It's all in your head
An MS diagnosis has its own emotional impact, as does living with an unpredictable chronic disease. In addition to these external challenges, some individuals with MS may experience cognitive and/or emotional changes due to MS-related neurological effects, which in turn are often associated with fatigue. Sorting out these various influences on your mood and/or mental abilities can be a complex but worthwhile process.
Not everyone with MS will experience cognitive difficulties, but about 50% usually have some mild impairment. There is little or no relationship between duration of the disease, or severity of physical symptoms, and cognitive changes.
Whereas brain lesions can result in more long-term cognitive problems, a number of factors can interfere with or impair cognition temporarily. These factors include:
- fatigue and tiredness
- emotional changes
- MS relapses
- physical difficulties that may require extra effort and concentration (eg, unstable walking)
- lifestyle changes, such as loss of employment and thus, mental stimulation
- some treatments for MS symptoms
Cognitive functions that may be affected by MS
- Attention and concentration may be affected, making it difficult to concentrate when more than one stimulus is competing for attention
- Memory may be impaired, particularly for recent events
- Information processing may take longer, but performance is not necessarily otherwise affected
- Abstract reasoning, problem-solving, and executive functions may be affected, making it more difficult to analyze a situation, identify the main points, plan a course of action, and carry it out. Judgment may also be affected
- Visual-spatial abilities may be impaired, which may reduce the ability to perform a variety of tasks such as reading a chart or map, recognizing objects accurately, or assembling things
- Verbal fluency may be affected, making it more difficult to find the words to communicate. (This is not the same as problems that slow speech down or change voice quality in MS.)
Emotional effects of MS
Individuals with multiple sclerosis are at increased (compared to the general population) risk for:
- depression
- bipolar disorder
- mood swings
Tackling the terrible trio
Depression, cognitive dysfunction and fatigue interact on a number of levels. Depression can worsen cognitive function and fatigue; changes in cognitive abilities can affect mood; and fatigue can interfere with both cognition and mood. In fact, some individuals who reported being affected by cognitive impairment were actually suffering from depression.
Greater awareness of the hidden symptoms of MS can improve recognition of these changes by both MS patients and their family members. Be aware that if you are (perhaps unknowingly) suffering from depression, the “voice” of your depression may lead you to believe things are really as bleak as they seem. That’s why it’s important to share your concerns with someone, rather than keeping them to yourself.
Once the causative factors are correctly identified, these problems can be managed. Depression can be treated with drugs and/or psychotherapy. Severe fatigue can be alleviated with medication and energy management strategies. And some cognitive changes may be addressed with simple practical strategies. Finding the appropriate treatment begins with you.