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MSWA Bulletin Magazine Summer 2018

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WHAT IS COGNITION?

WHAT IS COGNITION? ROSEMARIE DRAVNIEKS, MSWA MANAGER OCCUPATIONAL THERAPY REASONS WHY I MIGHT BE FALLING ROSEMARIE DRAVNIEKS, MSWA MANAGER OCCUPATIONAL THERAPY Cognition refers to all aspects of memory and thinking. Cognition includes the ability to: • Focus and maintain attention • Divide attention between tasks • Learn and recall new information • Think, reason and solve problems • Comprehend • Recognise objects and people • Plan, perform and control one’s actions Not everyone who has multiple sclerosis (MS) experiences cognitive problems, however, approximately 50–70% of people with MS have some degree of cognitive problems. Individuals may experience a different combination of problems. (Rehabilitation in MS, 2002) Common changes in cognition • Speed of thinking • Memory • Attention and concentration • Information processing • Problem solving (Leech, 2005) The most common area of change is the speed at which a person can take in and process information. Basically, it takes longer to process information. This is often misinterpreted as a memory problem. However, memory involves both the storage and recall of information. When the information is presented slower, such as by the rate of speech slowing down, then the person is able to respond appropriately. The most common type of memory problem is related to the recall of details of an event or discussion. A discussion may be recalled but not the details. Some people find the recall of names difficult; it is not uncommon for people to forget to do planned tasks. The ability to sustain attention can also be difficult. Tasks may not get finished as the person moves from one task to the next because attention is not sustained to complete each task. Such problems tend to occur more frequently when there are many things happening at the same time. Distractions, either visual or auditory, may make attention to detail more difficult. Difficulty in information processing refers to problems with being able to manage and absorb the information given and making sense of it. They may have difficulty understanding the main factors to be considered, to recall and study those factors, or to come up with an appropriate choice. Problem solving includes thinking and planning of actions and involves generating possible solutions based on the information presented. Causes of cognitive changes in MS MS in an autoimmune disease, whereby the body attacks the myelin and nerves of the central nervous system. Myelin is a fatty tissue that covers and protects the nerves in the brain and spinal cord. This process causes inflammation and scarring, disrupting the communication between the brain and the rest of the body. Scarring can occur anywhere in the brain and spinal cord, which leads to a wide range of symptoms being experienced by people who have MS. These symptoms can include changes in cognition. (Making Sense of Multiple Sclerosis, 2003) Cognition difficulties occur when scarring causes blocks in the pathways between the thinking modules of the brain. Benefits of recognising cognitive problems Changes in cognition can have an impact on a person’s daily life. When the nature of those changes is recognised, it is possible to use appropriate strategies to help manage these changes, and reduce the negative impact of change. (Leech, 2005) Although not common, where cognition is significantly impaired, strategies must be put in place to protect the person’s financial status and safety issues in the home. Other factors impacting on cognition Apart from the MS scarring, other factors can impact on cognition. These are normal to everybody, but more obvious where cognition functions are already challenged. • Feeling tired or fatigued • Feeling stressed • Pain • Raised core body temperature through exercise, heat or sickness • Excessive noise or visual distraction • Certain medications Personal reasons • Balance; reduced balance when walking, balance can also be affected by medications • Vision; difficulty seeing where you are going and tripping over obstacles • Medication; may make you drowsy and lessen your awareness • Physical Environment; clutter, steps, trip hazards • Cognition; attention, awareness or concentration difficulties • Fatigue; can affect your cognition, balance, vision • Pain; can make you weaker and increase your fatigue • Muscle weakness; difficulty holding weight whilst walking • Spasticity; difficulty walking • Reduced sensation; difficulty knowing where your body or feet are in the environment What are some others? • Footwear; may be too large, incorrectly fastened or have inappropriate grip to the floor • Overconfidence; important to know your capabilities and that they can change • Impulsivity; impulsively standing or walking without planning your route • Unfamiliar environment; unaware of hazards COGNITION GROUP Did you know, approximately 50% of people diagnosed with MS experience difficulties with thinking, planning and memory? MSWA Occupational Therapy staff are now holding regular four-week programs to help address the cognition issues common for people with MS and other neurological conditions. The groups discuss the following topics: • Memory • Attention • Information processing/learning • Higher brain functioning Don’t let MS take the fall for it! It is important to consider other potential reasons why you are falling, MS may not be the underlying reason you are falling. Make sure you discuss with your doctor when you fall. Some other causes of falls may be: • Nutrition • Low blood sugar • Depression or dizziness Why did I fall? Keep a record It is important to keep a record of: • Where you fell • What time of day you fell • What activity you were doing whilst you fell • How you were feeling before you fell • The environment you were in • What your plan of action was after you fell ROSEMARIE DRAVNIEKS, MSWA MANAGER OF OCCUPATIONAL THERAPY This information will help you and your health professional to work out why you are falling. It can help to eliminate the source of the fall, for instance if it is always in one spot due to slippery tiles or a folded rug. Knowing this information can help you and your health professional to create safe solutions to help keep you on your feet. If you have concerns you can speak with an MS nurse, physiotherapist or Occupational Therapist; call 9365 4888. These groups are open to anyone living with a neurological condition; this group will provide an opportunity to connect with your peers and to share your experiences and strategies. If you are interested in attending one of these groups, please get in touch with the MSWA Occupational Therapy Department on 9365 4888. 24 | MSWA BULLETIN SUMMER 2018 MSWA BULLETIN SUMMER 2018 | 25

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