Cognition is a term for the mental processes that take place in the brain, including thinking, attention, language, learning, memory and perception.

Cognitive abilities are the foundation of the many basic and complex tasks that we perform daily.  MS can impact the cognitive functioning in different ways and can vary from person to person. This is known as cognitive dysfunction and is often referred to as ‘cog-fog’.

As cognitive dysfunction is an invisible symptom, it can often be overlooked, hard to recognise and misunderstood by family, friends, co-workers and even health professionals. Equally, cognitive dysfunction can be a difficult symptom to talk about as it can be hard to admit that we are having problems.

Signs of cognitive dysfunction can be overlooked, as they are not initially noticeable and can occasionally be attributed to feeling tired, or perhaps a consequence of getting older. These “silent” symptoms can interfere with work, personal life, how a person feels about themselves, or other situations that require more complex thinking. Social situations can become difficult, which can result in increased anxiety.

As cognitive dysfunction is an invisible symptom, it can often be overlooked, hard to recognise and misunderstood by family, friends, co-workers and even health professionals. Equally, cognitive dysfunction can be a difficult symptom to talk about as it can be hard to admit that we are having problems.

There are particular cognitive functions that people with MS may encounter difficulties with:

The role that memory plays in supporting your everyday functions is complex, but fundamentally it underpins the ability to acquire, store, retain and retrieve information. Difficulty learning and remembering new things can be a problem as the memory can be less reliable in retaining information. Issues with short-term memory are more common, with long-term memory often unaffected.
This is the ability and speed at which your brain processes information to conduct a wide range of tasks. When this is impacted then processing lots of information at once or multitasking can become difficult. It can also have the effect of taking much longer to process what we are reading, hearing and experiencing through our senses. This can lead to a feeling of ‘getting lost’ as it can be more difficult to process spatial information.
Having poor concentration and being easily distracted, for example difficulty holding a conversation if there is background noise such as from a television, can be a problem for people with MS. Issues with concentration can be due to the impact of other cognitive symptoms such as difficulties with short-term memory and information processing.
Making decisions, planning and problem-solving form an integral part of our daily life, however, these tasks can be more challenging for some people with MS. Often we know what we want to do, but cannot figure out how to do it, as the process of evaluating information and making subsequent informed decisions is affected.
This is a wide-ranging area that covers the many different aspects of our daily interactions with others. It covers how you interpret social cues, the language used by others, emotional perception and much more. Many people with MS find that they are less able to comprehend and identify context during conversations and meetings. This includes failing to understand the nature and intentions of non- verbal cues and signals that others use during interactions.
Issues with speech and language in people with MS arise because of damage to the parts of the central nervous system that control these functions. There are different ways in which MS can affect your ability to communicate verbally. The most common changes in speech and communication are:

Dysarthria – When the ability to control the muscles which deliver speech is reduced and the speech may be slow and slurred, making it difficult to others to understand.

Dysphasia – This is characterised by difficulty in finding the right words, and forming sentences, with limited grammatical and vocabulary skills. This is the result of central processing problems and is a primary cognitive difficulty.

Dysphonia – Often accompanies dysarthria and affects voice quality, pitch control, nasal resonance, loudness and emphasis. The voice can sound hoarse or strained.

How you can help!

There is strong evidence that people with MS can protect and improve their cognitive health. Positive lifestyle choices, and managing stress and anxiety. Some of which may be hard to action but are important to consider include:

Less (or better no) smoking
Limiting the use of alcohol
Regular exercise
Maintain a healthy weight
Guided relaxation
Meditation
Yoga
Mindfulness
Breathing exercises
Aromatherapy

Taking part in regular challenging mental activities can help to maintain clear and fast thinking.  Such as:

You can retrain your brain by introducing new tasks and exercises to your daily life. Examples could include starting new hobbies, exploring new music, creative writing, learning a new language and even simply keeping a regular journal of your thoughts and feelings. Anything that gives your brain a workout and challenges you to think, feel and explore.
It is very much the case that taking part in regular physical exercise can have a positive impact on your cognitive health.
A recent review of studies which looked at this relationship found strong evidence of physical exercise having a significant influence in counteracting cognitive degeneration, in both a biological and psychological sense.

This positive impact extends to the management of cognitive problems for people with MS.

To date, various studies have found links between regular exercise and cognitive benefits for people with MS, such as improved information processing speed and verbal learning and effecting positive functional and structural changes to the brain.
Managing cognitive symptoms often involves finding strategies that work for you to minimise the effects of your symptoms. You could try some of the following suggestions:

establishing a fixed routine – keeping things in the same place or doing things in a certain order. 
visual and verbal associations may be helpful – for example picturing ‘Mr King’ as ‘the man with a crown on’ or putting meaningful tags onto words or names such as ‘Carole the lady who works in the library’.
using diaries or smartphones for reminders, planning or memory prompts.

prioritising tasks to focus on one thing at a time and removing distractions where possible, for example sitting in a quieter part of the office or turning the TV down.
breaking down longer tasks into more manageable chunks and carrying them out over a few days.

avoiding doing things when you are tired or anxious, so you have more chance of staying focused.

If your cognitive problems are worsened by your other MS symptoms, getting those symptoms treated can help. Always keep in touch with the clinical team (GP, MS nurses, neurologist) and timely inform them of any new MS symptoms.

Sources: Effects of Physical Exercise on Cognitive Functioning and Wellbeing: Biological and Psychological Benefits. Mandolesi L, Polverino A, Montuori S, Foti F, Ferraioli G, Sorrentino P, Sorrentino G. Published April 2018.

www.ncbi.nlm.nih.gov/pmc/articles/PMC5934999 

MS Brain Health. Six ways to lead a brain-healthy lifestyle.  www.msbrainhealth.org/people-with- ms/six-ways-to-lead-a-brain-healthy-lifestyle 

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