Attention

Tips and Tricks

Concentration can be more of an effort for some people with MS. This can be dispiriting if following a good book, or a good film, seems difficult. People with MS say that they “lose train of thought”, “…can’t concentrate when all the family is here”, and they have been “feeling stupid as I lost the point is conversations”. However, there are strategies which some people find helpful.

It is easier to concentrate when you are not tired, in short bursts and when you are interested in the information.
Try to schedule important discussions at a time when you won’t be fatigued, or arrange to have a rest beforehand.
If you want to read a lot of material, for example you enjoy reading novels, try alternating short bursts of reading with another activity. It may be enough to just put the book down and look away or stretch at the end of every page. You may find reading a chapter a day is enough and fill the rest of the day with other activities.
It helps to consciously review what you are reading or watching at regular intervals. For example, if it is hard to keep track of the plot of a book, at the end of every paragraph you might try saying a few words to yourself that summarise that paragraph’s developments. If you are finding it hard to keep track of a soap, you might try reminding yourself of what has just happened when the adverts come on.
If your attention wanders during conversation, you can always repeat or summarise what the other person had just said before making your comment. For example, you could say “I hear that you enjoyed your holiday in France, because the weather was so good. Have you ever been to France when it rained?”. It might feel a bit strange at first, but it will soon feel natural. In fact, this kind of summary when replying is used by professional interviewers and called “active listening”. You will find that your friends will feel flattered that you are paying so much attention to what they are saying.
If you know that your attention is poor, think carefully about adding distractions to your environment. For example, using a satnav or listening to the radio whilst driving might not be a good idea.

Gadgets and Gizmos

These details are supplied for information only, not by way of endorsement. Items are usually available from several retailers and items are often made by several manufacturers. The MS Trust cannot guarantee that these items are available, or suitable for any individual and accepts no responsibility or liability with regard to their usage.

2 fridge magnet imperial-metric converters (and vice versa)

Child’s MP3 player with voice recording function

Designed for youngsters, but looks adult, is compact and is good value.

For a range of voice recording devices go to www.olympus.co.uk/voice/.

Other Important Influences

There are a number of outside factors that might make your mental skills less efficient:

Having an infection, or being otherwise unwell. If this is the case, seek medical advice
Some drugs given for MS symptom management, including drugs for continence management and spasticity. If you think this may be the case for you, discuss with your doctor
Fatigue has been shown to affect mental skills in MS. Cognitive fatigue has more impact than physical fatigue on mental efficiency. Repeating the same mental task over and over again is especially vulnerable to fatigue in MS. You may find varying your mental tasks, taking breaks, being rested and choosing your best time of day all help. You are also less likely to employ your preparation and strategies when you are feeling fatigued, which reduces how well you can manage your cognitive difficulties.
Download 'MS Trust Publication living with Fatigue'
Anxiety may affect your mental performance, especially if you are “on the spot” and feeling tense. Try to stay relaxed and work round the immediate block.
Depression in MS reduces performance on cognitive tasks that need a lot of concentration. It seems to take up capacity (“thinking space in your brain”) with worries and recurrent bleak thoughts. Like fatigue, depression can also reduce your motivation to employ strategies to manage your cognitive difficulties. Because depression gives people a negative view of the world, you are also likely to view your cognitive difficulties as worse than they are and underestimate the effectiveness of your management strategies. If you think that you may be suffering from low mood or depression, seek medical advice.

Professional Help

If your concentration problems are fairly mild, and you are just concerned with slips at work, then your health professional is likely to work on tasks that mimic the work situation. For example, if you need to read insurance policies at work, the therapist may arrange for old, anonymous policies to have errors or rogue words typed in at intervals. You will then read the documents, attempting to spot the errors, using various strategies. By measuring how well you do, the therapist can assess how effective a strategy is.

If your concentration problems are more severe, for example it is hard for you to follow a conversation that contains important information about your health, more factors will be taken into account. It is likely that key situations will be identified with you by your health professional. These will be individually targeted using a combination of strategies.

MS Trust Publications

Cognition Factsheet

This factsheet describes the range of cognitive problems that can occur with MS difficulties with short-term memory, concentration, verbal fluency - and discusses ways to approach managing the various problems.

Cognition problems chatroom Transcript

Transcript of an open forum chatroom where issues raised about cognitive problems are answered by health professionals. The views expressed by participants are not necessarily those of the MS Trust.

More general information about MS

MS explained

MS Explained is a book for anyone who wants to understand the mechanisms of MS and what is causes symptoms to occur.

It describes the immune system and the central nervous system and then explains how MS is thought to cause them to malfunction and the symptoms that result.

MS: what does it mean for me?

If you have recently been diagnosed with MS, you will almost certainly have a number of questions about how it will affect your life.

In our experience, one of the best ways of learning to adjust to your new circumstances is to have access to clear and accurate information. This booklet provides a practical introduction to MS to help you to maintain a positive attitude to managing your MS.

At work with MS

The book considers some of the ways in which MS might affect work, the protection afforded under the Disability Discrimination Act and what adjustments can be made for a successful working life with MS.

Tips for living With MS

A compilation of nearly 150 useful ideas sent in by people with MS. The book contains practical suggestions on saving time and energy, getting around, making the most of benefits and getting equipped and more. There is also an extensive section of contact details for useful organisations.

Living with fatigue

Fatigue is one of the commonest symptoms of MS and can have a major impact on daily life. Living With Fatigue was written in conjunction with an MS specialist occupational therapist and illustrated with comments by people with MS who know what it is like to live with the symptom.

Open Door

Quarterly newsletter that contains articles news and research relevant to people living with MS and their families.

Practical management of cognitive impairments associated with MS

Patrick Carroll, Clinical Specialist Occupational Therapist, Gosport War Memorial Hospital, Gosport Way Ahead 2004;8(2):4-5.

Involving Family and Friends

Problems with attention can have subtle effects which wear away at communication and intimacy. You may have become aware of attention or concentration difficulties through not understanding information, or finding it hard to follow a TV soap. These difficulties will not be obvious to the people around you. Once they understand that this is part of your MS, they are likely to want to help. They can do this easily by:

having important discussions at the best part of the day for you.
speaking slowly and summarising the content of spoken information.
checking your understanding of what has been said
being part of important conversations, to help you and be a back-up for the information

Once you and your family are working together to overcome concentration problems, you can:

start to identify when lapses occur
work out what could be dome to make things easier in that or similar situations
implement the new technique

Research

Cognitive difficulties

Concentration and attention difficulties are the most likely problems to show on clinical tests of cognition. The more demanding the task (the more processing resources required), the more likely that someone with MS will have trouble.

Rehabilitation

Several studies have investigated the effect of computer training programmes on attention and concentration and most have not demonstrated an improvement. However, one study identified which type of attention was weakest for each person (selective attention, divided attention, vigilance, or alertness). The weakest type of attention was then trained by computer programme. The type of attention that had been trained improved, whilst the untrained types of attention did not improve for the individuals participating.