New Research Shows Link Between Sleep and Thinking Problems in People with MS

 A recent study showed that sleep problems and thinking (cognitive) problems occurred significantly more frequently in nurses with MS than in nurses who didn’t have MS, and these issues were linked. This means that sleep problems, which are common in MS, may be a factor in the development of cognitive problems. Sleep disorders are treatable (see below). Whether improving sleep can improve cognitive function as well has yet to be determined.

• Background: Sleep difficulties are more common in people with MS than in the general population. In addition, many people with MS develop problems with cognitive function, including information processing and memory. A team from the University of Michigan investigated whether sleep problems contribute to cognitive problems in people with MS.
• This Study: Investigators looked at questionnaires completed by 63,866 nurses (524 of with MS) enrolled in the Nurses’ Health Study. This ongoing study uses questionnaires to track chronic conditions and risk factors for chronic conditions in women nurses. Participants had been asked about diagnosed/suspected sleep disorders and daytime sleepiness. They also had been asked whether they had difficulties with memory, or with cognitive tasks such as following instructions or navigating familiar streets.
• Results: Sleep disorders, sleepiness, and cognitive problems were significantly more common in nurses with MS than in those without MS. Using advanced statistical methods, the group showed that the occurrence of sleep disorders and sleepiness were significantly associated with the development of cognitive impairment.
• The Meaning: Sleep problems and cognitive problems affect many people with MS. This study shows a possible connection, meaning that sleep disorders or excessive sleepiness may be leading to cognitive problems. Further study can help to determine if this is the case. This is important because sleep disorders are treatable. Research in people who do not have MS is starting to show that treatment for some sleep disorders may improve cognition, so there is hope that this may also be true for people living with MS.

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“Pathways between multiple sclerosis, sleep disorders, and cognitive function: Longitudinal
findings from The Nurses’ Health Study,” by Tiffany J Braley , Monica M Shieu, Afsara B. Zaheed and Galit Levi Dunietz, is published in the MS Journal (published online January 12, 2023),
 

New Guideline from the American Academy of Neurology

The American Academy of Neurology, an association of neurologists and neuroscientists dedicated to promoting high-quality care for people with nervous system disorders, has released a guideline on the use of complementary and alternative medicine (CAM) in MS. The guideline was created by a panel of medical experts who evaluated all available published research studies. Through a comprehensive process, the panel carefully assessed the outcomes of relevant research studies, and also whether study findings could be generalized to the larger population of people with MS, and whether any safety concerns should be considered by physicians and patients who might use these treatments.
The widespread use of CAM by people with MS highlights the unmet need for more research and better therapies that will help people with MS live their best lives. Summaries of the guideline are available for patients and for clinicians.
Specific Guideline Information
Among studies of several forms of marijuana and its derivatives that were evaluated by the panel, the guideline reports that evidence suggests that:

• Oral cannabis extract and synthetic THC (tetrahydrocannabinol, a major active component of marijuana) are effective for reducing patient-reported spasticity and pain, but not MS-related tremor or spasticity measured by tests administered by the physician;
• Sativex oral spray (GW Pharmaceuticals) is effective for improving patient-reported spasticity, pain, and urinary frequency, but not bladder incontinence, MS-related tremor or spasticity measured by tests administered by the physician;
• Smoked marijuana research studies have not produced enough evidence to assess its safety or effectiveness for treating MS symptoms including spasticity, pain, balance, posture, and cognition.

Oral cannabis extract, THC and Sativex are not currently approved by the FDA for use by people with MS. The guideline notes that, as with any therapy, along with potential benefits come potential side effects, and for these cannabis derivatives the most commonly reported side effects were dizziness, drowsiness, difficulty concentrating and memory disturbance.
The guideline also points out that the long-term safety of marijuana use for MS symptom management is not yet known.
Read about the National MS Society’s position statement and more about the use of marijuana for MS symptoms.
Among other CAM therapy studies in MS evaluated by the panel, the available research evidence suggested that:

• ginkgo biloba is ineffective for improving cognitive function, but might reduce fatigue;
• magnetic therapy might reduce fatigue;
• reflexology might help ease unusual skin sensations such as tingling, but there is insufficient evidence to evaluate its potential for treating pain, fatigue, and other symptoms;
• the use of omega-3 fatty acids with low-fat diet to reduce relapses or disability, or improving quality of life is not supported by current evidence.

The guideline includes a table of all of the CAM therapies that were evaluated. For many of these, the panel concluded that there was not enough evidence from research studies to advise as to their effectiveness in treating MS or its symptoms. The guideline also indicates that there is little known about how CAM therapies interact in the body with each other or with disease-modifying therapies that individuals may be taking. The effects and side effects reported from non-MS studies were not evaluated.
While many people with MS report that they experience benefits from CAM therapies, this guideline confirms the need for more research to demonstrate the effectiveness of these treatment strategies. The National MS Society is committed to ensuring that no opportunity is wasted in our mission to stop MS progression, restore function lost to MS, and end MS forever so that people with MS can live their best lives. We have supported, and will continue to support, CAM research and will continue to advocate for additional government funding for CAM research.

Thinking Problems in People With Multiple Sclerosis

When you've got multiple sclerosis, losing your keys or forgetting a name can be scary. You wonder whether the illness is clouding your thinking.
It's true that over time, about half of people with MS can have some cognitive problems. That means poor focus, slowed thinking, or a fuzzy memory.
Often these problems are mild and don't really interrupt your daily life. It's pretty rare to have severe thinking problems. They affect about 5% to 10% of people with MS.

Signs of Impaired Thinking in MS

The clues that you have fuzzy thinking due to MS are often subtle. You might not notice them until a friend, co-worker, or family member points them out. You may:

• Struggle to find the right words to say
• Forget things you need to do or tasks already done
• Find it hard to plan or set priorities
• Have trouble concentrating, especially when two things are happening at once

MS usually does not hurt your intelligence or long-term memory. It won't change your ability to read or carry on a conversation.

Tests and Diagnosis for Impaired Thinking

If you suspect impaired thinking, talk with your neurologist or family doctor. Fuzzy thinking can have many causes.
Your doctor can make sure your problems don't come from normal aging or drugs that may cause confusion, depression, anxiety, or fatigue.
Once you have any health problems fully treated, the next step is usually testing. Your doctor may refer you to a neuropsychologist, speech pathologist, or occupational therapist.

MS and Rehab for Your Brain

If test results show that MS is to blame for spotty memory or poor mental focus, you may want to try rehab to sharpen your thinking. It can include:

• Memory exercises on a computer
• Home or work strategies with notebooks, organizers, or filing systems to help you remember things

It’s possible, but rare, that thinking problems become so severe that someone with MS needs constant care or can't live on their own. If this becomes an issue, discuss your options with your doctor and family. A social worker or psychologist also can help explore options for care.

Can Medicine Help?

Scientists are doing studies to see whether the drugs that slow the nerve damage in MS -- called disease-modifying medicines -- can help with thinking problems, too.
Others are looking at treatments, such as Alzheimer’s medications, that may temporarily improve your memory and focus. Ask your doctor to give you updates on any promising results.

From www.WebMD.com