Multiple sclerosis (MS) is a chronic disease that affects the central nervous system, attacking the protective coverings of nerve cells and often severely damaging the nerves themselves. As MS progresses, it can cause problems with vision, muscle control, balance,
sensation, and memory. Because MS damages nerve fibers in the brain and spinal cord, it can directly impact how you think and feel.
How does MS affect cognition?
Over half of all people with MS experience issues with cognition, which refers to skills like memory, attention, processing information, planning and problem solving, and verbal fluency. Cognitive symptoms are often some of the most problematic for people with MS.
MS cognitive symptoms may include:
- Impaired learning and memory
- Difficulty paying attention and concentrating
- Slower information processing speed
- Problems with executive functions like planning, prioritizing, multitasking
- Impaired visual-spatial abilities
- Trouble with word-finding when speaking or naming objects
These issues can range from mild to severe. Many people with MS report that they feel like their thinking is “foggy” at times. The pattern of cognitive problems often depends on the location of MS lesions in the brain. For example, lesions in frontal and temporal lobe areas often cause issues with memory, attention, and executive functions.
Why does MS impair cognition?
Researchers believe there are several reasons why MS impacts thinking abilities:
- Inflammation and loss of myelin in the brain can disrupt and slow down nerve signaling.
- Scarring from MS lesions can interfere with how different parts of the brain communicate.
- Brain shrinkage or atrophy is common in MS and reduces information processing.
- People with MS often have reduced neurotransmitter chemicals.
- Fatigue, depression, sleep issues, and medication side effects may also affect cognition.
In many cases, cognitive symptoms result from a combination of these MS disease processes affecting overall brain functioning.
How does MS affect emotion?
MS can also direct impact moods, emotions, and personality. Up to half of people with MS deal with clinical depression at some point. Depression is not simply a reaction to having MS – the disease process itself commonly causes depressive symptoms.
MS depression may be linked to:
- Lesions affecting emotion regulating areas of the brain
- Imbalances in neurotransmitters like serotonin
- Side effects of medications used to treat MS
- Fatigue and sleep disturbances
- Stress and difficulties coping with MS
Other emotional changes that may occur with MS include:
- Mood swings
- Irritability or euphoric feelings
- Anxiety
- Apathy
- Difficulty controlling emotions or frequent crying
Personality changes like disinhibition, impulsiveness, and struggles with social cognition have also been linked to MS brain lesions. Emotional lability pseudobulbar affect, where someone laughs or cries very easily, also occurs more often with MS.
How do MS cognitive and emotional problems impact daily life?
Cognitive and neuropsychiatric symptoms often have a significant effect on quality of life for people living with MS. They can interfere with many aspects of daily functioning.
For example, problems with memory, attention, and processing speed can make tasks like working, managing finances, driving, following medication routines, or keeping track of appointments much more challenging. Difficulty multitasking and organizing can reduce efficiency and productivity at home or work. Impaired thinking can force people to cut back their hours or leave the workforce altogether.
Emotional and personality changes can strain relationships with friends and family. Depression, anxiety, and irritability often make coping with MS and navigating daily responsibilities more difficult. Even mild cognitive issues can have a meaningful impact by requiring extra time and effort to complete tasks.
How is cognition tested in MS?
A neuropsychological evaluation involves a clinical interview and paper and pencil tests to systematically assess:
- General intellect
- Learning and memory
- Processing speed
- Attention and concentration
- Executive functioning
- Language
- Visual spatial abilities
- Motor skills
Results are compared to scores expected based on age and education level to determine areas of relative strength and impairment. Some common tests used include:
| Cognitive Domain | Sample Tests |
|---|---|
| Intellectual functioning | Wechsler Adult Intelligence Scale (WAIS) |
| Learning/Memory | California Verbal Learning Test (CVLT), Brief Visuospatial Memory Test (BVMT) |
| Processing speed | Symbol Digit Modalities Test (SDMT), Trail Making Test A |
| Executive function | Delis-Kaplan Executive Function System (DKEFS) |
| Language | Boston Naming Test, Word Fluency |
| Visuospatial | Judgment of Line Orientation |
Results help diagnose specific areas of cognitive impairment. Repeating testing allows monitoring of any changes over time.
What MS treatments help cognition?
Disease modifying therapies that reduce MS inflammation and progression may help slow cognitive decline to some extent. Effective symptom management is also important.
Treating MS fatigue, sleep disorders, depression, and pain can help maximize cognitive abilities. Staying mentally active and socially engaged also seems to protect the brain. Specific tips include:
- Reading books, doing puzzles
- Learning new skills or hobbies
- Physical exercise
- Getting enough rest and maintaining a sleep routine
- Stress reduction and relaxation techniques
- Cognitive behavioral therapy (CBT) for depression or anxiety
- Memory aids and organizational strategies
Acetylcholinesterase inhibitor medications used for Alzheimer’s disease like donepezil (Aricept) may benefit processing speed, memory, and attention in MS. Stimulant drugs like modafinil can also improve fatigue-related cognitive problems. More research is needed to develop therapies that specifically target MS cognitive impairment.
What about emotional changes with MS?
Mood disorders like depression and anxiety should be treated early on with counseling, medication, or ideally a combination approach. SSRI antidepressants like sertraline (Zoloft) and SNRI medications like duloxetine (Cymbalta) often help both depression and anxiety in MS.
Cognitive behavioral therapy focuses on changing thought patterns and behaviors that contribute to emotional issues. Learning stress management and relaxation skills can lower distress. Regular exercise and social connection are excellent for supporting mental health.
For severe or treatment-resistant cases, electroconvulsive therapy and TMS transcranial magnetic stimulation show promise as depression treatments for MS patients. Off-label use of mood stabilizers like lamotrigine may ease emotional lability.
What is the outlook for MS cognitive and emotional problems?
The cognitive impact of MS is quite variable – some people remain only mildly affected while others develop more significant impairment. Generally, the level of physical MS disability correlates with the extent of cognitive deficits. Progressive cognitive decline is more likely with advancing disease.
Emotional symptoms like depression may come and go over the course of MS. Ongoing stress, isolation, uncontrolled symptoms, and disease activity can exacerbate mood issues.
The good news is that many people with MS maintain their intellect, personality, and ability to read, communicate, and manage their lives throughout the disease course. While MS can certainly affect cognition and emotions, with proper symptom management and a strong support system most people can minimize these changes.
Conclusion
MS frequently impacts cognition and emotion due to its effects on the brain. Common problems include slowed processing speed, impaired memory and executive functions, depression,
mood changes, and personality shifts.
These invisible symptoms often significantly affect quality of life. Catching them early and controlling disease activity helps. Cognitive rehabilitation, antidepressants, counseling, and lifestyle strategies can manage symptoms.
Living fully with MS involves monitoring how you think and feel, and reaching out for help when needed. Many people learn how to adapt and develop resilience to the cognitive and emotional challenges MS brings.