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Cognitive Changes

Reviewed by: HU Medical Review Board | Last reviewed: March 2022.

In multiple sclerosis (MS), the body’s immune system mistakenly attacks itself. This leads to damage in the central nervous system (CNS), including the brain and spinal cord.1,2

CNS damage can cause a variety of symptoms. Because of this, each person’s experience with MS will be unique. Cognitive changes are a common symptom experienced by many people living with MS. Cognitive changes are a group of symptoms related to how the brain functions.1,2

What are cognitive changes?

The way our brain works, thinks, and stores information is called our cognition. Any changes in these processes are called cognitive changes. When changes lead to worsening brain function, it is called cognitive dysfunction.1

About 40 to 70 percent of people with MS report having some type of cognitive change after diagnosis. Some of these include issues with:1-4

  • Short-term memory
  • Solving problems
  • Thinking about abstract concepts
  • Attention, focusing, or concentration
  • Using or understanding speech
  • Visual perception (how the brain processes the images we see)
  • Planning tasks or following steps of a process (executive functioning)
  • Judgment
  • Processing multiple pieces of information at once

Cognitive issues can happen at any time with MS. They can even occur at the time of diagnosis. While the severity of these issues can vary, they are usually mild.1,2

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Only about 5 percent of those with MS develop severe cognitive issues like dementia. Long-term memory, overall intelligence, reading comprehension, and the ability to have conversations are usually not affected.1,2

Even though MS-related cognitive changes are usually mild, they can still impact quality of life. It can be frustrating to have problems finding words, paying attention, or keeping track of things.

Why do cognitive changes happen in MS?

Cognitive changes can happen as a result of CNS damage in the brain. When more MS-related lesions and changes are found on brain magnetic resonance imaging (MRI), cognitive issues are usually worse. Cognitive changes are also more likely to occur in people with progressive MS rather than relapsing-remitting MS.1,2

Other factors like depression can also cause cognitive changes. People with MS are more likely than those without MS to have depression. Depression can further impact concentration, memory, and more. Depression may be related to symptoms like pain or fatigue, too. It can also come along with other aspects of life with MS, like stress or issues with social support.2

Cognitive and physical symptoms are not always connected. For example, a person with severe trouble walking may have no cognitive changes. However, someone with few to no physical MS symptoms may struggle a lot with cognition. Changes can occur slowly over time but often worsen from time to time.1-3

How are cognitive changes diagnosed and treated?

If you or a loved one has noticed changes, talk with your doctor. In some cases, changes can be so minor that they are not easily recognized by others, including doctors.

There are many tests (sometimes called neuropsychological tests) that can help detect even mild changes. These tests can take several hours to complete. Each test may involve memory games, puzzles, and other tasks to see how the brain works. Your doctor will test for other medical issues that can impact cognition, too.1,5

If you or a loved one does have cognitive changes, you can take several steps to help improve quality of life. These include different memory and learning exercises and using memory aids. It can also be helpful to use organization techniques like planners, recordings of your thoughts, and reminders to keep things on track.1,5

Drugs are used in some cases. These include drugs to treat MS, drugs specifically for memory-related issues, or depression treatments.1,5

You and your doctor can work together to determine the best approach for you. Improvement varies, but detecting changes early and using several different options may be helpful.