How Handwriting May Be a Clue Into Your MS-Related Cognitive Changes

Penmanship is a complex, delicate task that requires mental prowess

Handwriting May Offer Insignt Into Cognitive Problems in MS
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Cognitive problems, like difficulties processing information, concentrating, organizing, remembering, and/or finding words when speaking, affect more than 50 percent of people with multiple sclerosis (MS). In fact, you may be surprised to learn that such cognitive deficits may be a person's first MS symptom.

Additionally, while a person's cognitive dysfunction is connected to the number of brain lesions they have on their MRI, it's not connected to their physical abilities. In other words, a person may be unable to walk and yet have no cognitive problems. On the flip side, a person may not be able to work due to thinking and memory problems, but have only minor (or no) physical disabilities.

Due to the elusive and complex nature of cognition dysfunction in MS, and the fact that people adopt compensatory techniques to overcome their personal deficits (which is great), it's often tricky determining if (or how much of) your cognition is affected by MS.

The good news is that besides undergoing a battery of tests with a neuropsychologist, research now suggests your handwriting may provide some insight into your cognition—a window into your brain power, so to speak.

Research on Handwriting and Cognition in MS

In a study in Scientific Reports, the handwriting of 19 people with progressive multiple sclerosis was compared to the handwriting of 22 healthy people of the same age. All of the participants wrote a specific sentence on a digitizing tablet. Then various handwriting parameters were compared between the two groups.

Results revealed there was a significant difference between the two groups when it came to sentence and word duration, as well as the spacing between word duration. In other words, it took people with MS longer to write each sentence.

In addition, handwriting stroke was analyzed and compared between the two groups. The participants with progressive MS had significantly higher stroke duration and stroke size, as well as a higher jerk. Jerk refers to the change in acceleration over time per stroke. What this basically means is that the writing of those with progressive MS compared to the healthy controls was less smooth.

Lastly, using statistics, the investigators sought to determine whether there were any links between these handwriting parameters and clinical features of MS, like movement abilities and cognitive function—and several were found.

Links Between MS Movement Abilities and Handwriting

Here are three links the investigators found, suggesting that impaired movement abilities in MS affect handwriting, especially the speed of writing.

Finger Dexterity

One test used to determine whether or not a link existed between motor abilities and handwriting in people with MS was the nine-hole peg test (NHPT). This test measures finger dexterity, which is the strength and flexibility of your fingers.

During the NHPT, a person is timed on how long it takes them to place nine pegs in nine small holes—so the longer it takes to place the pegs in the holes, the less dexterous their fingers are.

In this study, the investigators found that the longer it took for the participants with MS to complete the nine-hole peg test (NHPT), the longer it also took to write their sentence.

Grip Strength

The investigators found that in the participants with MS, the stronger their grip strength was, the faster they could write the sentence.


There was a positive association found between perceived weakness and the time it took to finish one work and move to the next. In other words, the weaker a person feels, the longer the "break" time between writing words.

Link Between MS Cognitive Abilities and Handwriting

In terms of links to cognition, for the people with MS, the time it took to write the sentence increased with the decrease symbol digital modality test (SDMT) score.

The SDMT is a screening test used to sometimes measure cognitive impairments in MS. More specifically, this test evaluates information processing speed. Research suggests information processing speed is the most common cognitive deficit seen in MS, as well as the first one to emerge.

The fact that a link exists between SDMT score and sentence duration implies that handwriting is not simply an act of movement, but rather also tied to cognition.

The bottom line is that based on this study, a decline in cognition (as seen in MS) impacts handwriting skills.

More on MS-Related Cognitive Dysfunction and Handwriting

While we know handwriting problems are common in MS (prior research has revealed that people with MS are slower to write, and their writing overall is more irregular), the influence of a person's cognitive status on handwriting had not been previously explored. With this newfound link, it's possible that handwriting analysis could offer insight into a person's cognitive function.

This all said, it's important to remember that cognitive changes are commonly influenced by others issues like depression, anxiety, fatigue, stress, and medication. So teasing out and treating your cognitive deficits can be tricky, especially since some factors are reversible (for example, depression) whereas others are irreversible (for example, if your cognitive problems are from MS itself).

Finally, cognition is a broad term. With that, a person with MS may experience only one cognitive problem (like with processing information) while another person with MS may experience multiple cognitive problems (like with memory, information processing, and concentrating).

What this means is that a person may still have cognitive deficits and have "normal" handwriting. The reverse is true, too, as there are also other causes of deteriorating handwriting besides MS, like Parkinson's or certain psychiatric disorders like schizophrenia.

A Word From Verywell

If you are concerned about your cognitive abilities (or your loved one's), please speak with your neurologist.

Through cognitive rehabilitation, you can learn and practice techniques that can help you remember, plan, and think more easily. These techniques can also dramatically help improve your daily functioning and happiness.

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Article Sources
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