"Emotional and Cognitive Change Associated with Multiple Sclerosis"
Cynthia Socha-Gelgot, Ph.D., ABPP-CN
Center for Neurobehavioral Health, Ltd.
www.neurohealth.org

Individuals diagnosed with multiple sclerosis (MS) commonly report motor symptoms in the early stages of MS. However, thinking (cognitive) and emotional (depression) changes are often reported as well. Some studies indicate that 50 to 64% of individuals with MS report cognitive change. It is important to note, interestingly, that cognitive change does not necessarily correlate with the degree of physical change. Cognitive symptoms could be very subtle to an observer but create a lot of distress in the individual experiencing them. Some types of thinking changes can include problems with processing speed, attention, memory, language, and perception. Understanding that the cognitive change is real (related to changes in brain) is crucial to the individual and their support system (e.g., family, employer). It is important to note that cognitive changes cannot be explained completely by emotional changes such as depression.

Emotional changes such as depression can be due to the psychological stress of having MS. Depression, however, can also be due to underlying neural changes in the brain. Individuals with MS who experience more cognitive difficulty do not necessarily report more emotional changes. One factor that can further affect both thinking skills and emotional functioning is fatigue. Depression can affect motivation, drive, sleep, appetite, energy level, interest in activities, decision-making, and concentration. Emotional factors can interfere with relationships. Others around may not understand the nature of the emotional changes. As such, educating family members and MS individuals can be beneficial. Individuals with MS often feel more supported when others around them can understand that the emotional and cognitive changes are real -- it is not because someone is weak in spirit or not trying hard enough.

Thankfully, there are multiple resources to assist with the emotional and cognitive changes associated with MS. These include: (1) Individual Supportive Psychotherapy -- services typically conducted by a clinical psychologist, neuropsychologist, or social worker. (2) Behavior therapy -- can assist with symptoms of depression, anxiety, and pain. Services typically provided by a behavioral psychologist or neuropsychologist (3) Cognitive Rehabilitation -- a formal, often home or community-based program where a system is developed to help individuals compensate for thinking or memory weaknesses or whereby a weak system is rehabilitated. (4) Pharmacotherapy -- medication management of depression, anxiety, or thinking changes. Delivered by your family physician, neurologist, or rehabilitation medicine physician. It is important to note that common medications commonly used for depression can actually help with thinking efficiency even if a person is not feeling depressed. Other resources to assist with overall behavioral functioning can include clinical hypnosis, physical therapy, massage therapy, acupuncture, nutrition, wellness program, and feldenkrais (awareness through movement). You can speak with your physician or call the author for more information.

Overall, it is important to keep in mind that exercising your brain on a daily basis can make a noticeable difference in thinking and mood. The brain prefers new information. So, if you are typically good at language-based activities (e.g., reading) try a skill or new hobby that requires other brain strengths (e.g., pottery, photography). A really good resource for individuals who want to find out more about brain exercises can due so in the book: "Keep Your Brain Alive" written by Lawrence Katz, Ph.D. and Manning Rubin. Physical exercise has also been found to play a role in keeping our brains healthy.

In sum, there are multiple resources to assist with the cognitive and emotional changes in MS.

For more information, contact Dr. Socha-Gelgot at (717) 392-6061 in our Lancaster office, or (717) 737-3356 in our Camp Hill office, or by e-mail at braincenter@msn.com or on the web at www.neurohealth.org.