People with MS are less likely to volunteer problems to carers or health workers, unless that particular aspect is probed by a specific question. Recall memory can also let people down when it comes to the initiation of activity. They may report that things are fine during an interview, because the questions have prompted them to consider the problems that they are experiencing in everyday life, but when left to cope alone during the day, somehow the things discussed do not seem to happen as planned. Many people with MS will experience no significant cognitive loss. However, for some, cognitive difficulties are among the manifestations of MS and a proper appreciation of the full impact of the disease cannot exclude this area.
Cognitive dysfunction can be a hard subject to broach, even with family and friends.
It is not immediately apparent, in the way that physical disability can be. There may be only a partial appreciation of the problems by patients, carers and health professionals, each of whom have different perceptions of the changes that may have occurred. People often think that cognitive function is a single entity and so, for example, they fear that their failing to remember telephone numbers may mean that all aspects of memory and intelligence are compromised. This is hardly ever the case. Starting to discuss the problems, at the right time for those involved, can pay dividends in terms of reduced stress, improved coping and limiting the functional impact of the disease.