Problems with cognition and cognitive decline are common among people with multiple sclerosis (MS). An estimated 40 percent to 65 percent of people with MS experience some kind of cognitive symptoms (involving brain processes like thinking, memory, and attention).

Problems with cognition can include difficulties with working memory (the information you hold in your mind at a given time) or episodic memory (remembering specific events from the past), as well as attention and the ability to think and reason. MS memory and cognition tests can detect problems in these areas, such as memory loss.

Cognitive impairments can be a frustrating aspect of life with MS. Changes to cognition can affect personal relationships, work, and the ability to perform daily tasks.

Proactive steps recommended by the National Multiple Sclerosis Society can help you manage MS-related cognitive deficits and their impact on your quality of life. Cognition testing can be an early step to understanding your cognitive function and getting the support you need.

What Is a Cognitive Test for MS?

Cognitive testing is used to understand a person’s cognitive capabilities. Cognition tests for multiple sclerosis fall under the umbrella of neuropsychological testing and are important for a few reasons. Cognitive tests can:

• Detect brain dysfunction across multiple cognitive areas
• Improve understanding of changes happening in the brain
• Assist in recommendations for treatment planning

Neuropsychological tests can be used for a diverse range of neurological conditions. A neuropsychological test isn’t the same as a mental health evaluation, although some tests may include a section aimed at assessing mood disorders such as depression.

Several types of tests have been developed to evaluate cognition in people with MS. You may receive short screening tests in the doctor’s office or a more formal assessment supervised by a neuropsychologist (specialist who assesses and treats cognitive, emotional, and behavioral changes related to brain function).

Your doctor might discuss cognition testing as “testing batteries” or “batteries of tests.” These phrases simply refer to taking several tests that assess different areas of cognitive function in people with MS.

Cognition testing can help you and your doctor understand the challenges you’re experiencing and identify opportunities to support you.

Benefits of Cognition Testing for MS

Cognition testing offers many benefits for individuals with multiple sclerosis, including informing your treatment plan and monitoring symptoms of MS over time. Here are some key ways cognition testing can help.

1. Establish a Baseline of Cognitive Function

A baseline allows your healthcare provider to understand how and if your cognition changes over time. The National Multiple Sclerosis Society recommends that adults with MS undergo annual cognition testing to monitor disease progression, identify cognition changes, and see how well treatments are working.

2. Determine Potential Interventions

Cognition testing can help pinpoint the areas of cognition where you have the most challenges. This allows your provider to recommend the best interventions to help strengthen your cognitive function. Understanding your cognition can also help you and your healthcare provider evaluate and tailor your treatment plan to your needs.

3. Narrow Down the Cause of Cognitive Challenges

A comprehensive evaluation can help determine if depression, anxiety, fatigue, other health problems, or medication side effects are affecting cognition.

4. Meet Requirements for Government Disability Programs

A thorough evaluation from a particular type of provider may be necessary to qualify for government disability programs. This healthcare provider might be a neuropsychologist or a neurologist (doctor who diagnoses and treats disorders of the nervous system, including the brain, spinal cord, and nerves).

What To Expect From Cognition Testing

When considering cognitive evaluation, it’s helpful to know what to expect. You can’t study for a cognition test, but you can prepare by getting a good night’s sleep and eating a nutritious breakfast beforehand.

The length of a cognition test can vary — it might take just a few minutes or several hours. Comprehensive neuropsychological tests also check motor skills, which means they may involve physical activities. Because of this, some people feel tired afterward. You can ask your provider how long testing will last so you know what to expect.

You may be given a tablet such as an iPad or a paper form to take a test on your own, sometimes during a regular medical appointment or while waiting to be seen. In other cases, your doctor may ask you questions verbally. Some testing batteries combine cognitive and physical assessments.

Types of Cognition Tests for MS

There are several types of cognitive screening. Your doctor will help determine which tests are best for you. Below are examples of commonly used cognition tests.

Symbol Digit Modalities Test

Introduced in 1982, the Symbol Digit Modalities Test (SDMT) is a quick and widely used cognition test for adults with MS. The SDMT involves matching numbers with symbols based on a provided key, with 90 seconds to complete as many matches as possible. The entire test takes five minutes or less and can be done verbally or in writing.

Doctors often use the SDMT as a first step to check for cognitive changes before recommending further testing or specialists. It can also help track cognitive changes during MS relapses.

Processing Speed Test

The Processing Speed Test (PST) takes about two minutes, plus a few minutes for instruction. This test is similar to the SDMT, but it’s self-administered on a tablet in your provider’s office. A study at one clinic found that the PST might be slightly more effective than the SDMT at detecting certain brain lesions (areas of scarring or damage).

Computerized Speed Cognitive Test

The Computerized Speed Cognitive Test (CSCT) is a 90-second test in which you verbally answer questions on a computer. The CSCT is especially useful for detecting problems with processing information.

Multiple Sclerosis Neuropsychological Questionnaire

The Multiple Sclerosis Neuropsychological Questionnaire (MSNQ) is a 15-question survey about cognitive function. The MSNQ can be completed by either a person with MS or someone who knows them well. This self-reported test helps identify signs of depression and shows how aware a person is of their own cognitive abilities.

Multiple Sclerosis Functional Composite

The Multiple Sclerosis Functional Composite (MSFC) includes one cognitive test, a timed walking test, and a test of arm function. The MSFC can be given by a trained professional and doesn’t require a physician or neuropsychologist. The National Multiple Sclerosis Society’s Clinical Assessment Task Force developed the MSFC for use in clinical trials.

Brief International Cognitive Assessment for Multiple Sclerosis

The Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) includes the SDMT and other tests to evaluate language ability and spatial recall (the ability to remember locations, shapes, and object positions). The BICAMS is short, simple, and requires no equipment.

Minimal Assessment of Cognitive Function in Multiple Sclerosis

The Minimal Assessment of Cognitive Function in Multiple Sclerosis (MACFIMS) is a comprehensive evaluation that can last 90 minutes. It includes seven neuropsychological tests designed to evaluate language ability, working and spatial memory, and executive function — known as “cognitive domains.” The MACFIMS is unique in its ability to assess executive function, which refers to a set of mental skills that help with planning, decision-making, problem-solving, organizing, self-control, and flexible thinking. This test is administered or supervised by a neuropsychologist.

Taking the First Step

Cognition testing is the first step toward managing cognitive MS symptoms. Based on the results, your doctor may recommend further evaluations and follow-ups with other healthcare providers. Other interventions may be prescribed to improve your cognitive performance. These approaches include:

• Physical exercise
• Cognitive rehabilitation
• Brain exercises
• Diet
• Disease-modifying therapies

These strategies can help protect brain health, support cognitive function, and improve overall quality of life with MS.

Building a Community

MyMSTeam is the social network for people with multiple sclerosis and their loved ones. On MyMSTeam, more than 218,000 members come together to ask questions, give advice, and share their stories with others who understand life with multiple sclerosis.

Have you talked with your doctor about cognition testing? Have you taken any of these tests? Share your experience in the comments below, or start a conversation by posting in Activities.