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OVERVIEW
An MRI scan is a useful way to monitor any changes to your cognition. This refers to the mental processes that operate within the brain. Thoughts, memory, language, attention and perception are all known as 'executive functions' (Brummer, T. et al. 2022). Brain and spinal lesions in MS can cause impairment of your complex attention, and memory functions can along with a slowing down of the speed in which you process information. This occurs in 40-60 % of MS patients and symptoms can appear during all phases of the disease (Ziemssen, T. et. al. 2023).
COPING WITH COGNITIVE CHANGES
As people, we rely on high-level brain functions to process and accurately remember incoming information. It is important for organising and problem solving to cope with the environment around us. Cognitive impairment may severely impact your personal life. In particular, your vocational status. This may have a serious effect on your mental health, due to the amount of financial pressure for you and your family. In-fact, studies have shown that an increase in the severity of symptoms incurs lower levels of full time work participation, and a decrease in personal identity, fulfilment and social interactions. (Vijayasingham, L, 2018).
PSYCHOLOGICAL IMPACT AND MOOD CHANGES
Whilst symptoms of cognitive dysfunction may impair your employment experiences. Research has shown that outcomes may also be related to your individual coping strategies. Due to the ongoing process of dealing with uncertainty and the difficulties of living with MS, your psychological resources may be reduced. It is important to recognise that your emotions and behaviour can directly impact your ability to cope with occupational demands (Janssens, A.C. et al. 2003). Helpful therapies include Cognitive Behavioural Therapy (CBT), which can be organised through your GP.
WHAT IS COGNITIVE BEHAVIORAL THERAPY?
WHAT IS COGNITIVE BEHAVIORAL THERAPY?
Cognitive behavioural therapy (CBT) focuses on the way you think. Certain thoughts can lead to unhealthy behaviours and thinking errors. These are explained in more detail under 'types of MS'.
CBT is based on the concept of examining thought patterns with a goal to making positive behavioural changes. This combination can help you to deal with difficult emotions and develop healthier coping strategies.
CBT is a useful therapy for a variety of mental health disorders, and is widely used to help people with anxiety and depression. Steps involved with making changes to your life may include:
>Writing a list of unproductive thoughts
>Keeping a diary or record of when these thoughts appear
>Making changes by replacing negative thoughts
>Identify the positive changes and write a new list to help you change your thinking habits (NHS England, 2022).
Watch the short video here to understand more about the process involved with CBT, and the benefits of challenging negative thoughts, and beliefs. A therapist can talk to you about your symptoms and discuss how long they have been going on. It may be recommended that you are prescribed medication from your GP to help with day to day life whilst undergoing CBT (PsychHub, 2020).
COGNITIVE TESTING
COGNITIVE TESTING
Neurological testing forms an important part of diagnosing and treating MS. Patients referred to a neurologist will have their, attention, memory, language, vision and information processing speed tested to discover the extent of any deficits as a result of MS. Among the tools used to evaluate visual and auditory functions are the SDMT (Symbol Digit Modalities Test), which can measure cognitive processing speed. A slowing of cognitive processes affects memory, and levels of attention, which can make conversations difficult for patients of MS (Ochoa-Morales, A. et.al, 2019).
Many patients who suffer impairment in this way have reported struggling to understand their own mind and that reading the emotions of others by facial expression becomes challenging. Social cognition is tested using the MASC (Movie Assessment Social Cognition) exam. Evaluations of this kind can reveal any deficit to perception and identify the need for therapy or mindfulness techniques to improve a patients understanding of their social environment (Oreja-Guevara, C. et al. 2019).
As we know, the effects of cognitive impairment can have extensive social consequences for MS patients, resulting in a higher chance of isolation and loneliness, job losses and relationship problems. However, despite annual neurological testing, it may still be difficult to determine whether the disease itself is the cause of impairments. For example, anxiety and depression, or chronic fatigue may disrupt the accuracy of testing due to the deficits caused by any psychological illness.
Therefore, as a patient it is important to disclose any mental conditions, or pharmaceutical medications to your neurologist prior to testing, so that you can receive an accurate diagnosis regarding levels of cognitive functioning. All of us are unique therefore, visual disturbances or memory impairments will not necessarily offer the same social detriment for all people. Individual support networks will also determine how profoundly cognitive dysfunction impacts upon a patients life quality (Ratajska, A. et. al, 2020).
STAYING CONNECTED TO OTHERS
STAYING CONNECTED TO OTHERS
It is important to seek out support groups, and chat to other patients of MS who may be experiencing similar struggles with cognition. Feeling connected to other humans is essential for our wellbeing, and has been proven to reduce symptoms of anxiety and depression (Briones-Buixassa, et. al, 2015).
WORK & MS "The Multiple Sclerosis Trust"
WORK & MS "The Multiple Sclerosis Trust"
Watch the webinar to discover useful tips and advice on how to cope at work following your MS diagnosis. Here you may find it useful to listen to other patients talk about their personal experiences of living with MS and the impact on their employment. It also informs you of your rights as an employee: it is your employers responsibility to put into place reasonable adaptions to your work practices.
You are protected from work based discrimination under the Equality Act 2010 (The Multiple Sclerosis Trust, 2022).
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