Multiple Sclerosis Centers of Excellence
Cognitive Changes and Multiple Sclerosis
About 40 to 66 percent of people with multiple sclerosis (MS) will experience some changes in their thinking skills over the course of the disease. For most people, these changes are mild to moderate, but even mild problems can affect work, relationships, driving, and daily routines. The good news is that general intelligence is usually not affected by MS, and there are practical strategies that can help you manage cognitive challenges.
It is important to pay attention to cognitive changes early. They can happen at any point in the disease, and their severity does not always match a person’s level of physical disability. Someone with significant physical limitations may have no cognitive symptoms at all, while someone recently diagnosed with few physical symptoms may notice real thinking difficulties. The sooner these problems are identified, the easier they are to work around.
Common Cognitive Areas Affected by MS
Memory
The most common memory issue in MS involves learning new information. Research shows that people with MS may need more time or more repetitions to take in and store new information. However, once that information is stored, it can usually be recalled without much difficulty. You might take longer to memorize a list or learn a new process, but once you have it down, you will remember it as well as anyone else.
Processing Speed
Processing speed refers to how quickly your brain handles incoming information. When processing is slowed, it can be hard to keep up with conversations, follow a TV show, or read at your usual pace. People often describe this as feeling like their brain needs to be running faster. Slowed processing can also make other cognitive tasks - like learning or problem solving - more difficult.
Attention and Concentration
Many people with MS notice changes in their ability to focus, especially when there are distractions or when they need to juggle multiple things at once. You might find it harder to switch smoothly between tasks or to concentrate when there is background noise. Multi-tasking, which is essential in most jobs and in parenting, can become more challenging.
Executive Function
Executive functions are the higher-level skills used for planning, organizing, prioritizing, and solving problems. When these are affected, you may feel “stuck” when working through a complex project or have difficulty breaking a big task into smaller steps. Letting go of one topic in a conversation to move to a new one can also be harder.
Verbal Fluency
Word-finding difficulty is a very common complaint. You may know exactly what you want to say but struggle to come up with the right word in the moment. This can make conversations feel less smooth and may affect your confidence in social or professional settings.
Visual Perceptual Skills
Some people with MS experience changes in visual perception, including difficulty with sense of direction, spatial orientation, or recognizing objects. These problems can interfere with activities like reading a map, driving, or assembling things.
Cognitive Fatigue
Research has shown that people with MS who concentrate hard on a demanding mental task can experience a kind of mental exhaustion - a feeling of acute “brain drain.” This is different from physical fatigue. The good news is that a brief rest from the task usually helps you get back on track. Cognitive fatigue is one of the top reasons people with MS leave the workforce, but with good management it can often be addressed.
Practical Strategies
There are many things you can do to manage cognitive changes in your daily life. Here are strategies organized by the type of problem:
For memory difficulties: Write down important information as soon as you learn it. Use a calendar, planner, or smartphone app to track appointments and tasks. Keep commonly used objects in a designated spot. Use visual reminders - for example, place something in an obvious location to remind you of a task in progress.
For slowed processing: Ask people to slow down or repeat themselves during conversations. Allow extra time to complete tasks. Schedule your most demanding activities during the time of day when you feel sharpest. If something is taking too long, take a short break and come back to it.
For attention and executive function: Give your full attention to one task at a time and reduce background noise and distractions. Break large goals into smaller steps, prioritize them, and schedule them into your calendar. Make “to do” lists and cross items off as you complete them. If you run into a problem you cannot solve, ask for help or take a step back before trying again.
Cognitive Rehabilitation
Cognitive rehabilitation is a clinical approach to improving thinking skills or developing strategies to work around cognitive difficulties. It is often provided by speech therapists, occupational therapists, or neuropsychologists.
There are two main approaches. Compensatory strategies help you develop tools and habits to cope with a cognitive problem - like using a planner or setting phone alarms. Restorative approaches aim to strengthen a specific cognitive skill through structured exercises, often guided by a clinician or computer program.
Physical activity - such as walking, yoga, or Pilates - has also shown promise for supporting cognitive health. Relaxation and mindfulness exercises may help improve attention in addition to reducing stress.
You may have heard about computer-based “brain training” programs. While some have shown promise, it is still unclear whether they lead to lasting, real-world improvement. If you are already mentally and physically active, you do not necessarily need to add brain training. However, for those who are less active, these programs can be a way to engage in mental stimulation.
When to Talk to Your Provider
If you are noticing changes in your memory, thinking speed, or ability to focus, bring it up with your health care provider. A cognitive evaluation - often done by a neuropsychologist - can identify your specific strengths and weaknesses and guide a treatment plan. Getting enough sleep, managing depression and fatigue, staying physically active, and maintaining good nutrition can also support your cognitive health. Early assessment and the right strategies can make a real difference in your quality of life.
Based on articles by Adam Nelson, PhD, ABPP; Brett Parmenter, PhD; Rosalind Kalb, PhD, Nancy Holland, RN, EdD, MSCN, and Barbara Giesser, MD.
