Getting help for cognitive problems
It may feel upsetting or difficult to have to rely on these strategies if you have not done so before. But many people find that once they get used to using them, they feel more confident in managing these symptoms.
What should I do if I suspect cognitive problems?
The first signs of cognitive problems may be subtle. You may have difficulty in finding the right words to say, or trouble remembering what to do on the job or during daily routines at home. It may be that your family or friends become aware of the problem first, noticing changes in your behaviour or personal habits.
Even mild cognitive disturbances can cause uncertainty and fear. It is worth remembering that these are symptoms of MS and that there are ways of managing them.
It you are aware of even mild symptoms, you can try to find ways to cope with and compensate for them. On the other hand, the knowledge that MS can cause problems with memory and thinking may result in being too aware of minor memory lapses.
Everyone forgets things from time to time. It’s only a problem when the forgetfulness becomes more frequent than usual and has an impact on what you would like to do.
If you have repeated difficulties with your memory (for example, forgetting names and places, losing objects, struggling to remember familiar words), in ways that did not happen before, a first step may be to discuss this with your GP. It may be a symptom of MS or it may be due to other causes.
If, as a relative, you notice signs of cognitive problems, you may find it hard to talk openly about them. However, it can often be a relief for the person with MS when someone else brings up the subject. It can help with identification of their difficulties (and yours) and make it possible to talk about them as well.
Lists keep everything clear and my thoughts more manageable. Trishna, MS Society Ambassador
Sometimes you may need a professional to help you identify the areas where you could use some help. If you decide to ask for professional help, your GP should be able to refer you to an occupational therapist, who can help you think about ways of managing your symptoms and suggestions on equipment and aids that may help. Or you can ask your GP or MS nurse to refer you for a neuropsychological assessment with a clinical psychologist.
A neuropsychological assessment is used to find out what cognitive problems you are having. It may include a number of different spoken and written tests on areas such as attention, memory and problem solving.
The assessment usually takes about two to three hours, with a follow-up session for feedback. You will be asked to perform a number of tasks that are designed to test your ability to remember, concentrate and do things that you used to find easy.
For each task the instructions are explained and then you try to complete the task. For example, the task may be to remember a story that is read out.
The assessment will try to identify both the specific problems you are experiencing as well as your personal strengths that you can use to help you overcome and manage any weaknesses.
A psychologist will take into account whether you are depressed, unusually stressed or undergoing a relapse.
After the assessment, you may be offered different ways to help you manage any problems identified. This could include:
- practising and improving any weakened skills
- making better use of your strengths
- finding alternative ways to perform tasks
- finding ways to cope with limited abilities (both practically and emotionally)
- counselling (for you or your relatives)
Individual goals may be set, for example, to restore or improve your ability to work, to encourage and support future education, or to improve your general performance on tasks.
You may be offered individual or group sessions. Often a partner or family member will also be invited to attend – people close to you may also have concerns about your difficulties and the effects on family life. They may be able to help you put in practice new strategies and techniques.
If your problems appear to be progressive, practising weakening skills may seem a waste of time. However, recognising and understanding what is going on and reorganising the way you do things may still make it easier to cope.
It is often useful to learn to make the most of the skills that you are good at and to practise using different types of aids to help you. For example, a memory aid like a diary may help you stop worrying that you have forgotten something. Also, writing things down or putting them in your mobile phone can help to fix them in your mind.
Cognitive rehabilitation is a way of relearning the cognitive skills you have lost. It is provided by occupational therapists and psychologists in either a group setting or one to one. There is some evidence to suggest it may improve attention, memory and problem solving.