Having trouble concentrating? Forgetting things? Cognitive changes are a common symptom in multiple sclerosis.
How do you deal with the changes and continue to maintain a routine and quality of life? The answers are in the article.
What are cognitive changes?
People with MS sometimes report changes in thinking abilities. Indeed, studies show that in 34%-65% of cases there may be cognitive changes as a result of the disease 1 . Cognitive changes as a result of multiple sclerosis are different for each person. For example, in some cases, the changes may appear in the first stages of the disease while in other cases the changes may appear in later stages. Attention and concentration, information processing speed, memory and executive functions (such as planning, problem solving and decision making) are more likely to be affected. However, verbal abilities and intelligence often do not change significantly 2 .
The effect of cognitive changes on everyday life
Cognitive changes can affect almost every daily activity, from sorting laundry to the ability to hold a conversation with others. Some experience the changes mainly in complex tasks such as making an important decision or in an unfamiliar environment that distracts the mind, such as a new shopping center. Others will experience changes in household chores or leisure time. Cognitive changes can also be felt at work, driving, or in social gatherings 2 .
Thinking abilities are very much related to the way each of us perceives ourselves, the way we act, and our language from others. Therefore, cognitive change may trigger feelings of incompetence, decreased self-confidence or low self-esteem, anger and frustration. There may even be fear or anxiety about making mistakes or looking confused 2 .
Why is it important to share with others: family, friends and collegues?
Unlike motor symptoms, cognitive changes are hidden from view and are therefore more difficult to distinguish and understand by the other people. Sometimes people with multiple sclerosis choose not to share with others the difficulties they experience, but this concealment can prevent the ability to support others and lead to a feeling of loneliness. In addition, it may cause frustration and tension among those around, who may notice the changes, but do not understand why 2Â .
Since cognitive changes have the potential to significantly affect life, their effective and correct management is of utmost importance. Below are a wide variety of strategies that may help manage the difficulties.
Managing cognitive changes
There are many strategies that can be incorporated into everyday life to manage cognitive symptoms. They can lead to a significant improvement in daily functioning and increase the sense of control, self-confidence and self-esteem.
The strategies can be divided into three main types:
(1) strategies related to tasks,
(2) strategies related to the environment in which the task is performed, and
(3) strategies related to the person performing the task 2 .
Task-related strategies
Think:Â “How can a task be made simpler or easier”?
Below are some suggestions 2 :
Prioritizing tasks
which tasks are the most important to do and which ones can be given up or transferred to someone else?
Organizing the agenda using a diary
plan the agenda in advance and in an efficient way, for example spread challenging tasks throughout the week and not on one day, focus on one task at a time, avoid complex tasks when tired.
Flow charts
when dealing with complex tasks, it is recommended to break them down into simpler steps and perform each step separately.
Lists
for shopping, before a flight, of arrangements.
Reminder notes
it is important to place notes in a prominent place such as on the refrigerator, front door or closets, but avoid making too many notes.
Assistive technology
use of call recording, electronic diaries, alarm clocks, smart phones and more.
Strategies related to the environment
Think:Â “How can the environment be made more comfortable”?
Below are some suggestions 2 :
Weather
many people with multiple sclerosis are very sensitive to heat and/or humidity and cognitive abilities may be damaged in extreme weather conditions. It is recommended to stay in an air-conditioned environment, dress lightly, engage in complex tasks during cooler hours.
Congested spaces
messy or crowded spaces can add to the mental load and make cognitive tasks more challenging. Therefore, when you need to concentrate, it is recommended to work in organized places and avoid clutter on the desk, as well as keep objects in fixed and strategic places, for example, put things you usually take when you leave the house near the door. Even an environment that is simpler to maneuver like a neighborhood grocery store is sometimes preferable to a large and crowded place like a supermarket.
Crowded environments
it is more difficult to think in noisy and happening environments. It is recommended to perform cognitive tasks in quiet areas, turn off the TV and/or radio, perform cognitive activities when there are fewer people around, and use earplugs or headphones.
Strategies related to the person
Think: “How can I improve my thinking ability”?  Here are some suggestions 2 :
Brain training
the brain is a flexible organ that can change and studies show that cognitive training may preserve and even improve the ability to think. You can practice, play thinking or memory games, read, use unique programs for brain training, etc. Participating in leisure and social activities can also be a brain workout.
Thinking strategies to improve the performance of the assignment :
Organizing thoughts
when you feel scattered, overwhelmed by a big task or burdened by multitasking, it is recommended to turn on a “traffic light”: stop – think – and only then act. The traffic light helps organize thoughts and choose the best course of action.
 Reciting actions out loud
reciting out loud while doing a task helps to pay more attention to it and strengthens it in the memory. In the same way, when you are asked to remember something, such as the name of someone new or a certain food, repeating it out loud can improve the absorption of the information in memory.
Retracing steps
repeating the steps, physically or mentally, can help when you forget why we performed a certain action, for example why we entered this room.
Self-control
during the performance of a cognitive task it is very important to review the performance and make sure it is done in the best way. Self-control is done by asking questions like “Am I focused enough to do this task?”, “Are there any distractions that bother me?”. Performance awareness can improve performance.
Adjusting strategies 3
As you can see, there are many strategies that can help manage the cognitive changes and bring improvement in everyday life, but not every strategy is suitable for every person and every challenge. In order to adapt the strategy to the person and the task in the best way, it is recommended:
Choose a strategy based on strengths (cognitive in general). For example, a person who has always been very organized can use those organizational skills to perform tasks that require order and planning.
Choose strategies that fit your personal style . For example, although different technologies can be very attractive, some people feel uncomfortable getting to know a new application, and for them, using paper and pencil is more appropriate.
Choose simple solutions . It is recommended to choose available solutions, which can provide an immediate solution to the problem.
Increase the basket of strategies . If the strategies you know do not answer the difficulties, it is recommended to seek advice from experts, get information from reliable websites (such as patient associations), or get help from family/friends.
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Additional recommendations for improving cognitive abilities 3
A conversation with the attending physician – it is important to share cognitive changes with the physician. He or she can refer you to a diagnosis that will help you get to know your cognitive profile better – your strengths and areas for improvement. After the diagnosis, an adapted treatment plan can be built.
Sharing the environment – those around are not always aware of the symptoms experienced by a person with multiple sclerosis. Therefore, sharing the environment can benefit relationships and reduce misunderstanding, impatience and frustration. In addition, a supportive family or a supportive circle of friends can help in taking on some of the complex tasks, implementing the strategies and finding additional strategies.
Receiving support from the peer group – other people with multiple sclerosis, who are experiencing cognitive changes, can offer support, advice and inclusion from their personal experience. Coping partners can be found on social networks, in support groups and through patient associations.
In conclusion:
people with multiple sclerosis can experience cognitive changes that will significantly affect their daily routine. However, there are many strategies that can help manage these changes and improve daily functioning. Correct adaptation of strategies to a person – to his preferences and strengths – is very important for improving function, feeling of control, self-confidence and quality of life.
The author: Dr. Yifa Arbel (Ph.D.), occupational therapist
Sources:
- Benedict et al. Lancet Neurol. 2020;19,860–871
2. Ben Ari et al. 2012. Multiple Sclerosis Rehabilitation. 161–189
3. DeLuca et al. Nat Rev Neurol, 2020;16,319–332.
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