Expert Tips for Managing Word Retrieval Problems (aka Tip of the Tongue Phenomenon) in MS

At one time or another, pretty much everyone has difficulty trying to find a word while speaking. But for many people with multiple sclerosis (MS), this happens frequently — and it can be one of the more frustrating cognitive issues linked to MS.

While there isn't a simple fix for word retrieval problems in MS, a variety of strategies can help you deal with the practical and emotional challenges that may occur. Sometimes, treating issues that contribute to your cognitive challenges can even help improve your word finding.

Here are some tips for dealing with word retrieval problems related to MS.

What Causes Word Retrieval Problems in MS?

While experts are still learning about the causes of word retrieval problems in MS, there doesn’t seem to be any single brain process that explains what’s happening.

“With word finding, multiple areas of the brain work together to produce the word you want to say,” says Laura Hancock, PhD, a neuropsychologist at the Mellen Center for Multiple Sclerosis at Cleveland Clinic in Ohio.

According to Dr. Hancock, finding a word involves cognitive processes as varied as visualizing objects or situations, retrieving stored information about words and sounds, initiating speech, and the motor (muscle movement) aspects of speech. When word finding is delayed, “It could be any one of those places where the breakdown is happening,” she says.

In many people with MS, word-finding challenges are related to processing speed in the brain. “A lot of times the words are there, but the brain isn’t pulling the information as quickly as it should,” says Meghan Beier, PhD, a rehabilitation neuropsychologist who specializes in MS at the Rowan Center for Behavioral Medicine in Towson, Maryland.

Often, Dr. Beier says, slowed processing speed leads to pauses in speech and the “tip of the tongue” phenomenon in which you feel close to finding a word but can’t find it.

Word finding and other cognitive challenges in MS can be worsened by certain factors, says Lyana Frantz, a speech-language pathologist at Johns Hopkins Medicine in Columbia, Maryland:

• Fatigue
• Sleep difficulties
• Medication side effects
• Depression or anxiety

Frantz says that once difficulties with word finding begin, “A lot of times, people say that they start communicating less to avoid those issues,” potentially making the problem worse by reducing the everyday practice in conversation that most people get.

Experts Who Can Help

If you’re having word retrieval problems due to MS, there are experts who can help you navigate this problem.

In MS, “For most cognitive symptoms, the best tool we have is cognitive rehabilitation,” says Hancock, or therapy to help deal with problems related to thinking and memory. A number of different medical professionals can offer this therapy, depending on your needs:

• Speech-language pathologist (SLP or speech therapist)
• Neuropsychologist
• Rehabilitation psychologist
• Occupational therapist (OT)

“As a neuropsychologist, I often will work with people on cognitive rehabilitation strategies,” says Beier. That typically means offering tests and assessments to figure out what areas could benefit from therapy, and making referrals as needed.

“We often do verbal fluency tests, which is asking people to produce words very quickly,” Beier says. If these tests show word retrieval problems, “I would refer to speech therapy. They really are the experts, and they have lots of great tools to help people compensate and improve their cognitive functioning.”

Beier says she might hesitate to refer someone to speech therapy in certain situations, such as if they have another treatable medical condition that could be contributing to their cognitive issues — including depression or anxiety. “So I might have those things addressed first, then we might redo testing,” she says.

Frantz says that when patients with MS are referred to her for speech therapy, the first step is typically to give standardized assessments that look at cognitive function. To assess word retrieval, “That would be describing or naming pictures, or we try to replicate communication scenarios and see if people can retrieve words in a conversation.”

Techniques to Try on Your Own

While getting assessments and help from experts can be invaluable, there are also strategies you can try on your own if you’re having trouble with word retrieval.

Hancock suggests the following techniques for trying to remember a word.

• Talk around it. Discuss or think about characteristics of the word or thing you’re trying to remember.
• Visualize it. Try to think of the starting letter, or how long the word is.
• Think of a synonym. Another word with a similar meaning could lead to the word you’re looking for.
• Take your time. Don’t feel rushed — give your brain time to think of the word.
• Steer the conversation away. It’s okay to move on to something else, and say you’ll come back to the word later if you think of it.

It may also be a good idea to prioritize one-on-one or small group conversations in quiet environments. “Where I hear the most challenges are things like being in a loud restaurant with a large group of people,” says Beier. “It can be really cognitively fatiguing.”

Basic lifestyle measures can also help maximize your cognitive health, which is something that Frantz discusses with her patients. “We address things like proper nutrition and hydration, sleep hygiene, exercise, exercising your brain, and stress management techniques,” she says.

Coping With the Emotional Impact of Tip-of-the-Tongue Phenomenon

If you struggle with word finding, you’re not alone — this is a common issue among people with MS. “When I’m asking about symptoms and changes, almost all of them will say they have trouble finding the right word when they’re speaking,” says Hancock.

Still, word retrieval problems can take an emotional toll, whether they happen around coworkers or loved ones. But how you think about these issues when they occur can affect how you feel about them.

Hancock suggests keeping the following thoughts in mind.

• It probably bothers you more than others. Other people may not see your word finding issues as a distraction or major difficulty. “Sometimes our own perception of how we’re performing cognitively can be a bit skewed,” says Hancock.
• It’s not a crisis. Trouble with word finding is just something that happens sometimes, and many people know the feeling. Remember that the word will come eventually, or you can just move on.
• It doesn’t determine your worth. Your value as a human being “is not related to your ability to come up with a word, or any other cognitive symptom,” says Hancock.

In some cases, Beier says, your emotional response to word finding can even affect the problem itself. “Emotion regulation has a big impact on improving cognition,” she says, adding that mindfulness exercises may help you stay calm when you can’t think of a word.

Above all, be kind to yourself when you can’t think of a word. “Sometimes we have to practice giving ourselves grace and understanding,” says Hancock.