MS Society of Canada - Calgary Chapter

Psychological Problems

Page 17

Psychological factors relating to changes in sexual function are quite complex. They may involve loss of self-esteem, depression, anxiety, anger, and/or the stress of living with a chronic illness. Counseling by a mental health professional or trained sexual therapist can address both physiologic and psychological issues. This therapy should involve both partners.

Symptom Management – Cognitive

About 50% of people with MS will develop some cognitive impairment. In MS this generally means slowed ability to think, reason, concentrate, or remember. But only 10% of the group with cognitive impairment develop problems that are severe enough to interfere in a significant way with everyday activities. While cognitive impairment is more common among people who have had the disease for a long time, it can be seen early on, and occasionally cognitive problems are present from the onset of the disease.

The first signs of cognitive impairment may be subtle. The person 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. Often, the family becomes aware of the problem first, noticing changes in personality or personal habits.

People with MS and their families should seek medical help if they are concerned about cognitive dysfunction. Even early in the disease, cognitive impairment can have an impact on role performance at home and at work. People should also be aware that cognitive function can be affected by aging or medications. A careful evaluation is necessary to determine the cause of these mental changes.

To evaluate a person with MS for cognitive impairment a specially trained health professional (neuropsychologist, speech/ language pathologist, or occupational therapist) performs a battery of tests. Based on these tests the areas of cognitive deficit and strength can be determined. Strategies for coping with areas of deficit can usually be devised. In rare instances, cognitive impairment may become so serious that the person can no longer be cared for at home.

Which intellectual functions might be affected by MS?

Although investigators are still in the process of answering this, some consistent information has emerged.
Memory or recall problems are the most frequently reported. Memory loss seems to be confined largely to recent events. For example, a person may have trouble remembering an important phone number learned in the past year. In contrast, the same person will have little difficulty remembering information from the distant past, such as the meanings of words that were learned in school.

Several studies suggest that most people with MS are able to remember or store information adequately but may have difficulty recalling it quickly and effectively. However, some people with MS may take longer to learn new information. This suggests that poor recall in MS may be the result of not having adequately learned something.

Abstract reasoning and problem-solving abilities are sometimes affected. These include the capacity to analyze a situation, identify the salient points, plan a course of action, and carry it out. Occasionally people with MS report that their judgment is sometimes poor. More often, family members, or employers, notice changes in problem solving or reasoning.

Visual-spatial abilities can be affected in MS. These include the ability to recognize objects accurately and to draw or assemble things. Visual-spatial abilities are involved in many everyday tasks such as driving, finding one’s way around, or packing a suitcase.

Verbal fluency is still another area affected in MS. Fluency problems are different from MS speech problems, which slow speech down or change voice quality. A fluency problem often manifests itself as the “tip-of-the-tongue” phenomenon. A person wants to say a word, it’s on the tip of the tongue, but she or he just can’t think of it.

Speed of information processing—Both recall and fluency skills require rapid processing of information. People with MS performed as well as control volunteers on a specialized memory task, but they did so at a significantly slower speed. Many people with MS feel that their thinking is slowed and say they are not able to think through an issue and respond as quickly as they once did.

When intellectual problems stem from physical damage done by MS, the source is probably damage to brain tissue. Lesions (or areas of scarring) in the cerebral hemispheres—the higher areas of the brain—are the ones of greatest significance.

Research shows that nine out of ten people with MS are free of severe intellectual or cognitive problems. But what do mild or moderate problems mean in people’s lives? This question is hard to answer because people’s circumstances vary so much. For one person, mild intellectual impairment could require a major life shift—the end of a career or professional practice. But another with the same degree of impairment might need no change in lifestyle at all, because he or she is able to cope using self-help measures or through reasonable accommodations on the job.

The MS Society continues to fund studies on better ways of diagnosing and treating cognitive problems seen in people with MS. It is hoped that new treatments to slow the physical progression of MS will also slow cognitive deterioration as well.