Cognitive difficulties are common among people with multiple sclerosis (MS). One study of 100 people with MS found that 43 percent experience cognitive difficulties.¹ Common issues include problems with memory, concentrating, processing information, executive function, language ability, and visual-spatial skills (finding your way around, recognizing or assembling objects).² These cognitive difficulties are also referred to as “cog fog” or “brain fog.” Learn more about Day-to-Day Tips for Managing Cognitive Challenges due to Multiple Sclerosis.

Friends, family, work colleagues and even teachers can be an important support system for people with MS who experience cognitive difficulties.³ It starts by being open about your feelings and experiences. While you may feel vulnerable talking about cognition, being honest can help avoid misunderstandings and strengthen the relationships that are most important to you.⁴

Below you’ll find descriptions of a few social and professional situations that can lead to misunderstanding if friends, family, or colleagues aren’t familiar with MS and cognition. Use this article to jumpstart a conversation about cognition. You can also share it with your loved ones so they can better understand the cognitive difficulties you might face.

Difficulty concentrating and easily overwhelmed in social settings

If you experience difficulty concentrating or taking in new information, you may feel overwhelmed in loud and busy places.³ A friend or relative may think you’re uninterested in what they’re saying, when in fact, changes to your cognition are making it more challenging for you to focus.

Before a misunderstanding causes hurt feelings, explain to your loved one that crowded settings are tough for you. Reiterate that you want to spend time together and offer an alternative activity. You can suggest a one-on-one coffee date instead of attending a birthday party or eating at home instead of at a restaurant.

Difficulty concentrating and easily overwhelmed at work

A busy or noisy work environment may make it difficult to concentrate or complete projects successfully.³ If your supervisors or colleagues don’t understand how MS impacts your focus, they may develop negative perceptions about your work ethic or capabilities.

If you work in the United States, you may be entitled to accommodations under the Americans with Disability Act. Employees in other countries may also be entitled to similar protections. If you find yourself in a work environment that is too loud or distracting, you can work with the human resources department at your company to implement changes that will help you focus. Options include moving to a quieter workstation, working remotely (if possible), or using digital tools for task management and organization. Receiving workplace accommodations may improve your ability to maintain employment.^5,6

Problems with memory and recall

Problems with memory or recall are common among people with MS.³ If your spouse or child doesn’t understand what you’re experiencing, they may feel angry or frustrated if you forget to pick up milk or can’t recall an important conversation from earlier in the week.

Talk to your family and close friends about your memory challenges. Remind them that when you forget something, it’s not because you weren’t listening or don’t care. Ask them to adopt strategies that can help you keep track of important information. You can ask a loved one for a refresher on your last phone conversation. Family can also text reminders if you are supposed to pick something up at the store.

Difficulty finding words

Some people with MS have difficulty finding the right words when speaking.³ This “tip of the tongue” experience can make it harder to keep up a conversation or finish a thought. Friends and family may not know how to respond when you have trouble finding your words.

Talk to your loved ones about ways they can support you when you’re having difficulty with words. Your family or friends may want to help if they think you’re struggling, but you may prefer that they take a step back and wait before jumping in.⁴ Being clear about your preferences can help avoid hurt feelings and frustrations.

Trouble following steps in tasks

Sometimes people with MS find it harder to process information or to reason through a problem.² You might have a tough time planning out all of the individual tasks required to complete a larger project, or you may feel like you’re struggling to learn multiple steps in a new task. Whether at home or work, people may become frustrated or confused if they don’t understand what you’re experiencing.

Explain to your loved ones or coworkers that you may need extra time for certain projects, or that you may need to take frequent breaks to rest your mind. Ask them for help breaking down problems or to slow down when they’re making requests or presenting information. Friends and family can also help make to-do lists with numbered steps for you to follow to help stay on track.

If you’re struggling at work, talk to your supervisor or human resources department about accommodations that can help you. You may benefit from detailed, written instructions for new tasks or from cognitive support technology that can help with memory issues, time management, and task descriptions.^5,6

School accommodations

If you’re a college student with MS who experiences cognitive difficulties, you may have found yourself struggling to finish an exam in time, or having difficulty following lectures. If you struggle with words on the “tip of your tongue,” you may be self-conscious about speaking up in class. Your test scores and course grades may not reflect your full ability.

The vast majority of colleges and universities in the United States are required to provide academic or accessibility accommodations to students with disabilities. In most cases, students are required to bring documentation explaining their disability and outlining the requested accommodation. For a person with MS who has difficulty with concentration or other cognitive functions, an accommodation may be extended test time.⁷

These situations are examples. Not everyone with MS will experience the same cognitive changes.

It’s important to also talk to your doctor if you notice any of these cognitive symptoms. Learn about starting a conversation with your doctor in Talking with Your Doctor About Multiple Sclerosis and Brain Health.

Talking about cognition may feel intimidating, but starting the conversation can bring new people into your support system. You don’t have to face cognition changes alone.

References

1. Rao, S. M., Leo, G. J., Bernardin, L., & Unverzagt, F. (1991). Cognitive dysfunction in multiple sclerosis. I. Frequency, patterns, and prediction. Neurology, 41(5), 685–691. doi: 10.1212/WNL.41.5.685

2. Kalb, R., Beier, M., Benedict, R. H., Charvet, L., Costello, K., Feinstein, A., ... Deluca, J. (2018). Recommendations for cognitive screening and management in multiple sclerosis care. Multiple Sclerosis Journal, 24(13), 1665-1680. doi:10.1177/1352458518803785

3. Rahn, K., Slusher, B., & Kaplin, A. (2012). Cognitive Impairment in Multiple Sclerosis: A Forgotten Disability Remembered. Cerebrum: The Dana Forum on Brain Science, 2012(14). Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/23447800.

4. Jones, J. B., Walsh, S., & Isaac, C. (2017). The Relational Impact of Multiple Sclerosis: An Integrative Review of the Literature Using a Cognitive Analytic Framework. Journal of Clinical Psychology in Medical Settings, 24(3-4), 316-340. doi:10.1007/s10880-017-9506-y

5. Accommodation and Compliance Series: Employees with Multiple Sclerosis (pp. 1-28, Rep.). (2019). Morgantown, WV: Job Accommodation Network.

6. Leslie, M., Kinyanjui, B., Bishop, M., Rumrill, P. D., & Roessler, R. T. (2015). Patterns in workplace accommodations for people with multiple sclerosis to overcome cognitive and other disease-related limitations. NeuroRehabilitation, 37(3), 425-436. doi:10.3233/nre-151271

7. Students with Disabilities Preparing for Postsecondary Education. (2018, September 25). Retrieved August 15, 2019, from https://www2.ed.gov/about/offices/list/ocr/transition.html

FCH-US-3847 03/20