Cognitive problems in MS
"Cognition" refers to memory and thinking. It describes the way we:
- concentrate and focus attention
- do more than one thing at a time (multitask)
- learn and remember new things
- reason and solve problems
- plan, carry out and monitor our own activities
- understand and use language
- recognise objects, assemble things together and judge distances
These skills vary naturally in different people – we all have different strengths and weaknesses. Our cognitive powers are considered to be normal if our skills allow us to cope adequately with everyday life.
How MS affects cognition
Like other symptoms of MS, cognitive symptoms vary greatly from person to person. Just because you have some cognitive symptoms, it does not mean that you will experience all of them.
Problems with language, visual perception (recognising what you see) and spatial relations (judging distances and position) are less common in people with MS. The most common difficulties are with:
Learning and memory
There are different types of memory. MS most commonly affects remembering recent events and remembering to do things. Some people with MS also say that it may take more time and effort to actively search for a memory. This is known as recall.
Fortunately there are lots of ways that you can compensate for these kinds of problems. See 'coping with cognitive problems' for more information.
Attention, concentration and mental speed
Some people find it more difficult to concentrate for long periods of time or have trouble keeping track of what they are doing if they are interrupted (they ‘lose the thread’). It may also be more difficult to do several jobs at once or carry on a conversation while the TV or radio is on.
Many people describe feeling as though they can’t function as quickly as usual. They can still achieve tasks but it requires more time and effort than before. Research also suggests that the ability to process information may slow down.
Some people experience difficulties when making plans and solving problems. They know what they want to do but find it difficult to know where to begin, or find it difficult to work out the steps involved to achieve their goals. This can lead to confusion and stress, which in turn can hamper learning and memory.
People with MS may also experience difficulties finding the right word. (‘It’s on the tip of my tongue’ – you know the word but just can’t think of it.)
It may be difficult to take part in a discussion because it takes too long to express an opinion or find the correct word, by which time the discussion has already moved on.
The impact of problems with memory and thinking
Cognitive problems have different meanings for different people, and this can affect the way they react.
- It can be frightening for some people to feel that they do not have a grip on things that used to come more easily.
- Sometimes people worry that they are ‘losing it’ or going mad, or that they are becoming stupid.
- It can cause problems in relationships or with family life.
- Some people feel that no-one will like them if they aren’t as quick as they used to be.
- Some people fear they will lose their job, or that they won’t achieve their career goals.
Cognitive changes can be worrying, and even mild changes might need specific coping strategies. If cognitive symptoms are not recognised, people can often feel very frightened about what is happening to them. Having good accurate information for you and those around you about the problems is usually the best form of defence.
Even when the changes are gradual, people can go through a grieving process when they first realise their mental abilities are affected by MS. It may take time before you can bear to think about ways of dealing with the problems, though there may be simple strategies that make a real difference.
Even early on in MS, problems with cognition can have an impact at work. In fact, research has shown that cognitive issues are a major reason why people with MS might stop working.
As a person with MS, you have certain rights at work, which are set out in the Equality Act 2010 (if you live in England, Scotland or Wales) and the Disability Discrimination Act 1995 (if you live in Northern Ireland).
These laws state that if the symptoms of MS are affecting you and your ability to do your job, you have the right to ask your employer for ‘reasonable adjustments’ so you can continue to work.
There is more information about reasonable adjustments in our booklet Work and MS.
The same laws also apply if you are studying at college or university. They ensure that you are not discriminated against because of your MS, for example, by giving you more time to complete assignments or by providing study areas that are free from distractions. Most universities and colleges now have a dedicated member of staff to help with any issues you may have.