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Lesions, Atrophy, and Cognitive Symptoms

Lesions, Atrophy, and Cognitive Symptoms

Throughout this series, we have touched on some of the things that indirectly impact cognition such as fatigue, mood changes, and medication side effects. MS can also directly cause cognitive symptoms, and while symptoms are more common in the later or progressive stages, they can also occur in early relapsing-remitting MS.

Cognitive symptoms

MS does not impact your overall intelligence or long-term memory, but over 65% of people living with MS experience cognitive symptoms at some point.1 Symptoms include difficulty with short-term memory, attention, multi-tasking, word finding, and “executive functions” which include planning, prioritizing, and/or organizing.

Preventing damage to the nervous system

MS causes atrophy (or shrinkage) and lesions in the central nervous system (the brain, spinal cord, and optic nerves). Lesions and atrophy directly cause cognitive symptoms, so we would like to delay or prevent as much damage as possible to preserve function. The most important step in reducing risk and preventing cognitive loss is to slow the progression of MS by taking an effective disease modifying therapy (DMT). This means starting treatment as soon as possible, and regularly evaluating that treatment is working well.

How to evaluate if your treatment is working

We determine whether your treatment is working by doing exams regularly, through routine MRIs of the brain and/or spinal cord, and by quickly determining if new or worsening symptoms could be a relapse. If you are having relapses, progression of disability, or new lesions on your MRIs, it is time to discuss changing medications. Being proactive about starting and switching therapies is the best way to keep you doing your best, for as long as possible.

Can DMTs improve cognition?

Several studies have also been done that show some DMTs can actually improve cognition. In one study, patients treated with Tysabri showed significant improvement in cognitive testing over 2 years of therapy.2 Another similar study compared Gilenya with Betaseron, which showed that both groups saw improvement in cognition, but the patients on Gilenya had fewer relapses and new brain lesions which is associated with better long-term results.3

Cognitive rehabilitation

If MS directly causes cognitive issues, we can also try cognitive rehabilitation programs. Unfortunately, this type of rehab is not as readily available as physical and occupation therapy. Because resources are limited, many people with MS do not have facilities or therapists nearby to them. If you are interested in cognitive rehabilitation, talk to your healthcare provider or your local National MS Society chapter to see what resources are available in your area.

Studies on other potential treatments

In addition to what we know about the effect of DMTs on cognition, several other studies have been done on other potential treatments. Overall, we have found that medications for dementia, such as Aricept and Namenda, do not seem to be very effective for MS-related cognitive dysfunction. Researchers are also currently investigating whether Ampyra, a medication given to improve walking speed and lower extremity strength, improves cognitive symptoms. There is also some interesting research being done on the effects of stimulants, such as Modafinil, on fatigue and cognition. There are several ongoing studies on the benefits of diet and exercise, including one study on the effects of exercise and cognitive rehabilitation programs on cognition in people with progressive MS.

Non-drug therapies

Other non-drug therapies are also being studied, such as Transcranial Magnetic Stimulation (TMS), which involves putting a device on your head that sends electromagnetic pulses to certain pathways in the brain that are known to affect cognition. The ‘holy-grail’ of neurology right now is to figure out how to remyelinate and repair damage, which could even reverse cognitive loss. Remarkable breakthroughs in this field have been made in the past few years, so I am very hopeful that this will be a possibility in the not-too-distant future.

In this series, we have covered what cognitive dysfunction is, how to test for it, and how to treat the direct and indirect causes of symptoms. Despite recent advances in cognitive research, many of us still have to learn how to live with, and adapt to, cognitive changes. In the next article, we will cover some tips and tricks that can help make daily life a little bit easier.

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

  1. Rao SM, Leo GJ, Bernardin L, Unverzagt F. Cognitive dysfunction in multiple sclerosis. I. Frequency, patterns, and prediction. Neurology. 1991;41(5):685–91.
  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 MA, et al. Efficacy of fingolimod and interferon beta-1b on cognitive, MRI, and clinical outcomes in relapsing–remitting multiple sclerosis: an 18-month, open-label, rater-blinded, randomised, multicentre study (the GOLDEN study). Journal of Neurology. 2017;264(12):2436-2449. doi:10.1007/s00415-017-8642-5.


  • Beverly
    2 months ago

    PPMS doesn’t have DMTs, just progression. PT worsened my symptoms. Exercising in the pool was a joy, till we sold the pool house and my husband put in a bit tub. I’m smarter than getting in that. This isn’t what I planned. I have grandkids to play with, but no more. Basically housebound. Oh well.

  • Harleydog1
    3 months ago

    I just take one day at time

  • Linda Bush
    4 months ago

    New to me this year – constant vertigo (the ENT doc says. That’s impossible.) my M r I shows more than a third of my cerebellum has atrophied. So, we take another Neuro-psych exam. I have what they call”fevers of unknown origin “ which is accompanied with the vertigo, and a real loss of my memory. I was in a coma last year – I had double pneumonia and didn’t know it.
    Now they have stem cell surgery to correct the disease, and they put a limit of 50 years old to have it. I have waited more than 40 years for this surgery to be available and I’m 13 years too old. Talk about disappointment!
    Two weeks ago I had another UTI and the doctor put me on Levaquin. And more, there is a very rare side effect that causes every joint in your body, every muscle to hurt unbelievably so.
    I simply record every symptom and my doctor just shakes her head, I have had tens of strange effects.
    I finally have a good MS team, which is nearly impossible. I am now a patient at VA Commonwealth University where I am attended by dozens of doctors because it is a teaching hospital serving two colleges, the second being Medical College of VA.
    I hate this disease, I hate that I have waited for so long for a repairing surgery, but I’m too old. Some days I wish I weren’t.

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