Multiple Sclerosis from Both Sides of the Desk

Here’s an example of cognitive functioning that goes on many people's lives:

You are eating breakfast when your wife tells you that she has a meeting this afternoon and the kids need to be picked up from school. You ask what time they need to picked up at and your spouse says 3 o’clock. You think about your schedule for the day. You remember that you have a hair appointment at the same time. You say to yourself that you have to change the time of your appointment. You make a mental note to call and re-schedule your appointment when you get to work. You know that the school is on the way home from the hair place so if you can get an earlier appointment you’ll be able to pick up the kids after the haircut. You tell your wife, “No worries. I’ll pick them up.” You kiss her, finish your breakfast and the leave for work.

When you get to work, you call your hair stylist and move the appointment up to 2:15 pm. The day moves on. At 2 o’clock to go for your appointment. You get your haircut. You look fantastic. You pay your bill. You pick up the kids. They comment on how great your hair looks. You return home. Life is good.

The spheres of cognition used in this example include attention (being able to focus on what your spouse is telling you), short term memory (taking in new data), long term memory (recalling known data), visual spatial (understanding the spatial relationship of items), executive functioning (making a decision about what to do with the data), verbal (communicating data through speech) and processing speed (doing all these things in a timely fashion).

In the mind of the person with MS, the same situation commonly follows a slightly different course:

“Honey. I have a meeting today. Can you pick up the kids from school at 3 o’clock?”

“What?” you ask as your MS brain tries to focus on not pouring salt into your coffee like you have done every day since your beautiful wife bought new salt and sugar holders.

“Can you pick up the kids today for me?”

“Yeah. I guess.”

“Thanks,” she says and turns toward the door.

“From where?” you ask.

“School.”

“What time?”

“3 o’clock,” she answers with disappointment in her voice. You notice that she is unhappy and you try to cover up by saying, “Of course! I know they are at school but I just thought maybe they had an after-school thing going on.” She has heard this before so then she asks, “Do you want to put it in your PDA?” “No,” you reply. “I can remember the kids!” She leaves and you finish your breakfast, proud that you avoided the sugar/salt coffee conflict. As you get cleaned up, you notice your hair is long and remember that you have a hair cut appointment today. You say to yourself that you can’t miss that appointment. The day goes on and the PDA alarm that you set when you made the haircut appointment goes off saying you have a haircut appointment at 3 o’clock.

It’s not until you are halfway through your haircut, when your stylist asks how your kids are doing, that you remember that you were supposed to pick them up at 3pm. You look at your watch and see that it is 3:27 pm. You start to pull the hairdressing gown off as you get up and tell the hairdresser that you have to go. You rush out to your car and drive rapidly to the school to get the kids but when you get there they are gone. You then call your wife who says that she called her friend to pick them up when the school called her and said no one was there to pick up the kids. She goes on to say that she had called you first but your phone had gone to message so she called her friend.

In this example, we see deficits in attention (being distracted by the salt-sugar coffee confusion), immediate memory (not paying attention prevents normal memory tracks from being laid down), remote memory (forgetting about the hair appointment until seeing long hair in the mirror) and executive functioning (running out of the hair salon right away without thinking about the best way to find out what has happened to the kids.) 

The fact that you are walking around with a haircutting gown wrapped around your leg and half a haircut, while inconsequential in comparison with the welfare of your children, compounds the pathos of the situation.