Tuesday, June 12, 2012

MS symptoms explained.. Cognitive disturbances

Cognitive and emotional disturbances.
So today is the day I attack the MS symptom I find most troublesome.  Cognitive issues!  When the MS hit me in my early 20's, I couldn't imagine anything worse than losing my legs until I started having trouble using my hands.  But all this paled in comparison with losing some of my cognitive function.  It almost seemed as if from one day to the next, my short term memory faded away into nothingness.
It's strange how I can recall certain things happening at the time my memory began to vanish, yet at the time, I couldn't remember hardly anything.  For example there was a day, about ten years ago, when I called my mom maybe four or five times within a few minutes of hanging up with her to tell her the exact same thing.  I don't remember doing that, but I do know that it was the day my mom insisted I start writing things down and use my dry-erase board to keep track of the last time I had called.  It was at that time when I started using Post-It Notes as little reminders for many things and stick them on the outside of my computer monitor.

The scariest incident was about eight years ago, when I had decided to go back to a local junior college.  I thought that it would, perhaps, help in strengthening my cognitive thinking.  I recall driving home from class and was nearing my exit (I have to drive on the interstate for only a few seconds to get to my exit) when I became completely disoriented but didn't realize it.  I kept driving forward for probably at least a half hour to forty-five minutes before I questioned if I even lived so far from town or not.  I was frightened but had no idea what to do, where I was, or even who to call.  This was before I had a cell phone but even if I had had one, I don't think I would have had the presence of mind to use it.  How I eventually got home, I do not know.  What I remember is pulling into my driveway quite late that evening, in tears, walking into the house and hugging my girls as I honestly did not think I would ever see them again!  After this incident, I dropped a couple classes as I realized it was too much for me and it would be better to concentrate on two classes than make myself crazy with four.
I was evaluated by a psychiatrist at Rush Hospital in Chicago in 2006 or '07.  I had gone to see an MS specialist and agreed to see the psychiatrist, too, but mostly out of curiosity.  I found his analysis not only amusing, but he also justified many of my behaviors.  He read three paragraphs and asked what I could remember and in classic "MS form," I had some recollection of the first and third paragraphs but the second one did not exist in my memory.  The only reason I found it amusing was that for some time before seeing him, I had been having problems remembering lists of items of more than two things people would tell me.  Finally, justification!  It wasn't that I was not concentrating or didn't care.  It really was my MS!  I'm not one to blame things on my MS but this time, I had reason to do so.  But enough of my own personal stories.. I'll give some facts as stated on the Multiple Sclerosis International Federation site:

It is now recognized that MS may cause problems with memory, planning, foresight, and judgment. Studies have shown that minor defects in cognition are quite common (up to 70%), even in early MS (up to 50%) . Approximately 10% of people with MS will have fairly serious cognitive difficulties. Dementia can be an accompaniment of severe disabling MS of long-term duration. 

The most frequent cognitive abnormalities in MS are subtle defects in abstraction, memory, attention and word finding. They are usually associated with emotional lability and decreased speed on information processing. Thought processes of the brain are interconnected to the conscious areas of the brain via myelinated nerves. There can be problems transporting memories to consciousness and processing of thoughts…. creating difficulties with concentration and reasoning.

A number of compensatory techniques can help with the cognitive problems of MS. First, the difficulties need to be identified and their extent measured and considered in the context of the person's individual circumstances. This is done through testing, either by a speech pathologist or more formally by a neuropsychologist. It should be remembered that some tasks and occupations need an excellent memory while others do not. Nobody's memory is perfect and everyone suffers from memory lapses and occasional confusion. Stress, anxiety, and fatigue all decrease cognition, especially memory. Poor concentration may add to the problem. Depression must be treated. A person with MS often does not recognize his or her depression but may respond to medication and therapy. Psychological tests may be necessary to make the diagnosis of depression.

The following strategies have been found to be helpful in managing cognitive problems: 

  1. Make lists - shopping lists, lists of things to do, and so forth.
  2. Use a calendar for appointments and reminders of special days.
  3. Establish a memory notebook to log daily events, reminders, and/or messages from family and friends.
  4. Use a tape recorder to help remember information or make up lists.
  5. Organize your environment so that things remain in familiar places.
  6. Carry on conversations in quiet places to minimize environmental distractions.
  7. Ask people to keep directions simple.
  8. Repeat information and write down important points.
  9. Establish good eye contact during any discussion.
And then there's the second part of this category, emotional disturbances.  Yeah.  I think I'll get into this one tomorrow!  I actually have a longer list to add to what I've already gone through anyway, so imagine all the fun we'll have together!  But I do want to add this.  I realize how overwhelming all these facts are and how terribly frightening it all becomes when you are newly diagnosed or know someone facing MS.  As hard as it may be some days, the important thing is to not focus on the MS every moment of every day.  There is beauty in each day.  Focus on the wonderful aspects of your life that kept you going before your diagnosis, or find new meaning in activities you were afraid to try before.  You are not your MS.  MS is merely a small part of you but it does not define who you are.  Please, never forget this.

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