Solving Cognitive Problems 4 of 4
Clearing up misconceptions
Cognitive dysfunction is probably subject to more misconceptions than any other topic in MS, in part because we tend to avoid discussing it. Let’s dispel some misconceptions.
- Misconception: MS does not affect the intellect.
Most people with MS will never be troubled by severe intellectual problems, but mild problems are fairly common. Some professionals still cling to the idea that the intellect is never affected. We need open discussion of this topic in order to deal with it.
- Misconception: People who have cognitive dysfunction are emotionally unstable, or have a mental illness.
Cognitive dysfunction is not an emotional or mental disorder. Someone can have cognitive problems and be perfectly normal emotionally and mentally. While emotional problems such as depression or anxiety can adversely affect intellect, cognitive problems should not automatically be attributed to these causes.
- Misconception: Cognitive functioning can be assessed by asking a few simple questions.
Cognitive function must be assessed using a battery of standardized tests administered and interpreted by someone with the proper training. The “bedside mental status” test can detect only the most severe cognitive problems.
- Misconception: All people with MS should have a detailed cognitive assessment.
Not at all. A comprehensive assessment is necessary only if problems occur and then only after thorough consultation to rule out other factors.
- Misconception: When cognitive problems appear, they worsen rapidly.
Although very few long-term studies have been completed, clinical experience so far suggests that these problems progress
slowly.
- Misconception: Cognitive problems only occur in people who are severely disabled.
On the contrary, people who are severely disabled physically may have no cognitive problems at all. Studies completed by Robert Heaton, PhD, and his colleagues at the University of Colorado and by William Beatty, PhD, now at the University of Oklahoma Health Sciences Center, have shown that there is only a very weak relationship between extent of physical disability and cognitive dysfunction in MS. On the other hand, cognitive problems can affect people who have very few physical problems.
- Misconception: Cognitive problems only occur late in the course of MS.
Doctors Beatty and Heaton found that there is little relationship between duration of MS and the severity of cognitive dysfunction.
- Misconception: Cognitive problems only occur in people with progressive MS.
Cognitive dysfunction is likely to be somewhat worse in people with progressive MS. Memory deficits appear to be common among persons with relapsing-remitting MS. Individuals with any kind of MS can experience cognitive problems.
- Misconception: Relapses or attacks of MS do not involve cognitive functions.
Not true. People with MS can have attacks in which cognitive problems become dramatically worse very quickly. The problems can then improve as remission proceeds.
- Misconception: People with MS-related cognitive problems have euphoria.
Euphoria involves exaggerated and unrealistic expressions of happiness, often accompanied by a lack of concern about oneself. Euphoria is actually rare, affecting less than 10% of the MS population. It occurs almost exclusively in people with the most severe cognitive impairments.
- Misconception: Cognitive problems in MS are similar to Alzheimer’s disease.
No. MS bears little resemblance to Alzheimer’s disease. MS-related cognitive dysfunction is almost never as severe as Alzheimer’s.
MS-related cognitive problems may stabilize at any time, and no further progression will occur.
In contrast, Alzheimer’s affects many different functions. The deficits it causes increase rapidly and often predictably. Language declines along with memory, and a person with Alzheimer’s will eventually be unaware of where he or she is and forget even his or her own name.
Christopher Filley, MD, and colleagues at the University of Colorado, have published a study that compared cognitive aspects of the two diseases. A recent review article confirmed the differences between what is generally observed in MS and in Alzheimer’s.
Suggested reading
Improving Your Memory for Dummies, by John B. Arden. New York, Wiley Publishing, 2002, 336 pages, $19.99