Multiple Sclerosis: Understanding the Cognitive Challenges.

Multiple Sclerosis: Understanding the Cognitive Challenges

BY NICOLAS LAROCCA. PHD, AND ROSALIND KALB, PHD

Facing the Cognitive Challenges of Multiple Sclerosis BY JEFFREY N. GINGOLD

Long ago, a philosopher captured what it means to be human: "I think, therefore I am." Thus, cognitive changes can be among the most devastating ways that MS attacks who we are. They challenge as many as two-thirds of us.

MS cognitive changes are not always addressed by our health-care providers, leaving some to silently fear that they are losing their minds. These two timely books, in different, yet complementary ways, shine powerful light on this sometimes dark place.

Directed at patients, families, caregivers, and health-care professionals, Understanding the Cognitive Challenges first explores how the brain thinks and how thinking can be derailed by MS. The authors describe how cognitive changes are measured by neuropsychologists. They briefly discuss the limited data on the effectiveness of MS disease-modifying treatments, symptom management drugs, and rehabilitation on cognitive impairment.

The balance of the book provides concrete and easily applied strategies for managing the challenges. These strategies are neither cures nor treatments, but ways to compensate.

Strategies are outlined for specific problems--for example, forgetting what you went to the grocery store to buy. The authors work through several options, identifying different solutions that might work for different people.

The book also includes a series of vignettes about people with MS in situations made difficult by cognitive issues. These vignettes not only provide solutions that real people have found successful, but also highlight the emotional and social havoc cognitive changes in MS can cause.

In Facing the Cognitive Challenges, Jeffrey Gingold--attorney, father, speed skater, and person with MS--tells his own story of dealing with that havoc. Powerful and revealing, his is a story of denial and then acceptance, but with no hint of surrender.

Faced with repeated lapses in his ability to form a coherent sentence or thought, to remember the route for his drive home, or even to recognize his wife's face, Gingold faced the fact that his neurologist was not addressing nor even acknowledging these problems. He sought a better team: a neuropsychologist, a neurologist who "got it," and other providers including physical and occupational therapists.

With testing, counseling, and attentive medical treatments, Gingold retired at the ripe old age of and figured out how to live a life of purpose--for his community and his family. No longer the workaholic litigator, he has, with his team, developed a set of strategies that works for him. And by sharing his journey and the perspective he gained along the way, he tells an empowering story.

It is not a road map for every person who experiences cognitive changes.

He understands that each person with MS is unique and lays out a series of steps that allows people to find an individual path. He challenges us to have four goals: get educated about the cognitive changes in MS; take action to make the necessary adjustments in our lives; reach out for available answers; and leave room for "slow hugs."

Both of these books are packed with valuable information for people with MS and those who care for and about them. I would quibble that, despite the glossary at the end, the LaRocca and Kalb book may be hard going for some general readers, but it is, like Gingold's book, well worth the effort.

Both published by Demos Medical Publishing, 2006, $19.95 each. 386 Park Avenue South, New York, NY 10016. Web site: www.demosmedpub.com.

Bernice Schacter, PhD, a biomedical consultant and author of The New Medicines: How Drugs Are Created, Approved, Marketed, and Sold (Praeger, 2006). She has been living with MS since 1991.