MS cognitive symptoms frighten me more than the physical ones

Psychological testing indicates that I’m not crazy, but when I share some of the things I’ve done in the Army, people sometimes wonder. I never say that I’m not, because that’s what a crazy person would say. Instead, I provide a three-point answer: One, would I even know? Two, even if I did know, would I care? And three, what is the standard of judgment?

I’m aware the question isn’t serious; it’s just one of those things people say. My three-part answer isn’t serious, either, because I’m not really concerned about the issue. There is something else that concerns me, though. I ask the same three questions about it, but this time I’m serious.

That “something” is cognitive impairment due to multiple sclerosis (MS), and it includes difficulty focusing and processing information. The National MS Society estimates that more than half of the people who have this disease are affected by it. Of all my symptoms, this one worries me the most. An issue that’s invisible to other people is extremely frustrating. One that might be invisible to me is downright terrifying.

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That brings me to the first question: Would I even know if I were experiencing cognitive issues? I’d like to think that I would. I already struggle with what is known as “cog fog” or “brain fog,” which I’m aware of. But I wonder if I’m as aware of it as those around me, or if my awareness will decline if the cog fog worsens. I feel like I’ve gotten a better sense of my physical symptoms as they progress, but I don’t know if it will be the same with cognitive symptoms.

The second question is: If I did know, would I care? For me, that one’s easy and is probably pretty obvious. I’m writing this column because I’m concerned about the cognitive issues I’m having now and worried about the ones I might have later. If they worsen, so long as I’m the least bit aware of them, I’ll care — and not just for myself, but for those close to me as well. I already worry about not being there physically for my loved ones. I despair of any possibility of not being there for them mentally.

The final question is: What is the standard of judgment? I know there are cognitive tests, but it’s not as though I established a baseline before I was diagnosed with MS. I’m looking into establishing a baseline now, but without regular testing, there’s no way to accurately measure any progression. Studies point to the importance of cognitive assessments, and various patient-centric tools are available. It is my hope that this could become part of a multipronged approach to MS care.

I think my fear of cognitive issues could best be compared to the fear of swimming in dark water. The shark fin that I can see above the surface is like the physical symptoms of MS. It’s probably going to raise my pulse, but at least it’s a threat I can see coming. Mental symptoms are like the slimy thing that brushes my foot unseen. My imagination runs wild and makes the unknown much more frightening.

Maybe it’s all in my head. Wait a second, this is MS we’re talking about. It sort of is all in my head.

Note: Multiple Sclerosis News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Multiple Sclerosis News Today or its parent company, Bionews, and are intended to spark discussion about issues pertaining to multiple sclerosis.