This is the first installment of a two part series on the cognitive symptoms associated with MS.
While much attention is placed on the movement aspects of MS, most patients are concerned with the potential for cognitive symptoms, such as memory difficulties.
MS can cause tip-of-the-tongue phenomenon, where one has to struggle to find the word they are looking for. While this happens to all of us at some point, it can occur more often with people with MS.
Other cognitive symptoms include difficulty multitasking and difficulties with concentration/attention and even problems with the ability to learn and recall. This may sound scary to those who don't have these symptoms, but to those who do, it may be relieving to read that you are not alone.
This blog will deal with the causes of these troubling symptoms, while the next blog will deal with potential treatments.
Cognitive symptoms may be caused by:
- MS itself
- MS disease modifying agents
- MS symptomatic treatments
- MS rescue treatments
- Mood disorders
- Sleep disorders
- MS can cause white matter spots in areas of the brain responsible for creating, processing, storing and retrieving memory. Besides white areas of sclerosis (scarring) in these specific areas, MS can cause white spots in the frontal area of the brain responsible for how we interact with others appropriately. MS can also cause nerve loss leading to atrophy in both the white and, more importantly, the gray matter. 10% of people with MS have seizures, which can also lead to memory difficulties and headaches can lead to concentration problems.
- MS disease modifying agents can lead to fatigue, flu-like symptoms, depression and headaches, all of which can lead to problems with clear thinking.
- MS symptomatic treatments can lead to confusion from the drugs themselves, confusion from the effect of these drugs on the chemistry of the brain, fatigue and sleepiness from theses medicines and resulting headaches.
- MS rescue treatments, such as steroids can lead to insomnia and difficulty sleeping and even to a temporary psychotic state. Although IVIg (intravenous immunoglobulin) is used much less often, it can lead to excess clotting in the veins, which can even affect the veins in the brain. Plasmapheresis (cleaning out of the plasma, sort of like hemodialysis) can lead to fluid shifts and thereby temporarily make a person have less blood flow to the brain.
- Mood disorders include depression, grieving, mania (and bipolar disorder) and adjustment disorder. Adjustment disorder stems from the difficulty in getting used to an unpredictable neurologic diagnosis, the lifetime nature of the diagnosis and from a having a chronic diagnosis in general.
- Sleep disorders include hypersomina (too much sleepiness) with excessive daytime sleepiness and even narcolepsy (falling asleep suddenly), or insomnia (inability to fall or stay asleep). Many of these problems stem from poor sleep hygiene. Remember the bedroom should only be used for two things: sleep and sex. Eating, watching TV, fighting etc. should be done outside the bedroom. When you do these things in the bedroom, it confuses your body and you start to associate the bedroom with things that don't make you sleepy and don't make you relaxed.
- Stressors include financial stressors (in general and from healthcare costs specifically), family (the changes in the family dynamics and the person with MS taking the "sick" role), and the job (people with MS look to the Americans with Disabilities Act [ADA] or on the other side to disability).
All of these issues can contribute to thinking (cognitive) difficulties in a person with MS. Some of these issues can be controlled, and we will discuss these in the next blog.
If you have any other types of thinking problems you want to share with the MS community, please write to firstname.lastname@example.org and I will discuss them in future blogs.