People living with multiple sclerosis (MS) may experience cognitive changes as a symptom of the disease. Cognition refers to the way we acquire understanding and knowledge via our senses, thoughts, and experiences. Our cognitive abilities can affect our memory, the way we learn, and how we think. Cognition also provides us with the ability to focus, problem-solve, understand and process language, and perceive the environment accurately.

Although these symptoms can have an impact on quality of life, there are interventions to improve the severity of cognitive impairments.

How Does MS Cause Cognitive Changes?

To understand how MS causes cognitive changes, it is necessary to review some basic information about the central nervous system (CNS). The CNS is composed of the brain, spinal cord, and cranial nerves, including the associated optic nerves. Each component of the CNS is made up of a specialized nerve cell called a neuron, and there are more than 86 billion neurons in the brain.

Neurons work together to transmit sensory, motor, and cognitive information. Neurons are composed of three parts, including a cell body, axon, and dendrites. Messages in the form of electrical impulses are transmitted down the axon toward other neurons to continue the signal. Each axon is wrapped in a fatty substance called myelin. This material insulates the axon and increases the rate at which the electrical impulse can be transmitted.

Neurons are found in both the white matter and the gray matter in the brain. The white matter in the brain refers to areas rich in myelin-covered axons, a substance that is white in appearance. The gray matter refers to areas of the brain with more concentrated cell bodies from the neuron.

Cognitive dysfunction during MS is caused by the autoimmune destruction of the myelin sheath that covers axons. During this process, autoreactive immune cells attack the myelin sheath by producing substances such as antibodies and inflammatory cytokines. This immune activity and inflammation eventually lead to the formation of lesions in the CNS. Many of these lesions are found in the myelin-rich white matter areas, but lesions in the gray matter have also been found. These lesions are detectable using magnetic resonance imaging (MRI).

The autoimmune destruction of myelin affects the way neurons communicate with each other, which has an impact on their ability to transmit cognitive, sensory, and motor information. Cognitive difficulties during MS can be a result of the neurons in a person’s brain not being able to communicate properly.

The Cognitive Symptoms of MS

The symptoms of MS can affect cognition in many ways. This includes difficulty with problem-solving and memory issues. Some additional cognitive functions affected by MS include:

• Word-finding and verbal fluency
• Executive functions such as prioritizing and planning
• The ability to process information with all five senses
• Focus and attention
• Visuospatial processing, which assists with movement and depth perception

Cognitive impairment can be an early sign in the disease course of MS. If you notice any of these changes, speak with your doctor or a neurologist to find out more information about your symptoms and MS. These symptoms can also be a sign of an active relapse in individuals with relapsing-remitting forms of MS.

Cognitive Rehabilitation for MS

If you’re experiencing the cognitive symptoms of MS, treatment options are available. These include disease-modifying treatments (DMTs) to slow disease progression. There are also treatments specific to cognitive dysfunction that may be helpful.

A qualified neuropsychologist with experience treating MS can perform an evaluation to determine the extent of a person’s cognitive dysfunction. Occupational therapists and speech-language pathologists with MS experience may also be able to perform comprehensive cognitive analyses. Once a person’s cognitive deficits have been identified, health care providers can determine how to treat them.

Some approaches to treating the cognitive symptoms of MS include restorative activities that focus on memory and learning, such as:

• Using memory aids to build associations
• Repeating and practicing information over certain time intervals to improve memory
• Improving your attention and memory by repeating and verifying new information
• Trying to learn things in multiple ways by seeing, saying, and hearing the new information

Your team of health care providers can share the strategies and exercises that will assist you with your cognitive performance.

Physical exercise may also be connected to cognitive health and may aid in its improvement. Studies regarding exercise and cognitive ability have been performed in people with MS and have shown positive results. One particular study found that regular physical activity improved the information processing speed of people with MS.

Simple changes to everyday life such as restorative activity and physical exercise may help you combat the cognitive effects of MS. Tracking your cognitive health and coming up with an action plan with your health care provider can help you take control of your well-being. As researchers learn more about MS and its cognitive effects, more targeted treatment options may arise for this condition.

Talk With Others Who Understand

MyMSTeam is the social network for people with MS and their loved ones. On MyMSTeam, more than 168,000 members come together to ask questions, give advice, and share their stories with others who understand life with MS.

Are you living with MS? Share your experience in the comments below, or start a conversation by posting on your Activities page.