Cognitive impairment

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Cognitive impairment (sometimes called cognitive dysfunction) refers to problems with thinking processes, including attention and concentration, learning and memory, executive functions, and expression (how we communicate what we’re thinking). Although, up to two-thirds of people with MS will experience some sort of cognitive impairment related to the disease, in most cases this impairment is mild-to-moderate. Severe cognitive impairment affects only a small group of people with MS and cognitive changes tend to progress slowly.

Cognitive functions impacted by MS

  • Attention and concentration: Processing information coming into the brain
  • Learning and memory: Collecting, storing, and retrieving new information
  • Executive functions:
    • Problem-solving
    • Planning and executing activities
    • Organizing and manipulating information
  • Expression:
    • Acting on information
    • Communicating information to others

 

Importance of identifying cognitive problems early

Although in most people with MS, cognitive problems tend not to be severe, even mild symptoms can have a large impact on daily living. For instance, more people with MS decide to quit working due to cognitive problems than mobility problems. So, the sooner a problem is identified and strategies are developed for coping and compensating for the problem, the better.

 

Is it possible to predict who will develop cognitive problems?

Cognitive changes with MS can happen at any time, regardless of how long a person has been diagnosed or how mild or severe their physical disabilities are.

 

What is the cause of cognitive problems in MS and are some problems more common than others?

As with many other symptoms in MS, cognitive problems happen because of damage (lesions or scars) in the brain. The effect that lesions have on the way the brain functions depends on their specific location. The majority of MS lesions tend to be located in the white matter of a part of the brain called the periventricular region and in the fibers connecting the two cerebral hemispheres, known as the corpus callosum. These areas are involved in cognitive functions that are most often affected in people with MS, including short-term memory, information processing, and executive functioning. Cognitive functions including general intelligence and long-term memory tend not to be affected in MS.

 

What are some of the signs of cognitive problems?

Some of the first signs of cognitive dysfunction in people with MS are problems with verbal fluency, executive functioning,  information processing, attention and concentration.

 

Signs of cognitive problems

  • Verbal fluency: Difficulty finding words
  • Executive functioning:
    • Problems with decision-making
    • Poor judgment
  • Information processing: Difficulty keeping up with conversations
  • Attention and concentration: Difficulty recalling what to do on the job or as part of daily routines at home

 

How are cognitive problems evaluated?

If you suspect that you may have a cognitive problem because you’ve noticed some worrisome changes or a family member has given you feedback, you should speak with your doctor. Identifying a cognitive problem early is important so that you can develop strategies to compensate for your difficulties.

A comprehensive cognitive evaluation is used to detect problems that you may be experiencing. The evaluation includes a series of tests (also known as a test battery) typically given by specially trained health professionals, including neuropsychologist, occupational therapist, or speech/language pathologist. A test battery will include paper-and-pencil items and various types of puzzles. The goal of these tests is to determine how well you are functioning at work and home. A complete evaluation can last 6 to 8 hours and is typically conducted over the course of a couple days, however shorter examinations are available. Because a full evaluation can be expensive, you should ask about cost early in the process and find out if your insurance will cover the expense.

 

Are there treatment options for cognitive dysfunction?

There are three types of treatment for cognitive problems in MS, including symptomatic treatments, disease-modifying treatments, and cognitive remediation.

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