But because her employment had been as a betting shop manageress, whose mental calculation of odds and payouts had to be quick and faultless, she had become unemployed. In more severe cases, attentional deficits can deplete leisure options, as the thread of a novel gets lost beyond recovery, or the plot of a favourite soap opera confuses rather than entertains. A marked feature of the pattern of memory deficits in MS is that recall, or unprompted remembering, is more adversely affected than recognition, or prompted remembering. This leads patients to respond appropriately to reminders from relatives or professional workers, but when not prompted, MS patients with this type of difficulty may fail to remember essential health care activities or appointments. 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.