Have you seen my keys?
This bedeviling question will strike many healthy, college-educated, home-owning adults as altogether too familiar – especially when you’re late for work.
But to some people with multiple sclerosis, that question may hold a more painful resonance.
No one knows exactly why some people develop MS or what causes it.
MS involves an abnormal response of the body’s immune system, whereby the immune systems turns against the body’s central nervous system, which is made up of the brain, spinal cord and optic nerves. Within the central nervous system, damaged myelin tissues become scar tissues, or sclerosis, which lends the disease its name.
While many healthy adults struggle to keep track of belongings – and, for that matter, time – this realm of cognitive functioning can be particularly hard for people with multiple sclerosis. People tend to be diagnosed between 20 and 40 years old.
LuAnn Pierce, a licensed clinical social worker, traveled from Denver last week to give a presentation to two dozen Durangoans about coping strategies for those suffering from MS and for the people who care for them.
Poignantly, the presentation was called “Have You Seen My Keys?”
“Inside your brain, you have file folders filled with the information you need to find your keys,” Pierce said. “But you can’t access that part of the brain because the part that is impaired by MS is the frontal lobe, which contains executive functions.”
She said there were practical steps that people suffering from MS-related cognitive decline might take to mitigating the loss of executive functioning. Because people with MS sometimes struggle to accurately anticipate how much time it takes to complete a given task - like, driving to work - it’s best to leave early.
She suggested lists, too, were a good friend to those who find themselves becoming more forgetful.
And she said “a launching pad” is critical for people trying to keep track of things like keys, glasses, bags and wallets - setting aside a single place in the home or at work for all the irreplaceable items you need to go about your day.
Pierce said another important first step to coping with any MS-related declines in cognition is developing strategies to make the psychological symptoms of MS more emotionally manageable.
She said MS-spurred changes in a person’s cognition are often accompanied by depression, grief, stress, anxiety and mood swings, as well as bouts of hysterical laughter and uncontrollable crying.
In addition to being unpleasant in and of themselves, these emotionally draining symptoms can exacerbate cognitive decline.
Instances of impaired cognitive functioning – for example, losing one’s keys – can propel someone suffering from MS into a horrendous emotional tailspin from which there is no easy escape, especially without calming down.
In fact, the immediate cognitive task – locating the keys – becomes impossible, as the person with MS is battered by waves of confusion, agitation, fear and finally panic, causing chemicals to flood the brain.
“It takes 20 minutes for those chemicals to clear the brain,” Pierce said. “And that’s only if you calm down, or they can just come back, and then it’s at least another 20 minutes before you can think straight.”
Pierce said people with MS often become hypersensitive to noise and overstimulation.
Most people without MS tolerate trips to the mall and view airports as distasteful necessities. But someone with MS might experience those same venues – with their teeming crowds, general clamor, cacophonous background music and torturous fluorescent lighting – as houses of horror.
She said one man’s perception of noise in a Hallmark store pushed him over the edge.
“It was totally out of character for him, but he screamed at these people, ‘Will you please shut up!’ And that’s not who this guy was. He was mortified by what he did. He’s probably still embarrassed,” Pierce said. “But that can happen with MS, when people are over stimulated and have less impulse control.”
This, in turn, can evolve into a situation where someone with MS appears to outsiders like she’s in the throes of agoraphobia.
“I knew one woman who was so afraid of tipping over in her wheelchair and not being able to get up that she refused to go anywhere because it was so overwhelming,” Pierce said. “Then one day, she was out with her daughter, and her wheelchair did tip over. Her daughter wasn’t strong enough to put her back in it. So she was lying there until the nicest firemen in the world showed up and put her right.
“Then, she wasn’t afraid of tipping over anymore because her worst fear had happened. It stopped causing her anxiety.”
cmcallister@durangoherald.com
