Cognitive Impairment: Coping Strategies

Discovering that you have some degree of cognitive impairment can be a shock. For many of us, it affects our self-concept and feelings of self-worth. It is, however, just another aspect of the MonSter and, like getting a cane to help with walking, there are ways to compensate for some of the cognitive impairments most common with MS.

The first point is -- try not to lose your sense of humor! Not being able to remember what that thing-a-majig is called is not the end of the world. And laughter is healthy and healing. Never be afraid to laugh at yourself. If you laugh, others will find the cognitive changes less alarming and, therefore, feel more comfortable around you. And that's a good thing.

Make lists. Write down appointments, grocery lists, 'to-do' lists, even things like the names of people in your support group (or class or quilting group or ... ) or whatever else will give the needed 'boost' to your memory.

Use your brain as much as possible so that it stays active and flexible. Do crossword puzzles or other types of word puzzles (if you enjoy them). Get in the habit of carrying a 'memory book' (small notebook) and pen or pencil with you at all times. That way you always have the ability to make a note of something you need or want to remember.

Ask a trusted family or friend to help you by listening to your thoughts about solving a problem and to give you feedback on whether your thinking is reasonable and/or make suggestions on other ways you might think about the problem.

Many neuropsychologists also do training for people with cognitive problems. This is usually covered by insurance or Medicare. Don't be shy about asking for a referral. But before you do ... make sure you are ready and willing to work at it. The psychologist may well give you 'homework' assignments and doing them is a major part of helping yourself.

Above all... don't give up.

Related Topics: Depression and MS, Occupational Therapy

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Cognitive Testing

Cognitive function is measured with a series of verbal (talking) and pencil-and-paper tests. They are not difficult to do and there are no 'right' answers. The point is to find out how well you can do on them. There is an expectation that NO ONE, with or without MS, will be 'perfect'. The tests are standardized to allow the professional administering the test to allow for issues like age or effects of medications.

The testing should be done by a professional with experience in testing people with MS. Usually that will be a neuropsychologist who has specialized in this field. Testing is done in an office (although you may be given some tests to do at home) and can take a few hours to a full day. Do NOT try to cheat on this! The whole point is to find out how well your brain is really working.

I have a somewhat 'contrarian' point of view on the issue of when cognitive testing should be done. Many authorities suggest that cognitive testing be done at the point when people with MS and/or their families become concerned about cognitive functioning.

I think that is sort of closing the barn door after the horse is out. You want to know, ideally, what the cognitive function was BEFORE problems showed up. That means getting tested as early as possible in the course of the disease.

The purpose of this is to get a baseline against which future changes can be measured. Just as your doctor wants to know, for example, what your blood chemistry is like BEFORE starting you on one of the ABCR drugs, so you (and your doctor) should try to establish what your cognitive functioning is like as early as possible in the disease. This issue can become very important in applying for disability benefits at some point in the future.

If you want to read more about cognitive problems in MS, below are links to three good articles on the issue. The first two are aimed at the general populace while the third is a more research-focused article and somewhat more difficult to read.

• Cognitive Problems in Multiple Sclerosis


• Cognitive Dysfunction


• The Neuropsychiatry of Multiple Sclerosis

Related Topics:

• Diagnosis MS: Early Treatment is Best
• MS in the Workplace

Technorati Tags: MS, cognitive testing, brain fog

MS and Cognitive Function

Cognitive function refers to how a person thinks, solves problems, how their memory works, their ability to concentrate.

Although the physical effects of MS are widely recognized by the general public, issues related to cognitive function are less so. However, approximately 50% of people with MS will develop some degree of cognitive dysfunction during the course of their disease. There is little or no relationship between the level of physical disability and degree of cognitive impairment.

Cognitive impairment may even be the first symptom to appear. And, cognitive impairment is a significant source of disability. Some sources even report it as the most common reason for people with MS becoming officially 'disabled' to the point that they receive disability benefits.

Not all people with MS develop problems with cognitive functioning and those who do may have a variety of different problems. Word-finding difficulty is one of the most common problems reported. Other common difficulties include issues with memory (very common) as well as problems with planning, organizing, prioritizing, problem-solving, concentrating, or abstract reasoning.

The initial signs of cognitive dysfunction may be as slight as having problems finding the right word in conversation or remembering why you went to the store. Since that sort of thing happens to nearly everyone (with or without MS), not only do the people with MS tend to discount its significance, but so do their families and friends.

The affect of MS on cognitive function is complex. A primary issue is certainly the damage to the myelin and brain cells that is a part of the disease. Since cognitive function is centered in the brain, it makes sense that any sort of damage to the brain tissue could result in cognitive problems. Also, depression, fatigue and stress may all compromise cognitive functioning. Since all of those are common among people with MS, cognitive functioning gets a sort of 'double-whammy'.

I will write more about this issue later, focusing on cognitive testing.

Related Topics: Drug May Slow Down Multiple Sclerosis, Epstein-Barr Virus May Trigger MS

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Gratitude: Friends and Family

I'm lucky to have some of the most wonderful, amazing friends anyone could ask for. I have friends in many parts of the States and also in Mexico and Canada. As for my family, although there are a couple of less-than-satisfactory members (like most families), for the most part my family is warm and generous and fun to be with. The only problem is that they all live in Texas!

Don't get me wrong. I was born and raised in Texas and there are many wonderful things about it. There must be. I'm the only one in all of my extended family who left! Now that I'm mostly retired, visiting them is much easier. And I'm even thinking about moving back to Texas. After 25 years in Portland, Oregon, though, it will be a bit of an adjustment!

Related Topics: Toxic Friends, Preparing for Retirment

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Gratitude: Perfect, Peaceful Surroundings

As I re-read my last entry I realized that some of you may be picturing me in one of those giant, 40 ft long monster RVs with all modern conveniences.

No. My RV is a 1991, 25 ft long (and I would like to go smaller still). I spend most of my time outside, sitting under an awning over a concrete patio beside the RV or taking walks on the beach or finding the perfect palm tree to sit beneath. Sometimes I even sleep outside on the patio (it's where I'm sitting to write this!).

There are virtually no flying insects here, which is part of what makes sleeping outside possible. So that's another thing to appreciate. There is something sort of delicious about being outside when everyone else has gone inside and closed their doors. I'm only about 50 yards from the ocean and sometimes (if the moonlight is just right), I walk down to the beach late at night to watch the phosphoresence of the waves. They really do glow and sparkle in the night. Not always, though, which makes it a special treat to see.

I am also thankful for my dog. He is my traveling companion, my confidant, my guard (he's trained to get help if I fall). Cody (well, actually Kody, I guess -- he got the name because everyone thought he looked like a tiny
Kodiac bear as a puppy) is a 15 year old herding dog mix. Heavy on the border collie, lighter on the blue heeler and kelpie.

I didn't want a dog. But somehow, I let myself be talked into it. I had only had MS for a couple of years, was still in the phase of expecting major disability at any moment. Everyone thought I needed a dog; I'm not quite
sure why. But they were right and so I have something else to be grateful for.

Related Topics: Success Over Stress (Video), Work and Multiple Sclerosis

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