Why It’s Hard to Live With MS in a Fast-Paced World

Source: Mauro Mora/UnSplash

We live in a fast-paced world. Our attention is bombarded by fast-paced stimuli. In order to navigate successfully through the many challenges this presents, we need intact cognition. This is where that people with multiple sclerosis can suffer.

It is now known that cognitive difficulties affect a significant number of people with multiple sclerosis. Indeed, even before the diagnosis of multiple sclerosis is confirmed, namely in those individuals who present with a clinically isolated syndrome such as optic neuritis, rates of cognitive impairment are as high as 30 percent. With relapsing/remitting multiple sclerosis, the rates rise to 40 percent, while in the more progressive forms of the disease, namely primary and secondary multiple sclerosis, impairment rates are 80 to 90 percent.

The quintessential cognitive impairment in people with MS is slowed information processing speed. The ability to synthesize and process information slows down, and, given that we are constantly surrounded by stimuli and the need to process this information quickly, when this aspect of cognition falters, life can become more challenging.

The challenges are magnified further by data showing that impaired processing speed may, in turn, affect working memory and aspects of executive functioning. Thus, processing speed should be seen as a key cognitive variable, a bedrock upon which other aspects of cognition depend.

Data from my lab show that processing speed can falter further in the presence of distractions, which are impossible to avoid living in a fast-paced world. Healthy people can struggle with distractions too, but these struggles are significantly more marked in people with compromised brain function, like those with multiple sclerosis. Thus, should a person with MS be called upon to work in a busy office surrounded by noise, telephone ringing, people talking, the need to multitask and so on, their cognitive abilities can become overwhelmed. Not only do they have to move in a fast-paced, efficient manner, they also have to cut through the distractions that can derail their compromised cognitive abilities. This can explain why people with MS who have even an isolated cognitive deficit, such as slowed processing speed, will struggle to function at work and in a busy home.

Given that cognitive difficulties can bring people down very hard in terms of their day-to-day functioning, everyone with multiple sclerosis should have a cognitive assessment that includes a test of processing speed. Indeed, if a person with MS does not have access to a full neuropsychological assessment, at the very least, there should be a test of processing speed completed in a neurological office.

While slowed information speed casts a long shadow in terms of a person’s day-to-day functioning in a fast-paced world, there is some cautious optimism emerging from new treatment trials suggesting that cognitive rehabilitation may be able to enhance processing speed. In particular, trials are underway combining targeted cognitive rehabilitation (e.g., processing speed or memory) with promising adjunctive therapies, like high-intensity aerobic exercise or transcranial magnetic stimulation, to see if there are synergistic effects that transcend monotherapies. Replication and further validation of these results are required, but preliminary data look promising.