An Overview of Cognitive Impairment in Multiple Sclerosis

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Cognitive impairment is the loss of certain mental functions including learning, memory, perception, and problem-solving. While the term tends to be associated with dementia or Alzheimer's disease, it is not always so severe or debilitating with other diseases, like multiple sclerosis (MS).

With MS, the signs may be so subtle in the beginning that people don't notice them. At other times, they may be aware of the mental glitches, but chalk them up to everything from getting older to simply being tired.

Nearly 50 percent of people with MS will experience some form of cognitive dysfunction in the course of their disease.

Cognitive impairment in MS
 Verywell / JR Bee 

Symptoms

Because of the way the disease progresses and the parts of the central nervous system it affects, people with MS-related cognitive dysfunction will often experience the impairment of memory, attention, concentration, information processing, visual perception, verbal skills, and such executive functions as planning or prioritizing.

Symptoms of MS-related cognitive impairment can vary from person to person. Moreover, the severity and frequency of symptoms may also fluctuate, ranging from intermittent events to more persistent, debilitating disorders.

Among the more common symptoms:

  • Short-term memory deficit: This is the inability to remember simple, recent tasks or events. It may be as innocuous as not being able to remember a phone number you just looked at, forgetting if you took your medication or not, or losing track of what you were just talking about.
  • Problems with abstract conceptualization: Abstract conceptualization is key to learning and planning. It involves intangible concepts, ideas, or theories. Having cognitive impairment can interfere with being able to conceptualize things that are needed to make plans or take action.
  • Attention deficit: This refers to being easily distracted or unable to keep your mind on the task at hand.
  • Slowed information processing: This simply means that you are taking longer to process what you are reading, hearing, or experiencing through your senses. As a result, you may get lost because you are less able to process spatial information or be less able to comprehend social cues in conversations or meetings.

Cognitive problems are sometimes severe enough to interfere with work or any situation that requires quick or complex thinking. Even in social situations, awkwardness and anxiety can develop as the signs of dysfunction become more apparent. Isolation is not uncommon.

Causes

While many of the symptoms of MS-associated cognitive impairment mirror those of other conditions like attention-deficit disorder (ADD) or social anxiety disorder (SAD), the causes are very different.

MS is characterized by an abnormal immune response which causes the progressive damage to the protective coating of nerve cells (myelin sheath) and the formation of lesions throughout parts of the central nervous system.

Moreover, the disease can cause atrophy and shrinkage in certain parts of the brain and spinal cord, including the corpus callosum, which connects the right and left sides of the brain.

In the end, the symptoms vary by where the injury is located and may be complicated by other typical symptoms of MS such as depression and fatigue.

Diagnosis

There is no specific test to confirm a diagnosis of cognitive impairment, although some tests may be done and their results considered along with other factors. Many doctors diagnose mild cognitive impairment (MCI) based on the following criteria developed by a panel of international experts:

  • You have problems with memory or another mental function: You may have problems with your memory, planning, following instructions, or making decisions. Your own impressions should be confirmed by someone close to you.
  • You've declined over time: A careful medical history reveals that your cognitive ability has declined from a higher level. This change ideally is confirmed by a family member or a close friend.
  • Your overall mental function and daily activities aren't affected: Your medical history shows that your overall abilities and daily activities generally aren't impaired, although specific symptoms may cause worry and inconvenience.
  • Mental status testing shows a mild level of impairment for your age and education level: Doctors often assess mental performance with a brief test such as the Mini-Mental State Examination (MMSE). More-detailed neuropsychological testing may help determine the degree of memory impairment, which types of memory are most affected, and whether other mental skills also are impaired.
  • Your diagnosis isn't dementia: The problems that you describe and that your doctor documents through corroborating reports, your medical history, and mental status testing aren't severe enough to be diagnosed as Alzheimer's disease or another type of dementia.

As part of your physical exam, your doctor may perform some neurological tests that indicate how well your brain and nervous system are working. In some cases, he or she may order magnetic resonance imaging or a computed tomography (CT) scan to check for evidence of a brain tumor, stroke, or bleeding.

Treatment

Research on the treatment of cognitive impairment in MS is still in the early stages. Current disease-modifying drugs may provide some relief by preventing the progression of the disease. Other experimental treatments are being explored but, to date, none have been shown to actively reverse the symptoms of impairment.

This doesn't mean there is nothing you can do. In fact, by becoming better aware of your condition, you can often find ways to "work around" any challenges you may be facing and adjust your lifestyle to better cope. 

  • Start by managing your moods: If you are experiencing mental or emotional changes you can't explain, see a doctor to get checked out. In some cases, you may be experiencing symptoms of depression that are not only common in people with MS, but imminently treatable.
  • Find support: Rather than coping on your own, turn to family, friends, counselors, or support groups. The more these concerns are out in the open, the less you may feel the need to hide, excuse, or minimize them.
  • Plan your day: Always schedule your most challenging task for the time of day when you feel at your sharpest. By doing, so you may be able to be more productive and better able to prioritize tasks.
  • Compensate for shortcomings: If your memory is poor, focus on organization. If you need to learn something new, take extra time to practice and make plenty of notes to refer to. If you have an attention problem, set a time by which to complete an activity and use an alarm to keep you on schedule (or remind you if you're off track). 
  • Exercise your brain: While your brain is not a muscle, it functions like one. The more you give it a workout (with mental arithmetic, memory games, puzzles), the more you likely you will retain certain, key processing functions.
  • Get enough sleep: Avoid anything that might stimulate you before bedtime and try to go to sleep and wake up at the same time every day, including weekends.

A Word From Verywell

Experiencing deficits in cognitive functioning can be alarming and upsetting, but staying on top of your MS treatments and learning how to manage your issues with workarounds can help. Furthermore, while cognitive skills may be affected by MS, other brain functions such as intellect, conversational skills, reading comprehension, and long-term memory usually remain untouched.

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Article Sources

  • Gingold, J. (2011) Facing the Cognitive Challenges of Multiple Sclerosis (2nd Edition). New York, New York: Demos Medical Publishing.

  • National Multiple Sclerosis Society. Managing Cognitive Problems in MS. Washington, D.C.; published 2016. https://www.nationalmssociety.org/NationalMSSociety/media/MSNationalFiles/Brochures/Brochure-Managing-Cognitive-Problems_1.pdf