Juggling

I'm currently listening to music (the album A Curious Thing by Amy MacDonald, if you're interested), watching athletics on the telly, and attempting to write this. I used to be an ace multi-tasker. These days, my MS-ified self can barely cope with one thing at a time. So the fact that I've taken on three at once means that at least two of them are going to suffer. Life with MS is all about juggling your commitments, because of the effects it has on your cognitive skills.

Cognition is the term used to describe a person's "thinking ability". People will often realise they are starting to have cognitive problems when they begin to find it hard to read books or follow conversations. Cognition includes:

• focusing, maintaining and shifting your attention
• learning, remembering and recalling information
• understanding and using language appropriately and effectively
• performing maths calculations
• ‘executive function’ such as planning actions, performing tasks in the correct order, controlling one’s impulses, transferring learning from one situation to another, and working with abstract concepts

Mild cognitive problems are common in MS.It's thought that somewhere between 45% and 65% of people with MS have some degree of cognitive problem, though as with every symptom the degree and profile varies from person to person. It is most severe in people with secondary progressive MS. People with primary progressive MS seem to be rarely affected, possibly because this type of MS prefers to attack the spinal cord rather than the brain.

The most common problems are in:

• Learning and memory - almost always short term memory
• Attention, concentration and mental speed - it may be difficult to concentrate for long periods of time or keep track of what you're doing if you're interrupted, do several jobs at once or carry on a conversation if the TV or radio is on.
• Problem solving - planning, performing and evaluating tasks - you know what you want to do but find it difficult to know where to begin, or to work out the steps needed. Problems can lead to confusion and stress, which can in turn increase learning and memory problems.
• Word finding - particularly nouns, including abstract nouns. It can be difficult to take part in a conversation because it takes too long to express an opinion or find the correct word, and the discussion has moved on.

There seems to be little association between someone's level of physical disability and their cognitive problems. Cognitive changes can worsen with a relapse, or when the person is tired. People with MS rarely experience cognitive impairment as bad as that with (for instance) Alzheimer's disease, and then only in the very late stages of the disease.

The level of impairment can stabilise at any time rather than continuing to progress. Most people with MS who have cognitive impairment have mild symptoms.

Most of the ways of trying to deal with cognitive impairment are behavioural. They include things like:

• Writing everything down. Rely heavily on a diary, loose-leaf organiser and/or palm-held computer/organiser.
• Having a particular place for everything, always putting things back where they belong and encouraging others to do the same.
• Trying to focus your attention more keenly on the things that are important. Repeating important things that need to be remembered over and over in your head will often keep them there.
• Trying to jot everything down, including people's names and how they appear to you. Often just the act of writing something down will commit it to memory better. Pictures also help. These can be mental or drawn.
• Word recall is a problem that is often reported in MS. If you suffer from this, try not to get hung up about the exact word. People are often happy to chime in with the right word anyway - let them.
• Working slowly. Take your time to plan things and don't be rushed by anyone. Use paper and/or a calculator as necessary.

So, I've moved on to Snow Patrol's Eyes Open, the athletics are still on, and I'm thinking hard here about what my conclusions should be. But given my cognitive impairment, and my problems with pattern formation and word finding, I don't really have any. Except that I really should stick to one thing at a time...