Solving Cognitive Problems 2 of 4

by Nicholas G. LaRocca, PhD with Martha King

What can be done to alleviate intellectual problems?

• Get it out in the open. Years ago, professionals advocated not discussing MS-related intellectual problems in public because the issue would upset people. Today, health-care professionals recognize that people with MS almost always want information-on this or any other topic.  Talk over your concerns with your doctor or nurse.
• Share with others. Very often, fears about a problem are much worse than the reality. To keep up with the facts, ask questions, read, attend lectures if possible, and talk to others who have similar problems. For the most recent information on MS research, visit the National MS Society's Web site at nationalmssociety.org/research

In MS support groups or educational meetings, cognitive dysfunction is a frequent topic of discussion.  Sharing helps on an emotional level as well as on a practical one.  Comparing notes and learning how others cope can help to expand one's own resources and remove the feeling of stigma.

• Make it a family affair.  Family members may not realize that the person with MS has some intellectual disability due to this disease.  When the person with MS forgets parts of conversations, misses appointments, or misplaces things, it may be viewed as laziness, indifference, or carelessness.  If this happens, family members and friends need help to develop an understanding of what is going on.
• Get counselling if it seems appropriate.  Not everyone who experiences a few memory lapses needs counselling.  However, counselling or psychotherapy do help people deal with the impact intellectual problems have both on self-esteem and on practical everyday living.  They also address depression or anxiety, which can adversely affect intellectual function.
• Explore self-help options. Here are some practical suggestions that have worked for many:
• Where memory is weak, try substituting organization. Get yourself a good loose-leaf organizer and learn to use it consistently as your information center. Set up sections for appointments, to-do's, phone numbers, driving directions-anything that you need to remember but are likely to forget.  Get rid of all those little scraps of paper with notes on them that are always getting lost.
• Consider augmenting the loose-leaf organizer with an electronic gadget.  There are many small computer-based personal-information managers and personal digital assistants on the market.  Some can be programmed to beep as a reminder of tasks or appointments.
• When you are trying to learn something new, give yourself extra time to practice.  Studies have shown that with extra practice people with MS can improve their ability to recall information later.
• Set up a family calendar to track everyone's commitments.
• Assign a particular place for storing frequently used items such as your car keys.
• Encourage family members to return borrowed objects to their proper spots.  For example, the scissors always go in the top drawer of the desk.
• Work on your focus and concentration.  Sometimes we forget things because we never really learned them.  Frequently we only half pay attention.  Improving your concentration can enhance your recall.
• Plan your most challenging intellectual tasks for your best time of day. Recent studies have documented the existence of "cognitive fatigue".  This refers to a temporary decline in cognitive functioning following an extended period of intellectual effort.  Strategically scheduled rest periods will also help you avoid this form of fatigue.
• Use mental pictures to aid memory.  For example, to increase the likelihood that you will remember to close the windows before leaving the house, visualize a great deluge in which enormous streams of muddy water flood into every room through the open windows.  Hold on to that image for a few moments and you are more likely to remember to close windows later.
• When you meet a new person, jot down his or her name as soon as you can gracefully do so.  Later, make some notes in your loose-leaf organizer on the most striking things about that person.
• When you encounter word-finding problems, don't persist in trying to think of that elusive word.  Try to shift your attention to something else.  The word you want will come back to you later.

Visit your library or bookstore for books designed to help organize time or improve memory. Some of these involve wildly complicated schemes, but many have useful suggestions.