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Cognitive Changes and Multiple Sclerosis

Cognition refers to a range of high-level brain functions, including your ability to:
  • Learn and remember information
  • Process incoming information
  • Organize, plan, problem-solve and make decisions
  • Focus, maintain and shift attention
  • Act on information and communicate it to others
  • Find words
  • Relate visual information to the space around you (accurately perceiving your environment)
  • Perform calculations
Cognitive changes can be the first symptom of MS and over half of people living with MS experience some cognitive function change.For most people, the changes are mild, only involving one or two areas of cognitive functioning. For fewer people with MS, the changes in cognitive function will be more challenging, interfering with work or school performance. Either way, a number of strategies and treatments exist to help you manage.

Relationship Between MS and Cognition 

Cognitive changes are caused by lesions on the brain and brain atrophy, which is a loss of brain cells and connections between brain cells and brain shrinkage. The changes you experience will depend on the number of lesions and the location of the lesions on the brain, as well as the amount of brain atrophy.Cognitive changes:
  • Can happen with any disease course but are more common in progressive MS.
  • Are usually mild and generally progress slowly but can become more challenging over time.
  • Are unrelated to the degree of physical disability. You may have significant physical limitations with no cognitive issues or you may have significant cognitive limitations with no physical limitations.
  • Can lead you to leave the workforce early.
  • Can affect self-esteem, interfere with communication and impact relationships.
  • Are more likely to occur during an exacerbation.

Early Recognition of MS Cognitive Challenges

Early detection, assessment and treatment of cognitive changes are important. These changes can significantly affect your quality of life, relationships, activities and work performance. The first signs of cognitive dysfunction may be subtle. You, a family member or colleague may be the first to notice.

Cognitive Health Self-Assessment

To assess your cognitive health, you might start by asking yourself the following questions:Do you feel like your thinking has gotten slower?“I feel like I have molasses in my brain.”Do you struggle to find the right word?“I hit a wall in conversation and cannot come up with the word I want to say.”Do you forget steps in everyday tasks?“I couldn’t remember if I had put detergent in the washer, so I was washing clothes twice.”Do you have trouble making simple, everyday decisions?“I really struggle to make decisions, especially when they affect others—like where my family should go for dinner.”Have you gotten negative feedback at school or work about your performance?“Sometimes I’m questioned about why I’m late or miss deadlines when I never used to.”Do you have trouble keeping up with conversations?“I get lost in conversations and get distracted by other things happening in the room.”

Talk to Your Doctor

If the statements above feel familiar to you, let your healthcare provider know. The standard neurologic exam does not detect most cognitive changes in people with MS, and your provider can perform an additional, short screening test. Those results may lead to a referral for a more comprehensive cognitive evaluation. This will help you create a management plan.Learn more about what will happen at these appointments with the video below, excerpted from the Ask an MS Expert episode "Cognitive Evaluations and Interventions."
Help is available if you experience cognitive changes due to MS.

Comprehensive Evaluation of Cognitive Functioning

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The National Multiple Sclerosis Society is proud to be a source of information on multiple sclerosis related topics. Unless otherwise indicated, the information provided is based on professional advice, published experience and expert opinion. However, the information does not constitute medical or legal advice. For specific medical advice, consult a qualified physician. For specific legal advice, consult a qualified attorney.