Multiple sclerosis affects more than just physical abilities. It can change the way people feel about themselves and alter their cognitive functions. For many, the emotional and cognitive effects of the disease represent its greatest challenges.
Emotional changes
In MS there is no definite set of stages leading to “adjustment”. However, there are a number of emotional responses that appear to be common as people learn to deal with the disease.
Uncertainty and anxiety set in when the first symptoms appear, and continue until a diagnosis is established. The disease is unpredictable, and so people with MS are often called upon to adjust to a lifetime of uncertainty.
A person with MS may find many facets of self-image undermined by the disease. There is often a period of grieving for those losses before a renewed self-image can emerge, a process that may occur many times during the course of MS. Grief is a healing and restorative process, but one accompanied by pain and sadness.
MS adds considerable disease-related stress to the existing pressures of modern life. Learning to cope with stress is a major challenge. Moreover, persons with MS may worry that stress itself may make the disease worse by precipitating exacerbations. Research on the question of stress as a “trigger” for MS attacks has had mixed results. However, stress is an unavoidable part of life, and a person can create unnecessary, additional distress simply by trying to avoid the unavoidable.
There are a number of other emotional changes that may occur in MS including clinical depression, bipolar disorder, and mood swings. All are more common among persons with MS than in the general population.
Major depression is a serious and, at times, life-threatening condition. It is characterised, among other symptoms, by major depressive episodes that can be as disabling as the physical symptoms of MS. Major depression is different from the day-to-day “depression” that many people may experience for a few hours at a time. It is a severe and persistent state that may be accompanied by suicidal thoughts or actions. It requires professional attention and effective treatments including anti-depressant medication and psychotherapy. It is thought that MS may cause changes in the brain triggering major depression, however evidence for this remains limited.
Bipolar disorder is a rare condition characterised by alternating periods of depression and mania, or just mania. During manic periods, the affected person may engage in inappropriate behaviour such as spending large sums of money. As such this disorder can be very disturbing for family members. Just as with major depression, bipolar disorder requires professional attention and is often treated with a combination of anti-depressants and mood-stabilising drugs.
Mood swings of various types appear to be common in MS. As used in MS, the term “mood swings” refers to a number of phenomena including emotional instability (“lability”), uncontrollable laughing and crying, and euphoria.
Emotional lability refers to frequent changes in mood from happy to sad to angry, etc. These are not much different from the mood swings experienced by most people but they appear to be more common and perhaps more severe in MS. It is believed that the causes are both the extra stress brought on by MS as well as neurological changes at work.
Uncontrollable laughing and crying is a disorder affecting no more than 10 per cent of people with MS. It is characterised by periods in which the person laughs or cries uncontrollably and out of keeping with the situation. This disorder is thought to be caused by MS-related changes in the brain.
Euphoria is a very rare symptom in MS affecting no more than five to ten per cent of people with MS. It is characterised by an unrealistic sense of optimism, which can be expressed at times of significant problems and misfortune. Euphoria may be manifest by inappropriate giggling and is generally observed in individuals with significant cognitive impairment.
Although MS may be accompanied by a variety of emotional reactions and some serious disorders, there is no “MS personality” per se. People with MS face some very special challenges but, like everyone else, they are trying to do their best to cope with what life has sent their way. In most instances, they cope very well and often are stronger for having met these special challenges.
Cognitive changes
Cognition refers to the “higher” brain functions such as memory and reasoning. Approximately half of people with MS have no apparent cognitive changes.
The areas of cognitive functioning that are most commonly affected in MS include the following:
• Memory
• Attention and concentration
• Word-finding
• Speed of information processing
• Abstract reasoning and problem solving
• Visual spatial abilities
• Executive functions
Because MS can affect any part of the brain, almost any cognitive function can be impaired. Typically, MS affects some cognitive functions but leaves others relatively intact. For this reason, MS is not likely to lead to the sort of global cognitive decline seen in Alzheimer’s disease. However, in some cases, MS-related cognitive changes can be more pervasive, rendering the individual unable to deal adequately with day-to-day responsibilities.
Impact of cognitive changes
Cognitive changes can have a significant impact on one’s ability to work and fulfil family responsibilities. Family members are often unaware that MS can cause cognitive problems and this misunderstanding can result in anger and confusion. In such cases it is wise to obtain a professional evaluation to clarify the nature and cause of the problems.
MS is a complex disease with many psychological ramifications. Adjusting successfully to MS requires understanding and addressing these changes along with the physical ones. There are many resources available for education, evaluation, and treatment. By using these resources to the fullest, the family affected by MS can succeed in living more comfortably with an unwelcome but persistent intruder.
‘A person can create unnecessary, additional distress simply by trying
to avoid the unavoidable’
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