Overview of cognitive changes and multiple sclerosis
Cognition refers to a range of high-level brain functions including your ability to:
- Learn and remember information
- Organize, plan and problem-solve
- Focus, maintain and shift attention
- Understand and use language
- Accurately perceive the environment
- Perform calculations
A change in cognitive function — that is, cognitive dysfunction — is common in MS. More than half of all people with MS develop problems with cognition. It may have been your first symptom of MS. MS is more likely to affect some functions than others, including:
- Information processing (dealing with information gathered by the five senses)
- Memory (acquiring, retaining and retrieving new information)
- Attention and concentration (particularly divided attention)
- Executive functions (planning and prioritizing)
- Visuospatial functions (the ability to relate visual information to the space around you)
- Verbal fluency (word-finding)
For most people, the changes in cognitive function are mild and may involve one or two areas of cognitive functioning. For fewer people with MS, the changes in cognitive function will be more challenging.
Certain functions, including general intellect, long-term (remote) memory, conversational skill and reading comprehension, are not likely to change due to MS.
If you experience changes in cognitive function, certain strategies and tools can help you function effectively. However, cognitive dysfunction is one of the major factors that make people leave their jobs sooner than expected. Rarely, cognitive dysfunction may become so severe that people can no longer function independently.
Relationship to other disease factors
Cognitive problems are weakly related to other disease characteristics. This means you may have no physical limitations and have significant cognitive impairment while someone else is quite disabled physically and unaffected cognitively.
- Changes can occur at any time — even as a first symptom of MS — but are more common later in the disease.
- Cognitive function is related to the number of lesions and the location of the lesions on the brain, as well as brain atrophy.
- Cognitive dysfunction can occur with any disease course, but is slightly more likely in progressive MS.
- Cognitive dysfunction (the first signs or new changes) is more likely during an exacerbation.
- Cognitive changes generally progress slowly. They are unlikely to improve dramatically once they have begun.
Early recognition, assessment and treatment are important because cognitive changes — along with fatigue — can significantly affect a person’s quality of life, relationships, activities and employment. The first signs of cognitive dysfunction may be subtle. You, a family member or colleague may be the first to notice. They include difficulty:
- Finding the right words
- Remembering what to do on the job or during daily routines at home
- Making decisions or showing poor judgment
- Keeping up with tasks or conversations
- With job performance, which may result in either informal or formal disciplinary action
- With school performance, which may result in falling grades and social challenges
Research shows the importance of cognitive screening for people with MS. It is one of the most common MS symptoms. The National Multiple Sclerosis Society gathered healthcare providers, researchers and individuals affected by MS to review the scientific literature and make recommendations about how to manage cognitive symptoms. They advised:
- Education for people with MS and their family members
- Early screening and ongoing monitoring throughout the disease course
- Comprehensive evaluation for any adult or child who tests positive for dysfunction in the initial screening or demonstrates a significant cognitive decline
- Comprehensive evaluation for any individual who is applying for disability insurance due to cognitive impairment
- Interventions to improve cognitive functioning and participation in everyday activities
Concerned about cognitive dysfunction and your MS?
Talk to your healthcare provider. They will likely perform a short screening test. Those results may lead to a referral for a more comprehensive cognitive evaluation. A specially trained health professional (neuropsychologist, speech/language pathologist or occupational therapist) will evaluate your cognitive function using a series of tests to carefully evaluate all areas of cognitive function. Testing can take several hours. But this careful evaluation is needed to learn what specific cognitive functions are affected. It also helps sort out other possible causes of cognitive problems, such as medications, fatigue and changes in mood, including depression, anxiety or stress.
What can you do to improve your cognitive function?
Based on the cognitive test results, your provider may recommend a cognitive rehabilitation plan. Cognitive rehabilitation includes a combination of activities to restore losses and use strengths to compensate for them.
Restorative activities can include learning and memory exercises or strategies, such as:
Compensatory activities that help make up for functions that are no longer working well may include:
- Combine modes of learning: You will be more likely to remember something if you “see it, say it, hear it, write it, do it.” It’s okay to give yourself extra time.
- Repeat and verify: Say what you hear and make sure it is correct to improve your attention and memory.
- Spaced rehearsal: Repeat and practice information at intervals spread out over time to improve your ability to store information.
- Build associations: Use memory aids! For example, to remember the name of someone you just met, associate it with a friend or family member of the same name, or with a place, color or event that sounds like it.
- Consolidate and centralize: Designate one place in your home as information “Grand Central.” Include your master calendar, mail, bills, phone messages, keys, wallet and to-do and shopping lists.
- Plan. Post a calendar large enough to display everyone’s appointments, activities, social engagements and reminders. Keep pens or markers hanging right beside it. Or use a computer program set up with reminders for routine tasks. (Synchronize it with your mobile devices so you have your appointments with you while on the go.)
- Record. Dictate your to-do list, notes or other information to remember on a digital voice recorder (available on many phones).
- Remind. Use checklists, the alarm on your watch or phone, your kitchen timer and more.
- Eliminate or remove yourself from distractions. Turn off the TV, music and whatever else is “on” when speaking with someone in person or on the phone. Background visual and noise distractions can make learning or remembering more difficult. If you can’t eliminate the distraction (for example, people talking at a party) then ask, “Can we talk in a quieter place?”
- Take a break. If you are having difficulty concentrating, take a breath and refresh.
- Do one thing at a time. Avoid switching back and forth from one topic or task to another. Finish what you’re working on or find an appropriate stopping place before switching to something else.
Scientists are trying to identify ways to stabilize or improve cognitive dysfunction. Disease-modifying drugs have all been shown to reduce the accumulation of new demyelinating lesions. For this reason, it is likely that they help stabilize cognitive changes. However, more studies are needed to determine their effectiveness in this area.
The treatment of symptoms may temporarily improve cognitive functioning without changing its long-term course. Studies of some central nervous system stimulants have shown that they may be helpful for attention, processing speed and memory problems.
Studies funded by the Society are investigating the natural history of cognitive changes and seeking better ways of diagnosing and treating cognitive problems in MS. Hopefully, in the future, people with MS will have access to a combination of disease-modifying therapies, treatments of symptoms and cognitive rehabilitation that will modify the course and impact of the cognitive changes in MS.
More information on cognition
Learn more about cognitive changes and MS with the resources below.