Cognitive Changes in Secondary Progressive Multiple Sclerosis

Multiple sclerosis is an autoimmune disease that affects the central nervous system, particularly the spinal cord and the brain. There are four types of multiple sclerosis, aptly named according to the manner in which the disease affects the body. Secondary Progressive Multiple Sclerosis (SPMS) is a type of multiple sclerosis in which the symptoms worsen rapidly over time. The signs continue to decline with or without the occurrence of remissions and relapses. This type of multiple sclerosis impacts a person’s physical health as well as their cognitive abilities. It is essential to watch out for your mental health if you have secondary progressive multiple sclerosis. Here are some common cognitive changes in secondary progressive multiple sclerosis and how to deal with them.

What is Secondary Progressive Multiple Sclerosis?

Secondary Progressive Multiple Sclerosis (SPMS) is a type of multiple sclerosis that is considered to be a stage after relapsing-remitting multiple sclerosis.(1,2) With secondary progressive multiple sclerosis, you do not experience any signs of remission, meaning your condition continues to worsen in spite of the treatment being administered.(3) However, you will still need to keep getting treated to reduce the flare-ups and severity of your symptoms. Treatment also helps slow down the progression of disability commonly associated with multiple sclerosis.(4,5)

The stage of secondary progressive multiple sclerosis is common, and most people with the condition will go on to develop secondary progressive multiple sclerosis at some point if they are not managing their condition well and are not following an effective disease-modifying therapy.

Secondary progressive multiple sclerosis not only affects a person’s physical health, but it also has an impact on the cognitive abilities of a person.

A review published in 2019 found that many small-scale studies have discovered that nearly 55 to 80 percent of people with secondary progressive multiple sclerosis experience some type of cognitive impairment.(6)

Secondary progressive multiple sclerosis may have an impact on the memory and also slow down the speed at which your brain processes information. It may also decrease a person’s communication capabilities, attention span, or reasoning ability. These types of cognitive impacts are usually mild and manageable, but they tend to vary in severity from person to person.

It is possible to take various steps to maintain your cognitive health if you have been diagnosed with secondary progressive multiple sclerosis. The biggest factor that can help you retain your mental abilities with secondary progressive multiple sclerosis is to remain proactive. Here are some of the major cognitive changes you are likely to see with secondary progressive multiple sclerosis and how to manage and deal with these changes.

Signs of Cognitive Changes with Secondary Progressive Multiple Sclerosis

Secondary progressive multiple sclerosis is a progressive disorder, meaning it gets worse with time. Over a period of time, this disorder can give rise to various new cognitive symptoms. It can also cause your existing symptoms to get worse. For identifying mental changes, it is best to have regular screenings with your doctor. In fact, according to the recommendations of the National Multiple Sclerosis Society, it is best if people with multiple sclerosis get screened for cognitive changes once a year.(7)

It is also essential to inform your doctor at the earliest if you notice any changes in your cognitive capabilities. Here are some signs and symptoms of mental changes you may experience:(8,9)

  • Finding it difficult to navigate through social relationships
  • Forgetting things more than you usually used to
  • Having difficulty finding the right words to express yourself – you may feel like the word is right on the tip of your tongue but unable to recall the exact word.
  • Finding it more difficult to keep up with your day to day activities
  • Finding it harder to keep up with conversations
  • Changes in your speech(10)
  • Performing worse at work or receiving bad evaluations at school
  • Showing signs of impaired decision-making skills or poor judgment

If you notice any changes, even the slightest, in your concentrating power, memory, or any other cognitive skills, you should let your doctor know at the earliest. Your doctor will use various tests to check your cognitive skills and whether there is a decline in your abilities.

Identifying The Reason Behind Cognitive Changes

If you experience any kind of cognitive decline, your doctor will use a variety of tests to identify the exact cause of these changes. Secondary progressive multiple sclerosis is one of the many factors that can affect your cognitive abilities.(11) A person’s cognitive skills can also be impaired by other underlying medical conditions, medications, and even lifestyle habits.

The recommended treatment plan your doctor comes up with will depend on the underlying cause of your cognitive changes. Sometimes, your doctor may also refer you to another specialist or a psychologist for further testing and treatment.

How to Prevent a Decline in Cognitive Abilities Due to Secondary Progressive Multiple Sclerosis?

To prevent a decline in your cognitive abilities with multiple sclerosis and to manage the cognitive symptoms brought on by secondary progressive multiple sclerosis, your doctor may teach you several cognitive rehabilitation exercises. These are basically learning and memory techniques that have shown promise in various trials to help improve the cognitive abilities in people with different types of multiple sclerosis.(12)

Your healthcare team will also encourage you to start doing more mentally stimulating activities. This helps enhance and build your cognitive reserves. For example, many people find it helpful to play card games, complete crossword puzzles, learn to play a musical instrument or to even write poetry.

In case your doctor believes that your cognitive changes are being brought on because of another medical condition, they may order other treatments to manage it or refer to another specialist.

Suppose you believe that the cognitive changes you are experiencing are because of a side effect of your multiple sclerosis medication. In that case, you should discuss changing your treatment plan with your doctor. However, never stop taking your medicines or change the dosage without consulting your doctor.

You will also be advised to make healthy changes to your sleeping habits and diet. Exercising regularly is also known to improve your brain health. A healthy lifestyle is essential for supporting your mental and physical health, especially when you have a disorder like multiple sclerosis.

These changes don’t need to be anything big. Even changing your daily habits slightly can help you manage the changes to your cognitive abilities. For example, you may try to:

  • Reduce any distractions and background noise around yourself when you are trying to concentrate.
  • Try to focus on only one thing at one time and restrict the amount of multitasking you do daily.
  • Create more time for resting and keep taking breaks when you feel tired or get distracted.

Use a journal or any note-taking app on your smartphone to keep track of your upcoming doctor’s appointments, to-do lists, important information, and anything else that you might forget. Having everything in one place will keep you from feeling scattered and all over the place. Set alarms on your phone to remind yourself about deadlines, daily tasks that have to be completed, and important dates, especially your appointments.

If you are finding it challenging to manage your responsibilities, it is an excellent time to think about scaling back a bit on your commitments, be it at school, at work, or even in your personal life. Informing your friends and family about your condition will help you feel more comfortable that they will be understanding if you have to cancel plans.

If you find that due to the cognitive decline of secondary progressive multiple sclerosis, you are no longer able to work, you must let your doctor know. Your doctor may refer you to professionals like a social worker who may help you get on board the many government-sponsored disability benefits.

Conclusion

Secondary progressive multiple sclerosis is known to have an impact on your memory and other cognitive skills. In many cases, people are able to manage these mental changes with lifestyle changes, rehabilitation therapy, and different coping strategies.

It is important to inform your doctor if you notice any kind of decline in your cognitive abilities. Your doctor will identify the exact cause of these changes and come up with a treatment plan to help you cope better with these changes. They may also refer you to another specialist, like a psychologist, for getting the support you need.

References:

  1. Thompson, A.J., Kermode, A.G., Wicks, D., MacManus, D.G., Kendall, B.E., Kingsley, D.P.E. and McDonald, W.I., 1991. Major differences in the dynamics of primary and secondary progressive multiple sclerosis. Annals of Neurology: Official Journal of the American Neurological Association and the Child Neurology Society, 29(1), pp.53-62.
  2. Prineas, J.W., Kwon, E.E., Cho, E.S., Sharer, L.R., Barnett, M.H., Oleszak, E.L., Hoffman, B. and Morgan, B.P., 2001. Immunopathology of secondary‐progressive multiple sclerosis. Annals of Neurology: Official Journal of the American Neurological Association and the Child Neurology Society, 50(5), pp.646-657.
  3. Rovaris, M., Confavreux, C., Furlan, R., Kappos, L., Comi, G. and Filippi, M., 2006. Secondary progressive multiple sclerosis: current knowledge and future challenges. The Lancet Neurology, 5(4), pp.343-354.
  4. Tremlett, H., Zhao, Y. and Devonshire, V., 2008. Natural history of secondary-progressive multiple sclerosis. Multiple Sclerosis Journal, 14(3), pp.314-324.
  5. Beiske, A.G., Naess, H., Aarseth, J.H., Andersen, O., Elovaara, I., Farkkila, M., Hansen, H.J., Mellgren, S.I., Sandberg-Wollheim, M., Sorensen, P.S. and Myhr, K.M., 2007. Health-related quality of life in secondary progressive multiple sclerosis. Multiple Sclerosis Journal, 13(3), pp.386-392.
  6. Brochet, B. and Ruet, A., 2019. Cognitive impairment in multiple sclerosis with regards to disease duration and clinical phenotypes. Frontiers in Neurology, 10, p.261.
  7. Kalb, R., Beier, M., Benedict, R.H., Charvet, L., Costello, K., Feinstein, A., Gingold, J., Goverover, Y., Halper, J., Harris, C. and Kostich, L., 2018. Recommendations for cognitive screening and management in multiple sclerosis care. Multiple Sclerosis Journal, 24(13), pp.1665-1680.
  8. Huijbregts, S.C.J., Kalkers, N.F., De Sonneville, L.M.J., De Groot, V.R.I.E., Reuling, I.E.W. and Polman, C.H., 2004. Differences in cognitive impairment of relapsing remitting, secondary, and primary progressive MS. Neurology, 63(2), pp.335-339.
  9. Wachowius, U., Talley, M., Silver, N., Heinze, H.J. and Sailer, M., 2005. Cognitive impairment in primary and secondary progressive multiple sclerosis. Journal of Clinical and Experimental Neuropsychology, 27(1), pp.65-77.
  10. Svindt, V., Bóna, J. and Hoffmann, I., 2020. Changes in temporal features of speech in secondary progressive multiple sclerosis (SPMS)–case studies. Clinical Linguistics & Phonetics, 34(4), pp.339-356.
  11. Huijbregts, S.C., Kalkers, N.F., de Sonneville, L.M., de Groot, V. and Polman, C.H., 2006. Cognitive impairment and decline in different MS subtypes. Journal of the neurological sciences, 245(1-2), pp.187-194.
  12. Goverover, Y., Chiaravalloti, N., Genova, H. and DeLuca, J., 2018. A randomized controlled trial to treat impaired learning and memory in multiple sclerosis: The self-GEN trial. Multiple Sclerosis Journal, 24(8), pp.1096-1104.

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