Management of cognitive symptoms often involves finding strategies to minimise the
effects of symptoms, and sometimes a retraining approach whereby progressively more
challenging exercises are given to strengthen impaired function. Management often
involves psychologists, speech and language therapists and occupational therapists.
Cognitive behavioural therapy:
A form of psychotherapy that is commonly used in the treatment of conditions such
as anxiety and depression. It is based on the belief that how we think about a situation
influences how we act, and our actions subsequently influence how we think and feel.
It encourages the adoption of new thinking and behavioural techniques.
A number of studies have assessed the effectiveness of CBT as a treatment for MS-related
symptoms.
One study, measuring the impact of a telephone administered cognitive behavioural
therapy programme compared with an emotional support programme, found that CBT led
to significantly greater decreases in:
Disability.
Fatigue levels.
Depression.
A more recent trial assessed the effectiveness of CBT as a treatment for MS fatigue
compared with a relaxation training programme. While both programmes were deemed
to be clinically effective treatments for fatigue in MS, CBT proved to be the more
effective of the two.
A cognitive behavioural therapy programme may be delivered in a number of ways:
Group-based.
Computer-based.
Administered by telephone.
It usually consists of a programme of once weekly hour long sessions. It is available
on the NHS. Availability varies across the UK.
If you consider that CBT may be of benefit you should consult your health professional.
Mental status changes are common in MS and are relatively neglected. They need thorough
assessment with particular attention given to mood changes, cognition and perception.
There is a real danger that people with MS and mental illness will be excluded from
services and it is vital that health professionals in neurology, psychiatry and rehabilitation
work together to prevent this.
Cognitive Difficulty -Problems can arise early in the course of MS, however, the
greater the disease duration and severity the more likely problems are to occur.
Whilst they may be found to be disturbing and for some frightening, cognitive changes
are generally mild and management strategies can provide effective methods of lessening
if not eliminating the functional effects.
Memory difficulties -Many people with MS report that their memory is not as good
as before. Memory difficulties are primarily related to the recall of recent events
or information and forgetting to carry out planned actions in the future. These situations
lend themselves well to using systems to record information and to act as reminders
or prompts.
Information processing problems - This problem is described as experiencing difficulties
with being able to follow a series of, or complex, instructions, especially if the
information is given rapidly.
Problem solving difficulties - This may arise as the result of an individual being
so agitated and anxious about a task, that they are unable to mentally structure
their thoughts to instigate a series of separate actions. Consciously breaking down
a task into simpler steps or stages can allow progress.
Word finding - also called 'tip of the tongue' phenomenon, this is a recall problem
rather than the loss of memory for that word.
Concentration and attention span problems - This tends to occur when a lot of information
is being delivered to a person at once and only some is relevant, for example where
several people are talking at once.
As with physical symptoms, not all of those with MS will experience all of these
problems. Similarly, these problems can fluctuate from day to day and can worsen
during relapse and may improve during remission.
Some medications, including those used to counteract pain, fatigue and depression,
may also have an impact on these problems.
Although research suggests that these symptoms can affect approximately 50% of those
with MS, many may not recognise them as symptoms of MS or may find ways to compensate
for the problems without seeking treatment.
Approximately 50% of those with MS have some degree of problem with memory, attention
span or concentration at some time. For most people the symptoms are usually relatively
mild and as with other symptoms of MS may come and go.
