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What Causes Cognitive Dysfunction?

What Causes Cognitive Dysfunction?

Everyone living with MS knows that mobility challenges are just a small part of the challenges we face, even though they tend to get the most publicity. Multiple sclerosis also causes many invisible symptoms that many of us are all too familiar with including (but certainly not limited to) difficulty thinking, or cognitive dysfunction.

Our identities are often defined by our cognition

Our identities are often defined by our cognition. Cognition is the way we think, create, make plans, solve problems, make decisions, learn new things, and make memories. Fatigue and cognitive issues, not physical disability, are the biggest predictors of whether someone with MS will be able to continue working, or function independently at home. We can give you assistive devices to overcome your mobility challenges, but it is much more difficult to maintain employment or be a parent if you have difficulty multi-tasking or with retaining new information. Cognitive symptoms are particularly tricky to identify and treat because they may present differently in each person, and often the root cause of symptoms is complicated. That is why I teamed up with MultipleSclerosis.net to create this series, which will talk more about what cognition is, how we can better understand individual symptoms, and treatment options.

How MS affects cognition

Cognition is defined as our ability to think and perform. More than 65% of people with MS have difficulty with cognition during their lifetimes, making it one of the most common MS symptoms. The good news is that MS does not affect your overall intelligence, or long term memory. The most common cognitive symptoms in people living with MS include trouble with short term memory, attention, multi-tasking, word finding, and “executive functions” which include planning, prioritizing, and organizing. Cognitive decline generally occurs slowly over a long period of time, and while it is more common in progressive forms of MS, impairment can also occur at any point, including in the early stages of MS.

MS can directly impair cognition

MS can directly impair cognition in a few ways. During a relapse, or other extenuating circumstances (such as pain, illness, or being overheated) a sudden increase in fatigue and cognitive difficulties are common and even expected. When your body is in crisis mode your brain is distracted, and it has more difficulty thinking and performing normally. In these instances you should see your cognition improve as you recover, or get your pain under control. MS also causes the brain to atrophy, or shrink, at a faster rate which is associated with permanent cognitive dysfunction. It is difficult to track atrophy, but your neurologist will rely on your regular MRIs to show them whether you have significant atrophy. This is one reason why it is crucial to have regular MRIs to track your MS progression.

Other causes of cognitive dysfunction

While MS can directly lead to cognitive dysfunction, there are a lot of other factors to consider. In neurology we have a saying, “Treat the body right, and the mind will follow”. This basically means that when the body is struggling, the mind is too, and in MS we often see the consequences of this. When you are extremely fatigued, sick, sleep deprived, struggling to walk, or overheated it is very common to have cognitive symptoms at the same time. In those instances the brain is expending a lot of energy into a task that is normally second nature. If we find ways to help you manage fatigue, get better sleep, or preserve energy by using assistive mobility devices your brain will have more energy to think, and subsequently perform better. Sometimes just knowing that you have trouble doing a physical and cognitive task simultaneously (also called dual tasking), you can compensate. For instance, you can let your friend know that you would love to continue your lively conversation while sitting on that bench over there, because you are more likely to fall if you try to walk and talk at the same time.

Mental health

Mental health and cognition also go hand in hand. If a patient comes to me and says they have been struggling to remember things, the first thing I assess is their mood. Depression is one of the most common causes of cognitive dysfunction, and it is often overlooked because people do not realize they are depressed. We have been taught that depression means crying all the time, or feeling really blue. However, depression most often manifests as a disinterest in activities you used to enjoy, or a general lack of motivation. Anxiety also causes us to have trouble thinking through stressful situations, and can lead to trouble falling and/or staying asleep which leads to more fatigue and cognitive fogginess (often referred to as cog-fog). Treating depression and anxiety can significantly improve cognition, and a lot of my patients are shocked at what a difference it can make!

Medications

Medications can also either help or hurt cognition. Many of the medications that we use to control pain and muscle spasticity can make you tired, and worsen cog-fog. If your cognition seems to be worse than usual, mention it to your healthcare provider and see if your medications could be contributing. Often we can adjust dosages, or the timing of medications throughout the day to lessen the impact of side effects.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The MultipleSclerosis.net team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

  1. Doe N, Takahashi T, Kiriyama M. Behavioral Despair during a Water Maze Learning Task in Mice. Experimental Animals. 2010;59(2):191-197. doi:10.1538/expanim.59.191.
  2. Gudesblatt M, Wissemann K, Zarif M, et al. Improvement in Cognitive Function as Measured by NeuroTrax in Patients with Relapsing Multiple Sclerosis Treated with Natalizumab: A 2-Year Retrospective Analysis. CNS Drugs. 2018. doi:10.1007/s40263-018-0553-1.
  3. Comi, G., Patti, F., Rocca, M.A. et al. J Neurol (2017) 264: 2436. https://doi.org/10.1007/s00415-017-8642-5

Comments

  • Emilyjo
    4 months ago

    The cognitive defectthat my Dr says are part of the 0t perm damage due to 2ndarmy Ms now.. I’m having the hardest time with it .. I do believe that I have come from very gifted in my mind functioned as well as10. And I stayed u told truck was lapsed and onitts way. That. Goes against the “code”
    Today o no longer hold drivers lic. And I feel more like a student on a small bus to. Go to school …. It’s almost as if it happened in 2 wks or not much more
    . I don’t know 2hich day it is longer than 2 -3 minutes with total silence arondmosr others asking my opiniopm. I find my physical strent ca keep up any longe r
    . that’s driven me so my question is how do we balance about I’ve been trying and I can’t figure it out any suggestions would be great God bless you

  • mislissa1029
    12 months ago

    Thank you for this for this article. It was nice for this to show up in my email to remind me “I’m not alone.”
    So many times I struggle with the things that were once so simple. But I remember, it’s ok to ask for help and move at a slower rate.

  • Flowers For Algernon
    12 months ago

    In relation to Cognitive Impairment, Fatigue was mentioned as a correlating causality. So I thought that this may be of benefit for others as well.

    https://youtu.be/W9S-tYMy47o

  • Flowers For Algernon
    12 months ago

    This is potentially a helpful addendum to this for others. I find Dr. Boster’s information invaluable.

    https://www.youtube.com/watch?v=hH2SzmOR4_U

  • mislissa1029
    12 months ago

    Thank you for this for this article. It was nice for this to show up in my email to remind me “I’m not alone.”
    So many times I struggle with the things that were once so simple. But I remember, it’s ok to all for help and move at a slower rate.

  • collena
    12 months ago

    I explain it to my kids as “holes in my head”. As in “you can’t expect me to remember that, I got holes in my head”. True in both figurative and literal ways.

  • Flowers For Algernon
    12 months ago

    My wife and daughter actually say that about me. =)

  • @masbrautigam
    12 months ago

    Thank you for this great explanation. It’s sometimes hard to understand why.
    I find it really hard that others don’t have the understanding or patience when I’m in a conversation and get cognitive issues. They can get annoyed that I cannot follow , but I’m really trying to follow step by step but when fatigue hits its almost impossible.
    Wish there was more understanding to make us less stressed.

  • Emilyjo
    4 months ago

    The cognitive defectthat my Dr says are part of the 0t perm damage due to 2ndarmy Ms now.. I’m having the hardest time with it .. I do believe that I have come from very gifted in my mind functioned as well as10. And I stayed u told truck was lapsed and onitts way. That. Goes against the “code”
    Today o no longer hold drivers lic. And I feel more like a student on a small bus to. Go to school …. It’s almost as if it happened in 2 wks or not much more
    . I don’t know 2hich day it is longer than 2 -3 minutes with total silence arondmosr others asking my opiniopm. I find my physical strent ca keep up any longe r
    . that’s driven me so my question is how do we balance about I’ve been trying and I can’t figure it out any suggestions would be great God bless you

  • LeeAnn
    12 months ago

    I’m happy to have you as a friend.Some people have a hard time waiting for me to get out something to say. Sometimes it’s like my brain goes dead or asleep and I have to wait for it wake up. I also have ringing in the ears and sometimes it’s so loud that I can’t stand it.

  • Sonja51
    12 months ago

    This is something that has plagued me most of my life and for a very long time I didn’t know what was going on…I though it was all because of what my mom told me which was she sat on my head when she was giving birth to me. For years I thought that is why I struggled so with speaking and learning…getting through all of my school years…that she caused me a little brain damage by doing so…but no it is because I have MS. So much embarrassment I have suffered too and being poked and made fun of.:(

  • itasara
    12 months ago

    I have been reading about cognitive dysfunction In many blogs and articles, and no doubt, MS plays a big part. But I also have to add that getting older, and now I am 70+, some of the symptoms are part of the aging process. Maybe if they occur early it can be ascribed basically to MS. I am pretty sure that MS may play a part in some of my inattentiveness and difficulty finding word searches, but I know others who don’t have MS who have very similar problems because they are also in their 60s or 70s. I’ve always had some kind of an inattentive behavior even as a kid. Could this mean I have MS long before I found out at age 57? I probably did have some but maybe I just had that problem inborn as well and not having to do with MS but I don’t think we can prove these things.

  • chong61
    12 months ago

    I too had an IQ in the 140 range. I owned 2 insurance agencies and was a real estate broker. I would have put my intelligence with the best of them.

    Then along came MS and jacked with my abilities to do the least of work required. I am now 76 and my math ability is completely gone. That was my strongest suit and now to do the simplest I have to use a adding machine and then have trouble coping enough to even think I have it right.

    I would imagine some would call it getting old, but the will is still there and I get it done, just takes me forever. After losing my husband of 58 years in a matter of 5 hours I made myself come back to knowing I had to do all I could to stay in my home. I am blessed with 3 wonderful, loving children, but I have to do all I can and not rely on them unless it is a have too.

    The frustration triggers other symptoms, but I have to thank God for giving me a brain that still works, even if it is slower and frustrating.

    I do not think of myself as Old, I know I have MS.

  • Flowers For Algernon
    12 months ago

    Here is a funny one for you… Due to NDAs, ethics, etc. I can’t get into specifics, but the gig I was on when I had the episode that ended my career, was working with a consortium of hospitals to consolidate their infrastructures into an active/active stretched cluster delivering virtual desktops to all the endpoints for the users/staff. I’m not discussing my first rodeo, just the last one.

    The next time you are at your physicians, and you see them with the push carts or systems that all have Imprivata single sign on for the staff, and then log into the hosted Epic environment via Citrix to access your EMR… yeah, I did that. Don’t sweat it, I worked in numerous verticals, not just medical… lol.

    Cigna, apparently disagrees with my neurologists re: my LTD, and the amount of cognitive impairment due to the atrophy, lesions, yada yada. Playing hurry up and wait as the potential litigation wheels turn, only exacerbates my situation.

    Waiting to have Cigna play a bit more before I have the 6th District (guess where they got the desktop they are logging into or soon will be from) under ERISA provide my attorney $600K for Cigna not adhering to their legal obligation, and then cut my family a check. Apparently they don’t know liability when it is staring them in the face.

    Actually they do though, as they discontinued the LTD they had already approved once SSDI became approved. You have to love the system. I appreciate the little war of attrition. This isn’t going to go well for them.

  • Flowers For Algernon
    12 months ago

    With all due respect, it isn’t the natural aging process being discussed here. I went from having a 151 IQ, more technical credentials than you could imagine, and working for top names in the IT industry and for clients everyone here would recognize… back to the foot of the mountain again in astounding rapidity.

    I’m in my mid 40s, and apparently have had MS for many years prior to being diagnosed. Initial mental slippage was slow, and as you were asserting I had attributed to aging or the potential early onset of dementia. The last major episode I had while on a customer site (fortunately in the evening when back at the hotel) rendered me useless in my given vocation.

    At the ripe old age of 46, the cognitive impairment that MS caused by the atrophy, lesions, etc. took my livelihood, income, identity, and oh yeah… my mind. With the other side effects of MS, you can toss in my masculinity, but that isn’t the issue at hand.

  • Dawnceleste
    12 months ago

    OMG! Somebody gets it… I’ve been begging my PCP, psychiatrist and neurologist for about a year now for a neuropsych test to see where the greatest losses are for the purpose of finding out if there are any interventions. All I can tell them is I’ve gone retarded. I’ve asked each if they’ve ever read Flowers For Algernon because that’s how I feel, but no one on earth seems to know of it. Thank you so much for letting me know that it does exist in this timeline, ~verse, etc.

    Just reading your screen name made me smile and feel a bit less alone…and now I’m in tears. I too used to have a life, career etc, was a lawyer graduated from UCLA Law etc now 48 and back home w my parents who dont seem to notice how bad it is. No one does! Because of the education and vocabulary, they don’t take my word for it even though I really cant think up a more p.c. way to explain it than “I’ve gone retarded.” But it’s technically accurate too. Everything has slowed down. Auditory processing, idk what else.

    So thank you for the sign that I didn’t wholly imagine that book. I wish it was short enough to just hand to the doctors and say “Read it, this is what’s happening to me.”

  • @masbrautigam
    12 months ago

    I agree here. I am 47 and it’s not an age thing. I struggled with this for many years and have had MS for many years. It has gotten worse but not because of age but because I’ve had MS for so long.

  • cpcatchik
    12 months ago

    What a great article. The description of depression was especially enlightening as I don’t feel blue or sad but lack interest in almost everything. No happy, no anticipation, no fun. No motivation. You’ve given me something to discuss with my doctor at my check in next month. Thanks!

  • Shelby Comito moderator
    12 months ago

    Thank you for your comment @cpcatchik. I am so glad Stephanie’s article was helpful for you, and I commend you for reaching out to your doctor to discuss! We appreciate you sharing a little bit of your experience here and welcome you to do so anytime. Thinking of you, Shelby, MultipleSclerosis.net Team Member

  • baggie58
    12 months ago

    One of the best articles I’ve read for ages. Sets out very clearly the effects that cog fog has. Though I did smile when the need for regular MRIs was mentioned. I have PPMS and I’d have more of a chance of watching a pig fly past then I would of having MRIs here in the UK.

  • Tony Ayers
    12 months ago

    It’s not often I find informative information about MS. And with dyslexia, it takes a while. I found this to be short and sweet, and to the point. Living life with MS is mind blowing enough, add all the things that come with it, and it is overwhelming. Thank you for keeping it simple and to the point, and easy to understand. Even though I did have to look up some of the medical terms, that within itself I think helps my brain. Thank you.

  • Shelby Comito moderator
    12 months ago

    I’m so glad to hear Stephanie’s article was helpful to you, @gwrpa2. We appreciate you taking the time to reach out and share! Best, Shelby, MultipleSclerosis.net Team Member

  • Moshe
    12 months ago

    I have been dealing with MS for 30 years. I retired 7 years ago after a full career as a school psychologist. Mobility was the big issue. I now take copaxine and have a service dog for balance and mobility. Maybe I could have worked longer?

    For the last year I have been taking meds for Trigeminal Nueralgia. They work, but have effected my short term memory and word recall. It would be very hard to work with this problem. As a retired person, it’s easier to get by. The pain of TN is unbearable without meds. I just accommodate. I am very used to accommodating! God bless the MS community. It’s hard work to cope.

  • Flowers For Algernon
    12 months ago

    You’re most definitely not alone. I find solace here as well in others validating many of my own experiences in the articles and people’s comments.

  • Flowers For Algernon
    12 months ago

    My sincerest apologies. TL&DR version at bottom:

    Because of a very small group of greedy individuals who view problems, pain, and suffering as economic opportunity. Consider the term “Human Resources”… what makes a resource valuable? It’s scarcity.

    Is anyone feeling a shortage of human around you? So, what does that say about the value of those when viewed through that socioeconomic prism. It is very Hegelian Dialectic of them. It is also the rationale for birth control, abortion, and firearms.

    TL&DR:

    I generally assume the response to any questions I have beginning with “Why” these days to have a similar answer of “F%#k you. That’s why.”.

  • Dawnceleste
    12 months ago

    And today I got the denial on a referral for neuropsych testing, so now I have to fight with them. Why cant we have a National Health Service? If they don’t want to do any testing to see if there’s anything to be done, f#%k it, refer me to the suicide doctor while they’re still legal in CA and while my mind still wo rt ks enough to demand it.

  • Flowers For Algernon
    12 months ago

    Thank you for this article. It is frustratingly appreciated that someone can articulate what I can’t about me. This compounded by worry over having to put upon your loved one’s, the additional stress of having to fight with insurance, scheduling of medical, etc., as you watch in relative helplessness. The beatings will continue until morale improves.

  • chong61
    12 months ago

    Flowers For Algeron,
    As I read your post I found myself and what I have just begun to agonize about. I am at a place I never wanted to be. That is depending on my children to take me to doctor appointments and then my child has to sit in with me as I can’t remember what the doc said. Alas, it is a hill I just can’t climb by myself anymore so I have no choice. I am fortunate my children will do any and all for me.

    I was diagnosed almost 20 years ago and have gradually saw myself get a little lower each year, both physical and mental. I thought I had felt all the pain levels, but today my shoulders decided I still had other places to hurt.

    Now, to make it all perfect would be for me to be at a 10 pain level and have someone say to me “but you look so good.”

  • Dawnceleste
    12 months ago

    Ugh… same. Everything is SO SLOW! I can’t even.

  • Flowers For Algernon
    12 months ago

    I’m sorry chong61. It sounds as if you and I are blessed to have others that care, and I must admit I fear the loss of them due to being another burden to bare, unjustly so. I wouldn’t blame them a bit, and in a way, if they are going to, want them to leave me while I still am a semblance of my prior self.

    I completely understand the “but you look so good.”. Mine is “he doesn’t seem impaired.” Really sweetheart? Ask me a couple more questions, and it will become vividly obvious not only are my mental faculties slipping, but I no longer have a fuse to burn… so stop flicking your Bic.

  • baggie58
    12 months ago

    I can really relate to what you say … Not a nice place to find oneself in.

  • Dimitri
    12 months ago

    A cognitive dysfunction symptom that effects me is processing speed. My mind used to work so fast before. Now it works at a snail’s pace.

    I read awhile ago that anxiety and depression in MS are caused by inflammation in the brain. So I have a question, does inflammation of the brain show up on a MRI? For instance, in the early days of my disease before I had any lesions on my brain, if I had a MRI of my brain could the results show that my brain looked structurally healthy except for some inflammation?

    I had a MRI done years ago before my diagnosis when I was experiencing major anxiety and depression. In an ideal situation wouldn’t the inflammation in my brain show up on the MRI?

  • Flowers For Algernon
    12 months ago

    Yes Dimitri. To my understanding, for whatever that’s worth today, is that the MRIs taken show activity of the inflammation and lesions.

    http://journals.sagepub.com/doi/abs/10.1177/1352458515616701

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