Cognitive changes can occur with multiple sclerosis (MS), which may affect memory, learning, and the ability to carry out some everyday tasks.

Cognition refers to how people receive and process information.

It includes memory, reasoning, decision-making, and attention.

MS can cause certain cognitive changes, which may affect how people are able to function day to day.

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According to the Multiple Sclerosis International Federation, around half of people with MS may experience cognitive changes to varying degrees. The cognitive changes people can experience with MS may affect:

  • memory
  • concentration and attention
  • word-finding
  • information processing speed
  • problem-solving and abstract thinking
  • visual-spatial skills, which people use to gauge the spaces around them
  • executive functions, which include planning and working toward goals

Learn more about MS here.

According to a 2019 review, experts are not clear on the exact cause of cognitive changes in MS.

Research has found changes in the white and gray matter of the brain in people with MS. However, there is not a clear link between structural damage that doctors detect through MRI scans and symptoms of cognitive dysfunction.

According to the National Multiple Sclerosis Society, cognitive dysfunction in MS may cause difficulty in the following areas:

  • processing information from the five senses
  • memory, including processing, retaining, and retrieving new information
  • concentration and attention
  • planning, prioritizing, and other executive functions
  • being able to relate visual information to surrounding spaces
  • finding words

MS may only affect a few areas of cognitive function, and the changes can be mild. For other people, cognitive dysfunction may be more severe but is unlikely to affect their independence.

MS is not likely to affect the following areas:

At first, any cognitive changes may be subtle. People can experience the following:

  • difficulty finding the right words
  • poor judgment or difficulty making decisions
  • reduced performance at work or school, which may lead to disciplinary action or falling grades
  • difficulty keeping up with or remembering how to carry out tasks at work, school, or home
  • difficulty following conversations

Learn more about how MS affects the body here.

According to a 2019 review, early cognitive testing is important in people with MS to detect changes early and begin interventions.

Standard neurological testing may not be able to detect early cognitive changes, so early screening with appropriate evaluation is important.

Doctors carry out a range of tests to evaluate verbal and language skills, memory, and processing speed.

The review suggests the following tests for evaluating cognitive changes in MS:

  • symbol digit modalities test (SDMT) to assess visual processing speed
  • selective reminding test (SRT) and California Verbal Learning Test for assessing memory
  • spatial recall test (SPART) for assessing visual-spatial abilities
  • recognition tests to measure social cognition, such as the Reading the Mind in the Eyes test and Faces test

The National Multiple Sclerosis Society and experts on MS advise:

  • early screening for cognitive changes and ongoing monitoring
  • a comprehensive evaluation for any person with MS who has cognitive dysfunction present in initial screenings, who shows signs of significant cognitive changes, or who is applying for disability benefits due to cognitive dysfunction
  • education on cognitive dysfunction for people with MS and their families
  • early interventions to improve cognitive function and the ability to carry out everyday tasks

A healthcare professional can help people manage cognitive changes and advise a rehabilitation plan.

This may include learning and memory strategies, such as multiple ways of remembering something, for example, writing something down, hearing it, and seeing a visual reminder. It may also include repetition and associations to help aid memory.

Other tips to help people deal with cognitive challenges include:

  • Keep all important information, documents, or objects in one place, such as keeping keys, bills, and mail in one central place in the home.
  • Use planners, calendars, or apps to write down all appointments, schedules, and important deadlines.
  • Use a voice recorder on a phone or computer to record to-do lists or important information to listen back to.
  • Use checklists, alarms, and timers to help stay on track.
  • Reduce any distractions by working in quiet places and turning off background music or the TV.
  • Take a break to refresh whenever concentrating becomes difficult.
  • Focus on one thing at a time and avoid switching back and forth between tasks.
  • Get adequate rest, as fatigue and brain fog can contribute to cognitive challenges in MS.
  • Exercise regularly to allow the mind to wander and take a break from focusing on cognitive tasks.

If people with MS experience symptoms of cognitive changes or have concerns about cognitive dysfunction, they can contact a doctor.

A doctor may carry out an initial screening, which they can follow up with further testing depending on the results.

The doctor may refer people to a specialist in cognitive issues, such as a neuropsychologist or an occupational therapist.

A specialist will thoroughly evaluate a person’s cognitive function with a range of tests to find out which areas of cognitive function MS is affecting.

A doctor will also look at any other possible causes of cognitive changes, such as medications or mental health issues, including depression, anxiety, or stress.

Learn about occupational therapy for MS here.

Research is still investigating the best ways to manage cognitive dysfunction in MS. Certain disease-modifying drugs may be helpful in managing MS and cognitive symptoms.

Doctors may also recommend some central nervous system stimulants, which can help improve memory, attention, and processing speed.

Certain drugs, such as donepezil, help improve cognition and symptoms in some cases.

Cognitive changes may affect around half of all people with MS. Cognitive changes in MS include difficulties with memory, attention, word-finding, and executive functions.

Healthcare professionals can carry out thorough evaluations to assess cognitive function and will suggest rehabilitation steps.

Memory and learning strategies and certain medications may help people manage cognitive dysfunction.