Cognition refers to various aspects of thinking, including memory and concentration. About half of people with multiple sclerosis (MS) experience some kind of cognitive impairment.

Symptoms vary from person to person and time to time, getting worse during relapses and improving in remission. Someone who is disabled physically can be cognitively fine, and vice versa.

Depression, stress, pain, fatigue, anxiety and life changes associated with MS can also trigger temporary cognitive difficulties.

Cognitive changes can occur at any time, but are more common later in the course of the disease, as lesions in the brain accumulate. Only 5-10% of persons with MS develop cognitive problems that severely impede their lives.

A common cognitive problem is an inability to concentrate. People are often unable to think about more than one thing at a time, remain undistracted, or focus for long periods. Related to concentration issues are difficulties with planning and prioritising, following complex instructions, and problem solving.

Alcohol consumption, bad nutrition, ageing, other illnesses and certain medications can also affect concentration.

These changes are generally mild and progress slowly; while some are temporary, in the long term they’re unlikely to reverse. There’s no proven drug treatment for MS-related concentration or other cognitive problems, although research in this area is continuing.

However, certain strategies can minimise the effects of the damage. Psychologists, counsellors and occupational therapists can help you to:

• Optimise your intact cognitive functions, and strengthen affected abilities with special exercises.
• Prioritise tasks; do one thing at a time; remove distractions; break down tasks into simple stages.
• When you’re feeling tired or anxious, avoid tasks that require focus.
• Learn alternative techniques for performing tasks.
• Find emotional support from family members, friends and support groups.
• Establish a fixed routine: keep things in the same places, do activities at fixed times.
• Make use of diaries and other reminders and organising tools; use technology such as dictaphones, computers and mobile phones.

The first signs of cognitive dysfunction may be subtle, but early recognition and assessment are crucial. Talk to your doctor if you’re concerned.

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