Cognitive And Mood Swings

Cognitive problems occur in more than half of people with MS. Like other MS symptoms, it is highly likely that, over time and with duration of disease, cognition will be affected. Cognitive changes vary greatly from person to person, and advanced physical disease does not necessarily mean advanced cognitive decline.

This section will help you recognise cognitive dysfunction, understand the impact of cognitive dysfunction on your loved one and the family, and provide you with some practical suggestions to manage cognitive challenges.

It will also briefly discuss altered mood states, euphoria, and altered levels of consciousness as sometimes seen in advanced multiple sclerosis.

If you have concerns about cognitive changes in your loved one contact your local Occupational Therapist or GP for an appropriate referral. 

Cognition involves knowing, thinking, remembering and reasoning abilities. The five senses are used to gather information, organise and store that information, and give it back in the form of expressive ability. Cognitive changes in MS range from mild short-term memory problems and easy distractibility, to difficulties with planning and problem solving.

Quickness, cleverness, being “on the ball”, sharp - these are attributes of the mind that can be sacrificed to MS cognitive dysfunction and can often be seen in advanced MS.

Decision-making is a challenge for the cognitively impaired. Decisions can be made that are illogical, unrealistic and harmful. To assist your loved one in the process, write out the pros and cons to make the situation more visual. Confer with a knowledgeable source such as a solicitor, doctor, neutral observer, or relative if you need to. If there are important decisions to be made, such as life planning or financial decisions, try to address these issues when cognitive decline is first noticed and before decision-making is significantly impaired. 

In December 2015, the Government passed the Assisted Decision-Making (Capacity) Act. In April 2023, this Act came in to effect. It provides a legal framework for supported decision making and allows people to make legal agreements on how they wish to be supported to make decisions regarding their welfare, property and other affairs. It allows people to plan for a time when they may not have decision-making capacity for arrangements such advanced healthcare directives and enduring power of attorney

Altered mood states are considered neuropsychiatric rather than cognitive deficits. Neuropsychiatric changes can include mood swings, depression, irritability, anxiety, inappropriate and excessive cheerfulness (euphoria) agitation, apathy, and disinhibition.

Mood swings can fluctuate quickly between anger or rage and normal behaviour. A separate mood disorder termed pseudo-bulbar affect, also known as Involuntary Emotional Expressive Disorder (IEED), is characterised by uncontrollable episodes of laughing and/or crying, and affects 1 in 10 people with MS. These episodes are not necessarily associated with the person’s underlying emotion, and can be inappropriate to the external circumstance.

A minor stimulus, such as watching a television commercial or receiving a gift, can cause uncontrolled tears for example, while learning of a death can bring on uncontrolled laughter. Euphoria and disinhibition (inappropriate sexual talk or behaviour, loss of “social graces”) can occur in people with advanced MS. Treatment for altered mood states may involve medications, and successful management is possible. Ask a neurologist, mental health professional, or an MS nurse specialist about current treatments.

Consciousness level refers to how awake and alert a person is. Levels of consciousness include: alert, confused, drowsy, and unresponsive. Situations that might alter consciousness are medications (for example pain medications), infection, fluid and nutrition intake, or the underlying disease process. Infection, such as aspiration pneumonia, can worsen respiratory effort and affect level of consciousness.

Poor nutrition and hydration can also lead to states of altered consciousness.  Persistent vegetative state (unresponsiveness with no brain function beyond bodily activities such as heartbeat) can occur in multiple sclerosis. Care of these individuals is focused on maintaining dignity and hygiene. Life expectancy is 2 to 5 years.