this topic with a member of your healthcare team.
Identifying early changes in cognitive function is important to make sure they are managed and that you are receiving the best care possible for your MS.
References
1. National Multiple Sclerosis Society – Cognitive Changes. Available at: https://www.nationalmssociety.org/Symptoms-Diagnosis/MS-Symptoms/Cognitive-Changes. Last accessed: March 2021.
2. MS International Federation – Emotional and cognitive changes. Available at: https://www.msif.org/about-ms/symptoms-of-ms/cognition-and-emotional-changes/. Last accessed: March 2021.
3. Momentum – A closer look at cognition. Available at: https://momentummagazineonline.com/a-closer-look-at-cognition/. Last accessed: March 2021.
4. Multiple Sclerosis Society of America – Cognitive Change. Available at: https://mymsaa.org/ms-information/symptoms/cognitive/. Last accessed: March 2021.
5. Kalb R, Beier M, Benedict RH, et al. Mult Scler 2018; 24(13): 1665–1680.
6. MS Society – Cognitive problems in MS. Available at: https://www.mssociety.org.uk/about-ms/signs-and-symptoms/memory-and-thinking/cognitive-problems-in-ms. Last accessed: March 2021.
7. My Cognitive Changes Because of Multiple Sclerosis. Available at: https://multiplesclerosis.net/living-with-ms/my-cognitive-changes-because-of-multiple-sclerosis/. Last accessed: March 2021.
8. MS UK – Cognition. Available at: https://www.ms-uk.org/choices-cognition-content. Last accessed: March 2021.
9. Multiple Sclerosis Academy – A Clinician’s Guide to Cognition in MS. Available at: https://neurologyacademy.org/articles/a-clinicians-guide-to-cognition-in-ms-sarah-morrow. Last accessed: March 2021.
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