Cognitive problems, like difficulties processing information,
concentrating, organizing, remembering, and/or finding words when
speaking, affect more than 50 percent of people with
multiple sclerosis (MS). In fact, you may be surprised to learn that such cognitive deficits may be a person's first MS symptom.
Additionally, while a person's cognitive dysfunction is connected to
the number of brain lesions they have on their MRI, it's not connected
to their physical abilities. In other words, a person may be unable to
walk and yet have no cognitive problems. On the flip side, a person may
not be able to work due to thinking and memory problems, but have only
minor (or no) physical disabilities.
Due to the elusive and complex nature of cognition dysfunction in MS, and the fact that people adopt
compensatory techniques
to overcome their personal deficits (which is great), it's often tricky
determining if (or how much of) your cognition is affected by MS.
The good news is that besides undergoing a battery of tests with a
neuropsychologist, research now suggests your handwriting may provide
some insight into your cognition—a window into your brain power, so to
speak.
Research on Handwriting and Cognition in MS
In a
study in
Scientific Reports, the handwriting of 19 people with
progressive multiple sclerosis was
compared to the handwriting of 22 healthy people of the same age. All
of the participants wrote a specific sentence on a digitizing tablet.
Then various handwriting parameters were compared between the two
groups.
Results revealed there was a significant difference between the two
groups when it came to sentence and word duration, as well as the
spacing between word duration. In other words, it took people with MS
longer to write each sentence.
In addition, handwriting stroke was analyzed and compared between the
two groups. The participants with progressive MS had significantly
higher stroke duration and stroke size, as well as a higher jerk. Jerk
refers to the change in acceleration over time per stroke. What this
basically means is that the writing of those with progressive MS
compared to the healthy controls was less smooth.
Lastly, using statistics, the investigators sought to determine
whether there were any links between these handwriting parameters and
clinical features of MS, like movement abilities and cognitive
function—and several were found.
Links Between MS Movement Abilities and Handwriting
Here are three links the investigators found, suggesting that
impaired movement abilities in MS affect handwriting, especially the
speed of writing.
Finger Dexterity
One test used to determine whether or not a link existed between
motor abilities and handwriting in people with MS was the nine-hole peg
test (NHPT). This test measures finger dexterity, which is the strength
and flexibility of your fingers.
During the NHPT, a person is timed on how long it takes them to place
nine pegs in nine small holes—so the longer it takes to place the pegs
in the holes, the less dexterous their fingers are.
In this study, the investigators found that the longer it took for
the participants with MS to complete the nine-hole peg test (NHPT), the
longer it also took to write their sentence.
Grip Strength
The investigators found that in the participants with MS, the
stronger their grip strength was, the faster they could write the
sentence.
Weakness
There was a positive association found between perceived weakness and
the time it took to finish one work and move to the next. In other
words, the weaker a person feels, the longer the "break" time between
writing words.
Link Between MS Cognitive Abilities and Handwriting
In terms of links to cognition, for the people with MS, the time it
took to write the sentence increased with the decrease symbol digital
modality test (SDMT) score.
The SDMT is a screening test used to sometimes measure cognitive
impairments in MS. More specifically, this test evaluates information
processing speed. Research suggests information processing speed is the
most common cognitive deficit seen in MS, as well as the first one to
emerge.
The fact that a link exists between SDMT score and sentence duration
implies that handwriting is not simply an act of movement, but rather
also tied to cognition.
The bottom line is that based on this study, a decline in cognition (as seen in MS) impacts handwriting skills.
More on MS-Related Cognitive Dysfunction and Handwriting
While we know handwriting problems are common in MS (prior research
has revealed that people with MS are slower to write, and their writing
overall is more irregular), the influence of a person's cognitive status
on handwriting had not been previously explored. With this newfound
link, it's possible that handwriting analysis could offer insight into a
person's cognitive function.
This all said, it's important to remember that cognitive changes are
commonly influenced by others issues like depression, anxiety, fatigue,
stress, and medication. So teasing out and treating your cognitive
deficits can be tricky, especially since some factors are reversible
(for example,
depression) whereas others are irreversible (for example, if your cognitive problems are from MS itself).
Finally, cognition is a broad term. With that, a person with MS may
experience only one cognitive problem (like with processing information)
while another person with MS may experience multiple cognitive problems
(like with memory, information processing, and concentrating).
What this means is that a person may still have cognitive deficits
and have "normal" handwriting. The reverse is true, too, as there are
also other causes of deteriorating handwriting besides MS, like
Parkinson's or certain psychiatric disorders like schizophrenia.
A Word From Verywell
If you are concerned about your cognitive abilities (or your loved one's), please speak with your
neurologist.
Through cognitive rehabilitation, you can learn and practice
techniques that can help you remember, plan, and think more easily.
These techniques can also dramatically help improve your daily
functioning and happiness.
